Rural hospitals drove the entirety of the U.S.’ net hospital losses since 2001, closing at more than three times the rate they opened, according to data shared with Becker’s from Yale University’s Health Care Affordability Lab in New Haven, Conn.
Between 2001 and 2023, the period for which both openings and closures are fully tracked, rural hospitals posted a net loss of 234 nationally — 348 closures against 114 openings. The data covers general, short-term acute-care hospitals and excludes specialty facilities such as psychiatric, rehabilitation, children’s and VA hospitals. Rural and urban classifications follow the census-tract-level definition from the Health Resources & Services Administration’s Federal Office of Rural Health Policy.
The table below shows rural hospital net change by state from 2001 to 2023, total rural closures by state from 2000 through June 2026, and each state’s fiscal 2026 allocation under the $50 billion Rural Health Transformation Program, established under HR 1 and administered by CMS. RHTP award amounts are sourced from CMS. States with no rural hospital activity in the Yale dataset are not listed. (Note: The lab did not systematically track openings from 2024 forward; net figures are drawn from the 2001-2023 dataset only.)
Here is the rural hospital net change, total closures through June 2026, and RHTP funding, by state, according to data from the Affordability Lab and CMS:
| State | Openings (2001-2023) | Closures (2001-2023) | Net change (2001-2023) | Total closures (2000-June 2026) | RHTP FY2026 award |
|---|---|---|---|---|---|
| Alabama | 4 | 10 | -6 | 15 | $203M |
| Alaska | 0 | 1 | -1 | 1 | $272M |
| Arizona | 4 | 4 | 0 | 4 | $167M |
| Arkansas | 1 | 8 | -7 | 10 | $209M |
| California | 0 | 12 | -12 | 13 | $234M |
| Colorado | 4 | 1 | +3 | 2 | $200M |
| Florida | 2 | 8 | -6 | 8 | $210M |
| Georgia | 3 | 15 | -12 | 15 | $219M |
| Hawaii | 1 | 0 | +1 | 0 | $189M |
| Idaho | 0 | 1 | -1 | 3 | $186M |
| Illinois | 0 | 5 | -5 | 6 | $193M |
| Indiana | 0 | 5 | -5 | 5 | $207M |
| Iowa | 2 | 2 | 0 | 3 | $209M |
| Kansas | 2 | 12 | -10 | 14 | $222M |
| Kentucky | 2 | 6 | -4 | 7 | $213M |
| Louisiana | 3 | 5 | -2 | 5 | $208M |
| Maine | 0 | 2 | -2 | 3 | $190M |
| Maryland | 1 | 3 | -2 | 3 | $168M |
| Michigan | 1 | 8 | -7 | 8 | $173M |
| Minnesota | 0 | 5 | -5 | 7 | $193M |
| Mississippi | 8 | 13 | -5 | 17 | $206M |
| Missouri | 3 | 10 | -7 | 12 | $216M |
| Montana | 3 | 1 | +2 | 2 | $234M |
| Nebraska | 1 | 3 | -2 | 4 | $219M |
| Nevada | 4 | 1 | +3 | 1 | $180M |
| New Jersey | 0 | 1 | -1 | 1 | $147M |
| New Mexico | 2 | 1 | +1 | 1 | $211M |
| New York | 1 | 7 | -6 | 10 | $212M |
| North Carolina | 2 | 8 | -6 | 8 | $213M |
| North Dakota | 0 | 1 | -1 | 2 | $199M |
| Ohio | 5 | 4 | +1 | 5 | $202M |
| Oklahoma | 7 | 13 | -6 | 17 | $223M |
| Oregon | 1 | 0 | +1 | 0 | $197M |
| Pennsylvania | 3 | 7 | -4 | 9 | $193M |
| South Carolina | 3 | 7 | -4 | 8 | $200M |
| South Dakota | 2 | 3 | -1 | 4 | $189M |
| Tennessee | 3 | 17 | -14 | 19 | $207M |
| Texas | 13 | 37 | -24 | 39 | $281M |
| Utah | 2 | 0 | +2 | 0 | $196M |
| Virginia | 1 | 4 | -3 | 4 | $190M |
| Washington | 1 | 0 | +1 | 1 | $181M |
| West Virginia | 1 | 5 | -4 | 5 | $199M |
| Wisconsin | 5 | 3 | +2 | 4 | $204M |
| Wyoming | 5 | 0 | +5 | 0 | $205M |
Source: Yale University Health Care Affordability Lab; CMS (RHTP awards). Data covers general, short-term acute-care hospitals only. Explore the data here.
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