Rural Hospitals (Flex Program)


Supporting CAHs during the COVID-19 Pandemic: Results of a Survey of State Flex Coordinators

Document Type


Publication Date



COVID-19, rural, Critical Access Hospitals, survey, MRHRC, Flex Program


COVID-19 has exacerbated the financial and operational vulnerabilities of Critical Access Hospitals (CAHs), including loss of revenue, reductions in non-emergent utilization, shortages of specialized equipment (personal protective equipment, testing supplies, and ventilators) and limited capacity to care for COVID-19 patients. Due to these challenges, many CAHs are at increased risk for closure and others will emerge from this pandemic in significantly weakened financial states.

Under the Medicare Rural Hospital Flexibility (Flex) Program, State Flex Programs (SFPs) receive grant funding to support CAHs. COVID-19 complicated the work of SFPs and caused many to reassess their activities to better assist CAHs during the pandemic. Research staff in the Flex Monitoring Team at the University of Southern Maine administered a survey to collect information on COVID-19’s impact on CAHs, SFP efforts to support CAHs during the pandemic, their plans to support CAHs once the immediate crisis has passed, and SFP promising strategies. The survey also collected information on the immediate and post-pandemic technical assistance and resources needed by SFPs to support CAHs. This paper reports on the results of this survey and provides links to resources to assist SFPs in their efforts to support CAHs.

FMI: please contact John Gale,


COVID-19, pandemic, rural hospitals, survey,


The authors thank Teryl Eisinger and Chris Salyers from the National Organization of State Offices of Rural Health; Sally Buck and Tracy Morton from the Technical Assistance and Services Center at the National Rural Health Resource Center; and Kristin Martinsen, Victoria Leach, and Laura Seifert from the Federal Office of Rural Health Policy for their time and expertise in support of this project.

This study was conducted by the Flex Monitoring Team with funding from the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), under PHS Grant No. U27RH01080. The information, conclusions, and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.

Funding Organization

Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS)

Grant Number

PHS Grant No. U27RH01080