Alabama Flex Grant Program

The Alabama Flex Grant Program is part of the federally established Medicare Rural Hospital Flexibility (Flex) Program, which originated from the Balanced Budget Act of 1997. This national initiative allows states with rural hospitals to access federal funding from the Federal Office of Rural Health Policy (FORHP) to support the development of rural health networks, enhance regional coordination of services, and improve access to care in rural communities. The program also facilitates the Critical Access Hospital (CAH) designation, which offers rural hospitals cost-based reimbursement from Medicare to support their sustainability and operations. In Alabama, the Flex Grant Program is administered by the Alabama Department of Public Health (ADPH) through its State Office of Rural Health (SORH), in collaboration with the Alabama Hospital Association (AlaHA). This joint administration is overseen by the Alabama Flex Grant Oversight Committee, which provides strategic direction and ensures alignment with state rural health priorities. Alabama’s Flex Program includes key components such as quality improvement, financial and operational enhancements, population health efforts, and strategic partnerships. The Critical Access Hospital designation is central to the program. Eligible hospitals must have 25 or fewer acute care inpatient beds, maintain an average inpatient stay of 96 hours or less, be located in a rural area at least 35 miles from another hospital (with some exceptions), and provide 24/7 emergency care. Alabama hospitals pursuing CAH designation must complete the appropriate licensure change applications as part of the state’s formal process. Under the quality improvement initiative, Alabama’s CAHs participate in the Rural Quality Network (RQN) and engage in collaborative efforts like the Medicare Beneficiary Quality Improvement Projects (MBQIP), Emergency Department Transfer Communication (EDTC) measures, and national Quality Improvement Labs (QIL). These activities aim to raise care standards, improve internal data tracking, and promote best practices across participating institutions. For financial and operational support, Flex funding is used to conduct feasibility studies, offer training on Medicare cost reporting, and assess the financial impact of services like swing beds. These resources help hospitals refine their billing practices, optimize reimbursement, and enhance long-term sustainability. In parallel, population health initiatives identify measurable targets to address rural health disparities, using data-driven strategies and consultant-led improvement plans. Strategic partnerships play a vital role in extending the reach and impact of the Alabama Flex Program. The program actively encourages inter-agency and cross-sector collaboration to align rural health initiatives with broader state and national health goals. Organizations with aligned missions are invited to engage with the program for potential collaboration. For technical assistance or program-specific inquiries, stakeholders can contact Stanley Woodson, FLEX/SHIP Program Manager, at (334) 206-5441.

Participation in MBQIP is mandatory; QIL collaboration and cost report training are highly valued.