This Flex Program Monitoring Team Briefing Paper highlights recent trends in the development and implementation of State Flex Programs. Data for the Briefing Paper were collected from state FY03 Flex Program grant applications and records of budget revisions, and directly from a number of state Offices of Rural Health. The national level funding information reflects data from all 45 states participating in the Flex Program; while the programmatic information reflects data from 40 states (budget revisions were not available for five states).