Notice of Supplemental Funding, Medicare Rural Hospital Flexibility Program

HRSA published a Notice of Supplemental Funding in the Federal Register on September 10, 2026, announcing additional fiscal year 2026 appropriations under the Medicare Rural Hospital Flexibility (Flex) Program, authorized by 42 U.S.C. § 1395i-4(g)(1)-(2). The supplemental funding derives from increased appropriations provided in the Consolidated Appropriations Act, 2026 (H.R. 7148). Two non-competitive cooperative agreement awards totaling $620,742 cover the project period September 1, 2026, through August 31, 2027, under Assistance Listing Number 93.241. HRSA applied a uniform 2.5 percent baseline funding increase to all 45 existing Flex Program recipients nationwide. An additional 5 percent increase per newly designated Critical Access Hospital (CAH) was layered on top of the baseline for states that experienced CAH growth, directing extra resources to states with expanded program responsibilities. Two recipients received funding increases exceeding 25 percent as a result of this methodology: the Alabama Department of Public Health (Grant No. U2WRH33293) received $146,403, and the Texas Department of Agriculture (Grant No. U2WRH33313) received $474,339. Both awards reflect the number of newly designated CAHs in their respective states. The stated purposes of the awards are to strengthen CAHs, improve quality and performance, support financial and operational improvement activities, and sustain access to essential health care services in rural communities.