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.


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

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.

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.

SHIP funds state governments to support rural hospitals with 49 beds or fewer. Funding helps small hospitals in several ways:

  • Purchase equipment and/or training to attain value-based purchasing provision under the Patient Protection and Affordable Care Act (ACA);
  • Join or become accountable care organizations, or create shared savings programs through the ACA; and
  • Purchase health information technology, equipment, and/or training to comply with meaningful use, ICD-10 standards, and payment bundling.

States receive an average of $9,000 to support these efforts. Hospitals interested in participating in SHIP should contact their State Office of Rural Health exit disclaimer to determine eligibility.

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.  

SRHT helps small rural hospitals bridge gaps between the current health care system and the newly emerging system of health care delivery and payment. On-site technical assistance is provided to small rural hospitals with fewer than 50 staffed beds in persistent poverty areas of the U.S.  Technical assistance activities  include:

  • Financial assessments;
  • Creating a quality-focused environment; and
  • Aligning services to community need.

Those interested in learning about SRHT eligibility should visit Rural Health Innovations for more information.

Hospital Closures

Between 2010 and 2016, 80 rural hospitals closed, 27 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 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 2015, the FORHP-funded Rural Health Research Gateway 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 (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.

Last Reviewed: January 2017

Project Officers for Rural Hospital Programs

Additional Resources

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