Flex Program Funding Guidance
For the current funding cycle of the Medicare Rural Hospital Flexibility (Flex) Program, which runs from fiscal years (FYs) 2024-2028, the primary components of the Flex Program include activities in the following areas:
- Critical Access Hospital (CAH) Quality Improvement (MBQIP) (required)
- CAH Financial and Operational Improvement (required)
- CAH Population Health Improvement (optional)
- Rural Emergency Medical Services (EMS) Improvement (optional)
- CAH Designation (required if requested)
The Flex Program continues to encourage the identification of areas for improvement with defined targets and measurable outcomes. A minimum standard of reporting on outcomes is requested for all state Flex Programs. Information on the state Flex Program assessment can be found in the Flex Performance Management/Program Evaluation Guide.
Each state interested in acquiring federal Flex Program funding must submit an annual funding application to the Health Resources and Services Administration’s Federal Office of Rural Health Policy via the Electronic Handbooks (EHBs). The approximate timeline for non-competing continuation (NCC) applications and awards is:
- March: FORHP sends application guidance to states
- May: Application submission deadline to EHBs
- August: Notice of Award announcements
- September 1: Federal budget year begins
This schedule is subject to change, particularly in competing continuation years when program guidance may be released earlier. Please contact TASC for the current schedule.
Quickly Access Cooperative Agreement Materials by Year
FYs 2024 - 2028 Funding Cycle (Current)
- FY 2024 Notice of Funding Opportunity (NOFO): September 1, 2024 - August 31, 2025
-
FY 2024 EMS Supplement NOFO: September 1, 2024 - August 31, 2029
FYs 2019 - 2023 Funding Cycle (Most Recent)
- FY 2019 Notice of Funding Opportunity (NOFO): September 1, 2019 - August 31, 2020
- FY 2019 EMS Supplement Funding - FYs 2019 - 2021
- FY2020 NCC: September 1, 2020 - August 31, 2021
- FY2021 NCC: September 1, 2021 - August 31, 2022
- FY 2022 NCC: September 1, 2022 - August 31, 2023
- FY2022 EMS Supplement Funding - FYs 2022 - 2023
- FY2023 NCC: September 1, 2023 - August 31, 2024
FYs 2024-2028 (funding cycle beginning September 1, 2024)
Flex FY 2024 Notice of Funding Opportunity (NOFO): September 1, 2024 - August 31, 2025

Federal Office of Rural Health Policy (FORHP)

FORHP

FORHP

FORHP

FOHRP and National Rural Health Resource Center

FOHRP and National Rural Health Resource Center

FORHP, National Rural Health Resource Center, and Flex Monitoring Team

National Rural Health Resource Center

Flex Monitoring Team (FMT)

Flex Monitoring Team (FMT)
Flex FY 2024 EMS Supplement NOFO: September 1, 2024 - August 31, 2029

FORHP

FORHP

FORHP
FYs 2019-2023 Flex Program Cooperative Agreement Materials
Flex FY 2023 NCC: September 1, 2023 - August 31, 2024






FORHP

National Rural Health Resource Center

National Rural Health Resource Center

National Rural Health Resource Center

National Rural Health Resource Center
Flex FY 2022 NCC: September 1, 2022 - August 31, 2023


Flex Monitoring Team
National Rural Health Resource Center
Flex FY 2022 EMS Supplement: September 1, 2022 - August 31, 2023

National Rural Health Resource Center
Flex FY 2021 NCC: September 1, 2021 - August 31, 2022
FORHP
National Rural Health Resource Center
Flex FY 2020 NCC: September 1, 2020 - August 31, 2021
National Rural Health Resource Center
Flex FY 2019 Notice of Funding Opportunity (NOFO): September 1, 2019 - August 31, 2020
Materials below outline the intent for each program area of the state Flex Cooperative Agreement for the FY 2019 funding cycle. Note that the Flex Program award type changed from an intended three-year grant period (FYs 2015-2018) to a five-year cooperative agreement period effective FYs 2019-2023.
National Rural Health Resource Center
National Rural Health Resource Center
Flex Monitoring Team
National Rural Health Resource Center
National Rural Health Resource Center
Flex Program Fiscal Year 2019 EMS Supplement Funding Guidance and Supporting Materials

FORHP
National Rural Health Resource Center
National Rural Health Resource Center
National Rural Health Resource Center
For more information, please contact Nicole Clement at (218) 216-7028 or nclement@ruralcenter.org