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Nearly 800 rural hospitals across the United States are struggling financially with as many as 40% facing the immediate threat of closure, according to an analysis by the Center for Healthcare Quality and Payment Reform, which reviewed the most recent hospital cost reports submitted to the Centers for Medicare & Medicaid Services through June 2025. The center’s report categorizes rural hospitals into 2 levels of financial risk: those generally at risk; and those in immediate danger of shutting down. Hospitals in the first group typically have financial reserves sufficient to cover patient care losses for only 6-7 years. Nearly every state has hospitals in this category, and in more than half of all states, at least 25% of rural hospitals fall into this at-risk group. In 11 states, a majority of rural hospitals are in financial jeopardy. The second, more urgent category includes hospitals with reserves that can only sustain operations for 2-3 years. According to the analysis, 314 rural hospitals currently fall into this high-risk category and may be forced to close in the near future because of severe financial distress.
Regional differences: Risk varies by market. For example, Connecticut has 4 rural hospitals, and 2 are at immediate risk of closure. Alabama shows 23 of its 47 rural hospitals are in the immediate risk category, according to the analysis. Hawaii, Utah, Maryland, and Delaware have no rural hospitals currently in danger of closure among their combined 43 entities. In the past 10 years, at least 100 rural hospitals have closed and many more have reduced services because of financial pressures. As a result, rural areas are among the fastest growing locales for urgent care expansion. Read more from the JUCM archive: Rural Urgent Care Growth Continues, But Challenges Remain