Providers: $25.5 billion in Provider Relief Fund & American Rescue Plan rural funding is now available. Submit your application by October 26, 2021.

Rural Hospital Programs

Rural hospitals represent more than half of all hospitals in the United States, providing essential access to inpatient, outpatient, and emergency medical services in rural communities. FORHP provides technical assistance and support to address the unique needs of rural hospitals through the following programs. Learn more about the Hospital State Division at FORHP (PDF - 73 KB).

Delta Region Rural Health Workforce Training Program

The Delta Region Rural Health Workforce Training Program addresses the ongoing need in rural healthcare facilities for trained administrative support or business operations professionals through the development of Strategic Networks that support recruitment, formal training, certification, and placement of students. This program will provide training to future and current health professionals in the rural counties and parishes of the Mississippi River Delta Region and Alabama Black Belt (Delta Regional Authority (DRA) region) in the following critical administrative support occupations: medical coding and billing, claims processing, information management, and clinical documentation.

State Offices of Rural Health Program (SORH)

The SORH Program creates a focal point for rural health issues within each state, linking communities with state, federal and non-profit resources and helping to find long-term solutions.  Depending on the needs in each state, SORHs may help keep providers aware of new health care initiatives, collect and disseminate data and resources, offer technical assistance for funding and quality improvement, and support workforce recruitment and retention. Learn more about your State Office of Rural Health exit disclaimer

Medicare Rural Hospital Flexibility Program Evaluation

Provides a mechanism for monitoring and evaluating the Medicare Rural Hospital Flexibility program and resources to support quality improvement, financial and operational improvement, and health system development.

Medicare Rural Hospital Flexibility Grant (Flex)

State Support to Rural Hospitals Fact Sheet (PDF - 110 KB)

The Flex Program supports Critical Access Hospitals (CAHs) to promote quality and performance improvement including:

  • Stabilizing finances;
  • Integrating emergency medical services into health care systems;
  • Incorporating population health; and
  • Fostering innovative models of health care.

Under the Flex Program, the Medicare Beneficiary Quality Improvement Project seeks to improve the quality of care provided in CAHs by voluntarily reporting measures not required by CMS.  States coordinate technical assistance based on the needs of hospitals in their state. Hospitals interested in participating in the Flex Program should contact their State Office of Rural Health exit disclaimer to determine eligibility.

Small Rural Hospital Improvement Program (SHIP)

State Support to Rural Hospitals Fact Sheet (PDF - 110 KB)

SHIP funds state governments to support rural hospitals with 49 beds or fewer. SHIP enables small rural hospitals:

  • To become or join accountable care organizations (ACOs);
  • To participate in shared savings programs; and
  • To purchase health information technology (hardware and software), equipment, and/or training to comply with quality improvement activities such as advancing patient care information, promoting interoperability, and payment bundling.

Small rural hospitals interested in participating in SHIP should contact their State Office of Rural Health exit disclaimer to determine eligibility.

To further support COVID-19 testing in rural areas, HRSA provided $398 million to SHIP to work with 1,540 small rural hospitals on COVID-19 testing and mitigation.

Rural Quality Improvement Technical Assistance Cooperative Agreement

Funds technical assistance to Critical Access Hospitals and other rural providers participating in FORHP quality initiatives, and supports data tracking, analysis, and benchmarking toward quality improvement.  

Rural Healthcare Provider Transition Project (RHPTP)

RHPTP helps small rural hospitals and rural health clinics (RHCs) in strengthening their foundation in key elements of value-based care. Value-based care consists of key elements of quality, efficiency, patient experience and patient safety.

Those interested in learning about RHPTP should visit Rural Healthcare Provider Transition Project for more information.

Rural Veterans Health Access Program (RVHAP)

RVHAP provides funding to states to work with providers and other partners to improve the access to needed mental health and other healthcare services to improve the coordination of care for veterans living in rural areas.

Vulnerable Rural Hospitals Assistance Program (VRHAP)

Vulnerable Rural Hospitals Assistance Program Fact Sheet (PDF - 90 KB)

VRHAP provides targeted in-depth assistance to vulnerable rural hospitals struggling to maintain healthcare services with the goal for residents in those rural communities to continue to have access to essential health services. For more information, please visit the Center for Optimizing Rural Health exit disclaimer .

Delta Region Community Health Systems Development (DRCHSD)

Delta Region Community Health Systems Development Fact Sheet (PDF - 671 KB)

The DRCHSD Program enhances healthcare delivery in the Mississippi Delta region through intensive, multi-year on-site technical assistance to healthcare facilities in rural communities, targeted to the needs of each community. For more information, please visit the National Rural Health Resource Center.

Hospital Closures

Between January 2010 and January 2019, 95 rural hospitals closed, 32 of which were Critical Access Hospitals. Events such as these have caused rural hospitals to receive increased attention from policy makers, advocates, and the media.

FORHP evaluates the impact of rural hospital closures. Working with external partners, FORHP identifies actual and planned closures from direct reports and the media, which provides real-time monitoring of closures exit disclaimer not possible from administrative data files.

FOHRP grantees, the State Offices of Rural Health, and State Flex Programs have worked with communities to assess the impact of hospital closures. In recent years, the FORHP-funded Rural Health Research Gateway HRSA Exit Disclaimer published the following research:

The National Organization of State Offices of Rural Health developed the State Office of Rural Health Roadmap for Working with Vulnerable Hospitals exit disclaimer (October 2016) to identify tools and resources to help SORHs and communities deal with closures.

Resources for Hospitals

Technical Assistance and Services Center exit disclaimer receives a cooperative agreement from FORHP to develop resources and provide trainings to assist with CAH quality financial and operational improvement; population health; and emergency medical service activities. The center website houses toolkits, webinars and other resources on these topics.

The Flex Monitoring Team exit disclaimer is supported by a cooperative agreement to analyze data from CAHs and evaluate the impact of Medicare Rural Hospital Flexibility investments. Data and reports specific to CAH quality, finance, and community health topics are available on the website. CAH managers can request a password to access CAHMPAS, the Critical Access Hospital Measurement and Performance Assessment System, to compare their hospital’s performance on numerous quality and financial indicators with other CAHs in the state and around the country.

Date Last Reviewed:  April 2021


Project Officers for Rural Hospital Programs

U.S. map showing regions

Additional Resources

Guide for Rural Health Care Collaboration and Coordination (2019) (PDF - 2 MB) This Guide describes how rural hospitals, community health centers, local public health departments, and other rural stakeholders can work together to assess and address their rural communities’ health needs.

North Carolina Rural Health Research and Policy Analysis Center exit disclaimer maintains a publicly available map for tracking and counting rural hospital closures.

For more information about services and population characteristics of rural hospitals, review The 21 Century Rural Hospital Chartbook exit disclaimer (PDF - 3.8 MB).

Please share information regarding hospital closures with the research center at ncrural@unc.edu.