2026-2029 Rural Hospital Flexibility Grant Program

The Rural Hospital Flexibility Program (Flex Program) is a federal grant program directed to State Offices of Rural Health to support:

  • Improving the quality of health care provided in communities served by Critical Access Hospitals (CAHs)
  • Improving the financial and operational performance of CAHs
  • Developing collaborative regional and systems in CAH communities

The purpose of these Flex Program funds is to improve the quality of care provided by CAHs by focusing on improvement of financial and operational and quality measures as guided by the Federal Office of Rural Health Policy. These funds will support a technical assistance model that includes group and individual projects with the 20 CAHs in North Carolina.

The Office of Rural Health reserves the right to fund proposals in whole or in part and may request budget modifications prior to issuing an award. Organizations may submit only one application as the lead applicant and may act as subcontractors in these activities:

  • Plan, organize, and facilitate statewide and regional meetings with CAHs in a forum where they can learn and share best practices. In these meetings, the hospitals will receive technical assistance on improving quality, financial and operational areas, population health strategies; primary care capacity, development of innovative models, and assist with workforce recruitment and retention. The statewide and/or regional meetings require contractor attendance and participation. 
  • Plan and implement individual technical assistance projects with CAHs, or network of CAHs, to identify opportunities to improve quality, financial and operational performance.
  • Organize collaborative networks for CAHs to share best practices and work together on various quality or financial improvement initiatives.
  • Engage CAHs in submitting quality performance data as required by the Medicare Beneficiary Quality Improvement Program (MBQIP):
    • Key financial indicators identified by the Flex Monitoring Team (FMT)
    • Inpatient and Outpatient core measures as defined by MBQIP.
    • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores 
    • Emergency Department Transfer Communication (EDTC) reporting.

The maximum total per grant year cannot exceed $380,000. Year One funds must be expended by August 31, 2027. Year Two funds must be expended by August 31, 2028, and year three by August 31, 2029. No Carryover of funds unless approved by HRSA Project Officer.
Funding is dependent on federal allocation each year and the availability of funds by NCDHHS. Budgets are subject to modification based on HRSA and NCDHHS discretion.

2026-2029 Rural Hospital Flexibility Grant Program RFA Instructions

All required forms may be found on the ORH website www.ncdhhs.gov/divisions/orh. Applications must be complete, and applicants must respond to all application requirements. Incomplete applications, or applications not completed in accordance with the instructions, will not be reviewed.
Application Submission: All complete applications must be emailed to nick.galvez@dhhs.nc.gov 

Application Deadline
Grant applications must be submitted electronically by 11:59 p.m., March 27, 2026.  
Applications must be emailed to: nick.galvez@dhhs.nc.gov 
Only electronic applications will be accepted. All applicants will receive a confirmation notice after an application has been successfully submitted.

Eligible Applicants
Any organization that is staffed to provide quality, financial and operational technical assistance in areas specified in this RFA to Critical Access Hospitals is eligible to apply. All eligible applicants must submit a complete grant application to be considered for funding.

Funding Cycle
Funding Period is yearly for the three-year periods September 1, 2026 - August 31, 2029.
Year 1: September 1, 2026 – August 31, 2027
Year 2: September 1, 2027 – August 31, 2028
Year 3: September 1, 2028 – August 31, 2029

Documents

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