This brief reports on promising State Flex Program (SFP) strategies to support Critical Access Hospitals (CAHs) during the COVID-19 pandemic. SFPs adapted existing initiatives and implemented new activities to address the emerging needs of CAHs during the pandemic. With FORHP’s approval, the SFPs redirected funds and activities to address the evolving COVID-19 needs of CAHs while maintaining fidelity to Flex Program goals. Based on qualitative interviews with seven SFPs, we discuss initiatives such as resiliency training for frontline staff; packaging and dissemination of COVID-19 information; public health messaging; infection prevention and pharmacy consultations; and financial technical assistance and programs. The brief also lays out ongoing COVID-19 needs of CAHs as described by the SFPs, including increased financial vulnerability, rural workforce shortages, and support for telehealth.