Lessons Learned from Efforts to Support Vulnerable Critical Access and Other Rural Hospitals

Document Type

Briefing Paper

Publication Date



Rural Hospitals (Flex Program), rural models, Critical Access Hospitals, financial vulnerability


The financial vulnerability of Critical Access Hospitals (CAHs) and rural hospitals and their risk of closure has been an ongoing area of concern. Since 1973, the United States has experienced multiple waves of rural hospital closures. As a result, states and the federal government have implemented a variety of demonstrations and programs to stem the waves of closures. These efforts include experimentation with limited-service hospital models that led to the development of CAH designation in 1997. More recent demonstrations have tested alternative payment systems (e.g., global budgets and accountable care organizations) as well as new delivery models, such as the Rural Emergency Hospital. This paper summarizes state and federal programs, demonstrations, and models to support CAHs and other rural hospitals. Grouped by program characteristics, the summaries provide lessons learned to inform current policy discussions, describe the trends driving the various waves of rural hospital closures, and explore trends likely to impact CAHs and other rural hospitals in the foreseeable future.

FMI: John Gale, john.gale@maine.edu


Rural Hospitals


This report was completed 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

HRSA-Federal Office of Rural Health Policy

Grant Number