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Flex - Impact in North Dakota

Updated January 2010


The “Flex” program originated from the Balanced Budget Act of 1997. Its purpose is to improve rural health by addressing access and quality of care issues for rural citizens. Flex is a grant from the federal government to a state entity. In North Dakota, the Center for Rural Health receives and administers the grant in partnership with the North Dakota Hospital Association, the Quality Health Associates of North Dakota (the state’s quality improvement organization) and the North Dakota Department of Health (Division of Emergency Medical Services and Trauma).

The Flex program works to stabilize the rural health delivery system by addressing a number of rural health issues: developing rural health and hospital networks, improving rural emergency medical services, improving quality of care, and developing new community-based services. Assistance is provided through direct funding to critical access hospitals and technical assistance from program staff and partners to rural hospitals and their communities. The current grant is for $636,000.


Since 1999, the Flex program has provided over 3.75 million in grants to North Dakota’s rural communities. There have been 140 CAH grants, 47 EMS Network grants, 44 CAH Network Enhancement grants and five Making a Difference grants. Thirty-five (35) of 38 rural hospital have been designated as CAHs in North Dakota; however, approximately 100 communities have benefited from the varying types of Flex grants.

Technical assistance has been provided as follows:

  • 150+ community and hospital meetings (program issues, grants, etc.)
  • 23 community health assessment surveys (of a hospital’s service area)
  • 20 strategic planning sessions with hospital board members, staff, EMS units, and community
  • 11 internal personnel audits to measure staff attitudes toward their work
  • 8 balanced scorecard/performance improvement implementation plans
  • 20 statewide workshops for CAHs
  • formation of the North Dakota CAH Quality Network

To learn more or request technical assistance contact Lynette Dickson
( or call (701) 777-6049.