Healthcare Insights

How many critical access hospitals are in the U.S.?

Critical access hospitals (CAHs) are essential to providing healthcare to rural communities in the U.S. They are small healthcare facilities that provide essential medical services, including emergency care, to underserved communities. Along with rural health clinics, critical access hospitals are an integral part of the healthcare community in rural areas and help ensure that residents have access to basic medical services closer to their homes.

The Centers for Medicare and Medicaid Services (CMS) grants CAH status to qualifying hospitals nationwide. This special designation was established in response to a wave of rural hospital closures that occurred in the 1980s and 1990s. Since the passage of the Balanced Budget Act in 1997, states have had the authority to implement the Medicare Rural Hospital Flex Program (MRHFP), which offers state grants to help fund CAHs. This initiative has effectively enhanced the financial stability of CAHs, ensuring better access to healthcare services and preserving local healthcare options rather than forcing patients to seek care at more distant facilities.

The map below includes the number of active critical access hospitals across each state in the U.S. according to data from the Definitive Healthcare HospitalView data product. Data is accurate as of November 2023.

Number of critical access hospitals per state

Fig 1 Data is from the Definitive Healthcare HospitalView data product. The number of facilities represents critical access hospitals with a status of “active.” Accessed October 2023.

Critical access hospitals are currently located in 45 states. Connecticut, Delaware, Maryland, New Jersey, and Rhode Island do not have any CAHs, due to the population density of these states.

The state with the highest number of CAHs is Texas, with 88 hospitals, followed by Iowa (82 hospitals) and Kansas (81 hospitals). These states have large swaths of rurally populated areas, so it is no surprise that together these states account for 19% of all CAHs. The states in the Midwest region comprise the largest number of critical access hospitals at 46%, followed by the West at 20%. Considering the Midwest only comprises 21% of the U.S. population, this demonstrates the large part CAHs play in providing the necessary care to this part of the country.

What are some key characteristics of critical access hospitals?

Some critical access hospital requirements and key attributes include:

Located in a state that has established a Medicare Rural Hospital Flexibility Program.
Located in a rural area and more than a 35-mile drive from another hospital, or more than a 15-mile drive in an area with mountainous terrain or only secondary roads.
Smaller hospitals with a limited number of inpatient beds (25 beds or fewer).
Maintain an annual average length of stay of 96 hours or less per patient for acute inpatient care.
Required to provide 24/7 emergency care, ensuring that patients can receive medical attention during emergencies and urgent situations.
Eligible for cost-based reimbursement from Medicare, which helps them cover their operational expenses and maintain financial stability.
Focus on primary care services, such as general medical and surgical care, as well as basic diagnostic services like laboratory testing and radiology. CAHs may also offer some specialty services, such as obstetrics, but the primary goal is to address the basic healthcare needs of their communities. Typically have transfer agreements with larger hospitals to ensure that patients with more complex or specialized medical needs can be transferred to facilities that can provide more advanced care when necessary. According to our Atlas Reference & Affiliation Dataset, about 57% of CAHs are part of an integrated delivery network (IDN).

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