Responding to a request from Senate Democratic leadership for insights into the impact of the House-passed budget reconciliation package, researchers at the Sheps Center for Health Services Research, University of North Carolina at Chapel Hill in a June 10, 2025 letter outlined the rural hospital at risk of closure if the legislation as written becomes law.

To determine which hospitals are most at risk, researchers looked at those in the top 10% of Medicaid receiving hospitals, and those that had negative margins for the last three consecutive years. Over 300 (338) hospitals met one, or both criteria.

The letter lays out the Congressional districts with rural hospitals at risk with the highest numbers of hospitals at risk in Kentucky, Louisiana, California, and Oklahoma.

Hospitals are key referral partners for rural skilled nursing and home health agencies. Reduced access to acute care services in rural areas will send a ripple effect through rural aging services providers who rely on these partners not only for referrals but to support critical emergency services for their patients.

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