25 years of Flex: Supporting states in maintaining rural access to care

The Medicare Rural Hospital Flexibility (Flex) Program secured access to care for rural communities, through the creation of the Critical Access Hospital provider type, keeping hospitals open in many communities where they may have otherwise closed. The Health Resources and Services Administration's Federal Office of Rural Health Policy has worked in partnership with hospitals, State Offices of Rural Health, State Flex Program coordinators, researchers, and rural hospital finance and quality experts to direct the Flex Program to ensure rural communities have access to high-quality care. This article outlines the history of the Flex Program, its program framework and state-level implementation, and the ways the program aligns with other federal programs with similar goals.