Hospital Closures in Rural America: Impact on Local Health
Rural hospital distress remains a national access problem, but the strongest current numbers are narrower and more specific than the previous version of this page suggested. The latest monitoring from the Center for Healthcare Quality and Payment Reform (data current as of January 2026) shows 734 rural hospitals at risk of closing and 309 at immediate risk. The UNC Sheps Center closure tracker shows 195 rural hospital closures and conversions since January 2005, including 110 complete closures.
This page combines the latest CHQPR financial-risk snapshot with Sheps closure monitoring, CMS program documentation for Rural Emergency Hospitals, Census rural-population context, and GAO evidence on what closures do to travel distance and access. It is designed as a practical reference block for readers who want the current scale of the crisis without inflated or unsupported counts.
Federal sources do not provide one single all-in-one dashboard for closures, state risk counts and REH conversions, so this page uses the most current official and primary monitoring sources available for each component.
At a glance: the current scale of the problem
Methodology
What this page measures
The central state table ranks states by the number of rural hospitals at risk of closing in the latest CHQPR national snapshot, not by total hospitals, population or healthcare spending. The goal is to show where the current financial-risk burden is most concentrated.
Data year and source logic
The risk table uses the January 2026 CHQPR rural hospital report, which provides state counts for open rural inpatient hospitals, hospitals at risk of closing and hospitals at immediate risk. Historical closure context comes from the UNC Sheps Center closure monitor. REH program rules and payment mechanics come from CMS. Rural population context comes from the 2020 Census. Distance-to-care impact comes from GAO-21-93.
Why the table does not use a federal-only dataset
No single federal source currently combines state-by-state rural closure counts, live financial-risk counts and REH conversions into one clean, current dashboard. For that reason, the page uses official federal sources where they exist and supplements them with the primary monitoring datasets most widely used in this topic area.
Important limitation: “At risk” is not the same as “will close this year.” It is a financial-stress category based on hospital margins and reserves. It is best read as a warning indicator, not as a closure schedule.
Why rural hospitals remain vulnerable
Low volume and fixed-cost pressure
Rural hospitals spread staffing, compliance and facility costs across far fewer encounters than large urban hospitals. That makes thin or negative margins much more common even before any sudden shock hits the local economy.
Coverage mix and uncompensated-care exposure
KFF’s current hospital facts show that Medicare covers a larger share of rural discharges than urban ones, while private insurance covers a smaller share. When charity care and underpayment are already high, low-volume facilities have less room to absorb losses.
Workforce and service-line fragility
Rural access problems do not begin only when a hospital shuts entirely. They also deepen when hospitals lose staff or close inpatient, obstetric or specialty service lines, forcing patients to travel farther even before a formal closure is recorded.
REH conversion is access preservation, not full service preservation
CMS created the Rural Emergency Hospital provider type in 2023 to preserve emergency and outpatient care. But REH status does not preserve inpatient beds. In access terms, that is much better than a full closure, but it is still a loss of local hospital capacity.
State-level data: rural hospitals at risk of closing, latest snapshot
The table below shows 20 states with the highest number of rural hospitals at risk of closing in the January 2026 CHQPR dataset. U.S. total at risk: 734 hospitals. The share toggle expresses each state’s at-risk count as a share of that national total.
| # | State | At-Risk Hospitals (2026) | Immediate Risk (2026) | Closures Since 2015 |
|---|---|---|---|---|
| 1 | Texas | 8411.44% | 23 | 14 |
| 2 | Kansas | 689.26% | 30 | 8 |
| 3 | Oklahoma | 486.54% | 20 | 7 |
| 4 | Mississippi | 354.77% | 24 | 3 |
| 5 | Arkansas | 314.22% | 12 | 0 |
| 6 | Alabama | 283.81% | 22 | 3 |
| 7 | Missouri | 283.81% | 10 | 9 |
| 8 | Georgia | 253.41% | 11 | 3 |
| 9 | Louisiana | 253.41% | 11 | 1 |
| 10 | New York | 233.13% | 15 | 3 |
| 11 | Washington | 192.59% | 7 | 0 |
| 12 | Minnesota | 192.59% | 6 | 3 |
| 13 | Tennessee | 172.32% | 13 | 10 |
| 14 | Pennsylvania | 172.32% | 9 | 3 |
| 15 | Illinois | 162.18% | 8 | 3 |
| 16 | California | 162.18% | 5 | 2 |
| 17 | Kentucky | 152.04% | 2 | 2 |
| 18 | North Dakota | 141.91% | 3 | 0 |
| 19 | West Virginia | 131.77% | 6 | 1 |
| 20 | Wisconsin | 121.63% | 5 | 0 |
Source: CHQPR, Rural Hospitals at Risk of Closing, data current as of January 2026. Share values use the national at-risk total of 734 hospitals. The table remains fully readable without JavaScript; JS only improves search, sorting and the Units/Share toggle.
Chart 1. Top 10 states by at-risk rural hospitals vs. immediate risk
The chart compares the 10 states with the largest at-risk counts against their subset of hospitals at immediate risk. Kansas stands out because it has the highest immediate-risk count in the country even though Texas has the larger total at-risk count.
Chart 2. National snapshot of rural hospital stress and access loss
This summary chart combines the main national markers used on this page. It should be read as a status overview, not as a single federal dashboard series.
Analytical insights
The South still dominates the upper-risk cluster
Eight of the top 10 states by at-risk count in the current table are in the South. That does not mean every Southern state is equally vulnerable, but it does show how strongly rural financial stress still clusters in the South and lower-volume parts of the Midwest.
Kansas is the clearest immediate warning state
Texas has the largest number of at-risk rural hospitals in absolute terms, but Kansas has the largest number in immediate risk. That makes it the sharpest current warning signal in the dataset.
Current warning signal: Kansas shows 68 at-risk hospitals and 30 at immediate risk in the January 2026 CHQPR snapshot. That is the highest immediate-risk count in the country and a much stronger near-term warning than a generic closure total alone.
REH status slows complete collapse but does not fully preserve hospital capacity
The REH pathway matters because it can keep emergency and outpatient care alive. But for communities that lose inpatient beds, obstetric care or other hospital functions, the practical access loss is still substantial even if the facility remains open in a narrower form.
The access consequences are measurable, not abstract
GAO found that residents in areas affected by rural hospital closures had to travel about 20 miles farther for common services such as inpatient care and about 40 miles farther for less common services such as alcohol or drug treatment. That is a clinically meaningful access penalty, not just an administrative inconvenience.
What this means for readers
If you live in a rural community: a hospital can remain open on paper while losing inpatient beds or specific service lines. That is why the REH question matters almost as much as the closure question.
If you are following state policy: the table helps identify where the current burden is most concentrated, but it should be paired with local facility-level information before making claims about any one town or county.
If you are reading this economically: rural hospitals are anchor institutions. When access erodes, the effect is not only clinical; it also affects labour supply, recruitment, local business conditions and long-run population retention.
FAQ
On this page it follows CHQPR’s financial-risk framework. It means the hospital is under sustained financial stress, not that a closure date has already been announced.
Not as a full closure. But an REH no longer operates inpatient beds, so it still represents a reduction in local hospital capacity even when emergency services remain.
Because federal sources do not currently provide one clean, current dashboard that combines closures, state financial risk and REH conversions. The best available picture still requires combining federal material with primary monitoring sources.
In the current January 2026 CHQPR snapshot, Texas has the largest total number of at-risk rural hospitals, while Kansas has the largest number at immediate risk.
Yes, but it is not the whole story. Coverage policy affects uncompensated care and margins, yet low volume, workforce shortages and service-line economics still matter even in states with broader coverage.
Primary data sources and references
Updated: April 8, 2026. Official federal material is used wherever it exists; current closure and state risk counts still rely on the primary monitoring sources most widely used in this field.
Primary source for state counts of hospitals at risk of closing and hospitals at immediate risk. Data current as of January 2026.
Current tracker for closures and conversions since January 2005.
Current operating count for REH facilities.
Official CMS provider-type page for REH rules and program structure.
CMS fact sheet with current REH payment details, including the CY 2026 facility monthly payment.
Federal evidence on how closures increase travel distance and reduce access to care.
Official source for the 20.0% rural population share used here.
Used for current hospital finance context and the 2005–2024 rural closure summary cited in national discussion.
