Is the Medicare Rural Hospital Flexibility (Flex) Program and small rural hospitals’ conversion to Critical Access Hospital (CAH) status improving the quality of care and the performance of small rural hospitals, enhancing local emergency medical services, and fostering network development? A case study highlighting Jerold Phelps Community Hospital in Garberville, California, was conducted as part of California’s Medicare Rural Hospital Flexibility (Flex) Program and its program evaluation activities to examine and report on these questions.