One-Third of Rural Hospitals Could Close. Congress Just Made It Worse.

734 Hospitals. 46 Million People at Risk.

The Chartis 2026 Rural Health State of the State report found that 432 rural hospitals are vulnerable to closure. The Center for Healthcare Quality and Payment Reform puts the broader at-risk number at 734, roughly one in three rural hospitals nationwide. Eighteen rural hospitals closed or converted away from inpatient care in 2025 alone, bringing the total since 2010 to 182 lost facilities.

Then Congress passed the One Big Beautiful Bill. The law cuts $911 billion from Medicaid over ten years. Families USA estimates that independent rural hospitals will lose $465 million in patient revenue in 2026, an average of $630,665 per facility. Fifty-five more hospitals will fall into negative net income this year, pushing the total at serious risk to 380 facilities across 26 states.

“The AMA is outraged by the passage of OBBBA, which will cause an estimated 11.8 million people to lose health care coverage.” American Medical Association

States Losing the Most Hospitals

The damage concentrates in the South and lower Midwest. Chartis data shows these states face the worst vulnerability rates and the steepest year-over-year declines.

Rural Hospitals Vulnerable to Closure (2026)

State	Vulnerable hospitals	% of rural hospitals	Change from 2025
Tennessee	27	61%	+17 points
Arkansas	n/a	55%	n/a
Florida	n/a	52%	n/a
Texas	50	44%	n/a
Kansas	44	44%	n/a
South Dakota	n/a	42%	+14 points
Mississippi	24	42%	n/a
Georgia	25	n/a	n/a

Tennessee’s jump from 44% to 61% in a single year is the sharpest decline any state has recorded. South Dakota went from 28% to 42%.

Cumulative Hospital Closures Since 2010

State	Hospitals lost
Texas	27
Tennessee	18
Oklahoma	13
Kansas	12
Mississippi	12

Source: Chartis 2026 report and UNC Sheps Center

Maternity Wards Are Disappearing Faster

Since 2020, 133 rural hospitals have stopped delivering babies or announced closures before the end of 2026. That is a 12% reduction in rural labor and delivery units. In 2025, 27 hospitals shut down maternity services, up from 21 the year before. Only 41% of rural hospitals still deliver babies.

Pennsylvania shows where this leads. Twenty-three of the state’s 67 counties have no hospital with a labor and delivery unit. Warren General Hospital ended maternity services in January 2026, leaving eight contiguous counties in northwestern Pennsylvania without a place to give birth.

Rural patients now travel 30 minutes or more to reach a delivery unit. In these new maternity deserts, that number can exceed an hour.

The $50 Billion Band-Aid

Congress included a $50 billion Rural Health Transformation Fund in the law. It covers only 37% of projected rural Medicaid losses. If every rural hospital got an equal share, each would receive $4.5 million per year for five years.

Then the money disappears. The Medicaid cuts do not.

In Nebraska, a rural hospital CEO announced the end of dialysis services the same week state officials celebrated receiving first-year Rural Health Fund dollars. In Oklahoma, one health system projects a $130 million loss from the combined Medicaid and Medicare cuts.

What You Can Do

Contact your senators about the CMS state-directed payments rule. The proposed rule would cap Medicaid payments and cut another $510 billion. Public comments are open until July 21. Use Resist Bot to reach your members of Congress.
Submit a public comment to CMS directly. Tell the agency how hospital closures affect your community. The Federal Register page accepts comments from anyone.
Call your governor’s office. Governors decide whether to maintain Medicaid expansion as federal matching funds drop. Demand they keep expansion in place.
Track your state’s rural hospitals. The UNC Sheps Center maintains a live map of closures. The CHQPR risk list identifies which hospitals near you are vulnerable.
Show up at state budget hearings. State legislatures are deciding how to absorb these cuts right now. Your testimony puts a face on the numbers.

The Bigger Picture

This brief covers rural hospital closures specifically. For the full scope of Medicaid cuts taking effect under the One Big Beautiful Bill, including work requirements and FMAP reductions, read our Medicaid cuts brief. For the broader fight to protect American healthcare access, see our Healthcare and Science hub.