Hundreds of small, rural hospitals could close. Many are in big states.

Many rural hospitals have been on the brink of closure, and some may not be able to keep the doors open much longer.

Nearly 700 rural hospitals are facing financial pressures that are putting them in danger of shutting down, according to a new report from the Center for Healthcare Quality & Payment Reform.

The report states that 260 hospitals are at immediate risk of closing due to their perilous financial condition.

Texas has the highest number of rural hospitals (26) deemed at immediate risk of closing, followed by Mississippi (24), according to the report. Alabama has the highest percentage of rural hospitals (37%) that are at imminent risk of shutting down.

Many of the states with significant numbers or percentages of rural hospitals at risk are largely rural states. But New York, Pennsylvania, and Georgia are also among the states with the most rural hospitals that are deemed at grave risk of closure.

More than 40% of America’s rural hospitals are losing money on patient care, the report states.

The report follows an American Hospital Association report released earlier this month, which found that the financial difficulties of rural hospitals are threatening access to care for 46 million Americans.

Healthcare leaders say rural hospitals are facing more financial pressures due to cuts in Medicaid coming in the next decade, following the passage of the H.R. 1 tax and spending package signed by President Trump last year. Millions of Americans are expected to lose Medicaid coverage in the coming years, due to new work requirements and new rules requiring recipients to verify their eligibility twice per year.

‘Layoffs and closures and cutbacks’

A roundtable organized by Chief Healthcare Executive examining the implications of the 2026 elections pointed to Medicaid cuts pushing rural hospitals to the brink.

Robert E. Andrews, the CEO of the Health Transformation Alliance, said the Medicaid cuts could push rural hospitals over the edge. Andrews spent 24 years in Congress representing part of New Jersey in the U.S. House of Representatives.

Andrews said some of the hospitals most threatened by Medicaid cuts are rural hospitals, and many are in heavily Republican districts.

“Although all providers and patients are injured by H.R. 1, in my view, the rural providers are really hurt the most, and a lot of Republican members represent districts where these rural providers are in a lot of trouble now,” Andrews said. “The trouble has been theoretical until now, but the law fully went into effect on October 1. So we're going to start to see layoffs and closures and cutbacks of services at rural hospitals across the country, and those are in red districts.”

Lisa Kidder Hrobsky, the senior vice president of federal relations, advocacy and political affairs at the American Hospital Association, said the $50 billion Rural Health Transformation Program was initially passed as a lifeline to hospitals, but it won’t offset the cuts to rural hospitals. The American Hospital Association estimates rural hospitals alone will lose $137 million over the next decade due to Medicaid cuts.

“I do think as well we saw the rural health transformation program, which was really intended to to boost the rural hospitals out of the OBBBA bill, and again, we've seen some of the money is not actually not allowed to go directly to hospitals, so it's going to the community for telehealth, for workforce for some broader,” Kidder Hrobsky said during the roundtable.

“The impacts are real now,” she said. “Rural hospitals are already struggling.”

Losing access

More than 100 rural hospitals have closed nationwide between 2015 and 2026, the report notes.

In addition, 56 rural hospitals have eliminated inpatient services since the beginning of 2023. They’ve cut those services to qualify for additional support from the federal Rural Emergency Hospitals program, which has offered a lifeline to keep the facilities open. But residents in those communities will need to be transferred to another hospital if they need inpatient care, and those hospitals will likely be a significant distance.

Rural hospitals say they have faced additional pressures due to inadequate payments from Medicare Advantage plans.

At immediate risk

These states have the highest number of rural hospitals considered to be at immediate risk of closure, according to the Center for Healthcare Quality & Payment Reform.