Document Type

Policy Brief

Publication Date



COVID-19, rural, Critical Access Hospitals, State Flex Program, strategies, public heatlh


This brief reports on promising State Flex Program (SFP) strategies to support Critical Access Hospitals during the COVID-19 pandemic. SFPs adapted existing initiatives and implemented new activities to address the emerging needs of CAHs during the pandemic. With approval from the Federal Office of Rural Health, the SFPs redirected funds and activities to address the evolving COVID-19 needs of CAHs while maintaining fidelity to Flex Program goals. Based on qualitative interviews with seven SFPs, the authors, members of the Flex Monitoring Team, discuss initiatives such as resiliency training for frontline staff; packaging and dissemination of COVID-19 information; public health messaging; infection prevention and pharmacy consultations; and financial technical assistance and programs. The authors also highlight ongoing COVID-19 needs of CAHs as described by the SFPs, which include increased financial vulnerability, rural workforce shortages, and support for telehealth.

FMI: Celia Jewell,


hospitals, public health, rural, COVID-19


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

Grant Number




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