National Closure Tracker
Rural Hospital Closures Since 2005
195 rural hospitals have closed or converted across 37 states, eliminating an estimated 6,782 hospital beds. Each closure reduces access to emergency care, obstetric services, and inpatient treatment for surrounding communities.
States Most Affected
Closure Timeline
Annual rural hospital closures from 2005 to 2025. Closures accelerated sharply starting in 2013, with peaks in 2015 and 2019.
Source: UNC Sheps Center for Health Services Research. Includes complete closures and conversions to non-hospital use.
Closures by State
37 states have experienced at least one rural hospital closure since 2005. Texas leads with 25 closures.
| State | Closures | |
|---|---|---|
| TexasTX | 25 | |
| TennesseeTN | 14 | |
| North CarolinaNC | 12 | |
| CaliforniaCA | 10 | |
| MissouriMO | 10 | |
| OklahomaOK | 10 | |
| AlabamaAL | 9 | |
| GeorgiaGA | 9 | |
| KansasKS | 9 | |
| FloridaFL | 8 | |
| MinnesotaMN | 6 | |
| PennsylvaniaPA | 6 | |
| MississippiMS | 5 | |
| New YorkNY | 5 | |
| ArizonaAZ | 4 | |
| IllinoisIL | 4 | |
| IndianaIN | 4 | |
| KentuckyKY | 4 | |
| MaineME | 4 | |
| MichiganMI | 4 | |
| South CarolinaSC | 4 | |
| West VirginiaWV | 4 | |
| OhioOH | 3 | |
| South DakotaSD | 3 | |
| ArkansasAR | 2 | |
| IowaIA | 2 | |
| LouisianaLA | 2 | |
| NebraskaNE | 2 | |
| NevadaNV | 2 | |
| VirginiaVA | 2 | |
| AlaskaAK | 1 | |
| MarylandMD | 1 | |
| North DakotaND | 1 | |
| New JerseyNJ | 1 | |
| New MexicoNM | 1 | |
| WashingtonWA | 1 | |
| WisconsinWI | 1 |
The Downstream Impact: Hospital Deserts
When a rural hospital closes, the county it served often becomes a hospital desert. Today, 691 counties across the United States have no hospital at all — 22% of all U.S. counties. Residents in these areas must travel to neighboring counties for emergency care, obstetric services, and inpatient treatment.
The relationship between closures and deserts is direct: many of the 195 hospitals that closed since 2005 were the sole hospital in their county. Their closure did not just reduce capacity — it eliminated access entirely.
See the full breakdown: 691 counties with no hospital
Financial Warning Signs
Hospital closures rarely happen overnight. The financial distress that leads to closure is visible years in advance in publicly available CMS cost report data.
Negative Operating Margins
Hospitals that closed had a pattern of sustained negative operating margins — often for 3 to 5 consecutive years before closure. CMS HCRIS cost reports track revenue, expenses, and margins for every Medicare-certified hospital in the country. RHT Compass makes this data accessible and benchmarkable across peer hospitals.
Low Occupancy Rates
Declining inpatient volume is a leading indicator of financial distress. Many closed hospitals had occupancy rates below 25% for multiple years before shutting down. Fixed costs remain constant regardless of census, making low occupancy a structural problem that cannot be managed through cost-cutting alone.
Insufficient Days Cash on Hand
Days cash on hand measures how long a hospital can operate without new revenue. Hospitals approaching closure often show rapid deterioration in liquidity — dropping below 30 days and eventually to single digits. This metric is available in HCRIS data and tracked in the RHT Compass analytics platform.
Source: CMS Healthcare Cost Report Information System (HCRIS). Financial data available for FY2020–2024 across all 50 states. See data sources for methodology.
What Can Be Done
Federal programs, data-driven early warning, and new payment models offer pathways to prevent the next wave of closures.
RHT Transformation Program
The CMS Rural Health Transformation program allocates $10 billion over FY2026–2030 to strengthen rural health infrastructure, expand access, and support workforce development. Every state receives a direct allocation. RHT Compass tracks all 50 state awards.
See your state's allocationAHEAD Model
The CMS AHEAD model shifts eligible hospitals from fee-for-service to global budgets, providing predictable revenue regardless of volume. This directly addresses the low-occupancy death spiral that drives most rural closures.
Assess AHEAD readinessData-Driven Monitoring
RHT Compass integrates financial data, county health metrics, and vulnerability scores to identify hospitals showing early signs of distress — before they reach the point of no return. HRSA Flex Program funding can support state-level monitoring programs.
Explore the platformCheck Your State's At-Risk Hospitals
Every state page includes hospital financial data, closure history, and hospital desert mapping. Start with your state, or request a demo to see the full analytics platform.
Closure data from the UNC Sheps Center for Health Services Research. Financial data from CMS Healthcare Cost Report Information System (HCRIS). Hospital registry from CMS Provider of Services. Last updated: 2026-02-15.