States With the Most Rural Hospitals per 100,000

From Becker’s Hospital Review

Massachusetts has the most hospitals per 100,000 rural residents while Delaware has the fewest, according to a University of North Carolina at Chapel Hill report.

The Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill used CMS’ rural health transformation program data to determine the number of healthcare facilities and population in rural communities. The report includes population, hospital and non-hospital facilities, and uncompensated care in every state. The data was published in October.

Here is how the states stack up with respect to hospitals per 100,000 rural residents:

  1. Massachusetts: 13.99
  2. North Dakota: 12.13
  3. South Dakota: 10.40
  4. Kansas: 9.54
  5. Nebraska: 9.49
  6. Montana: 9.44
  7. Florida: 8.80
  8. Arizona: 7.38
  9. Iowa: 6.76
  10. Nevada: 6.62
  11. Alaska: 6.55
  12. Wyoming: 6.37
  13. Minnesota: 6.37
  14. Louisiana: 6.40
  15. Connecticut: 6.19
  16. Oklahoma: 6.02
  17. Washington: 5.38
  18. Hawaii: 5.31
  19. Illinois: 5.95
  20. Colorado: 5.85
  21. Utah: 5.80
  22. Idaho: 5.50
  23. New York: 5.03
  24. Michigan: 4.92
  25. Texas: 4.89
  26. West Virginia: 4.80
  27. Wisconsin: 4.76
  28. Mississippi: 4.68
  29. Arkansas: 4.64
  30. New Mexico: 4.44
  31. California: 4.20
  32. Alabama: 4.21
  33. Rhode Island: 4.04
  34. Ohio: 3.86
  35. Indiana: 3.88
  36. Pennsylvania: 3.83
  37. Maine: 3.90
  38. Georgia: 3.68
  39. Missouri: 3.66
  40. Oregon: 3.65
  41. Virginia: 3.56
  42. Kentucky: 3.43
  43. Tennessee: 3.21
  44. South Carolina: 3.21
  45. New Hampshire: 3.20
  46. Vermont: 2.95
  47. New Jersey: 2.90
  48. North Carolina: 2.50
  49. Maryland: 1.86
  50. Delaware: 1.64

In 2024, the Sheps Center published a report with the number of total hospitals per state. Read the report here.

New Learning Network Launched on Increasing Access to Primary Care in Rural Communities

The National Academy for State Health Policy (NASHP) is excited to announce a new Increasing Access to Primary Care in Rural Communities Learning Network (Rural Primary Care Learning Network) launching in February 2026. This new learning network will provide a forum for state officials to share promising state approaches for strengthening primary care systems, with a focus on the unique challenges facing rural communities.  

Building on many of the strategies outlined in NASHP’s Implementing High-Quality Primary Care: A Policy Menu for States report, the Rural Primary Care Learning Network will facilitate state-to-state learning and conversations around how to strengthen primary care systems and reduce barriers to accessing primary care services, particularly in rural and underserved areas.

Discussions will include how to navigate challenges and opportunities in the current fiscal and policy environment, such as implementation of the One Big Beautiful Bill Act (OBBBA), or H.R. 1, as well as how to leverage new resources and momentum for primary care under the CMS Rural Health Transformation program.

Other key strategies and topics will include:

  • Expanding, strengthening, and retaining the rural primary care workforce
  • Strengthening rural primary care infrastructure, including Community Health Centers, Rural Health Clinics, local networks, and other primary care providers
  • Aligning funding and reimbursement strategies to increase access to whole person care
  • Investing in technology, data, and other infrastructure to increase access to care
  • Reducing administrative and regulatory burdens while preserving program integrity

NASHP’s Rural Primary Care Learning Network is open to all state officials interested in primary care and rural health, including officials from state health and human service agencies, Medicaid programs, state primary care offices, offices of rural health, Medicaid agencies, and state officials engaged in state primary care strategy and policy.

Experts from the National Organization of State Offices of Rural Health (NOSORH) and Milbank Memorial Fund will also provide insights and support for the network.

To learn more or to be added to the network list, please fill out this interest form.

Input Requested on Hospital Supply Chain Policy

The Centers for Medicare & Medicaid Services (CMS) is requesting public comments on an advance notice of proposed rulemaking focused on strengthening hospital supply chains for personal protective equipment (PPE) and essential medicines. Potential future approaches to support domestic procurement of PPE and essential medicines include a “Secure American Medical Supplies” friendly hospital designation, new payment policies, and a new structural quality measure that would be part of the Hospital Inpatient Quality Reporting Program.

Hospital and health system leaders are encouraged to submit comments by March 30 through Regulations.gov.

See Input Requested on Hospital Supply Chain Policy

DEA Finalizes Rule for EMS Under the Protecting Patient Access to Emergency Medications Act

The Drug Enforcement Administration (DEA) issued a Final Rule updating the 2017 Act.  The amendment allows for a new registration category for emergency medical services agencies that handle controlled substances and sets new requirements for delivery, storage, and record-keeping related to their handling of controlled substances.  See DEA Finalizes Rule for EMS Under the Protecting Patient Access to Emergency Medications Act.

New! Rural Health Value Glossary of Value-Based Care Terms Published

Does talking about Value-Based Care remind you of alphabet soup? The Rural Health Value team is pleased to share a new resource – a Glossary of Value-Based Care Terms. This compilation of key terms with brief definitions will help readers understand the vocabulary and terminology used in value‑based care and payment.

Related resources on the Rural Health Value website:

Rural Health Value facilitates the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Visit www.ruralhealthvalue.org. For more information, contact Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu.

HRSA Releases the 2025 Year in Review 

The Federal Office of Rural Health Policy (FORHP) is one of the offices within the Health Resources and Services Administration (HRSA).  Among agency-wide strides made to deliver health services to medically underserved areas and households with low incomes, the Federal Office of Rural Health Policy reached more than half a million people in rural communities, expanding access to health care through programs at both local and state levels.

See more here: HRSA 2025 Year in Review.

Three Program Open for HRSA NHSC Loan Repayment

The Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce supports the National Health Service Corps (NHSC) and three different options for receiving up to $100,000 to pay off student loans for health professionals.  The programs include the NHSC Rural Community Loan Repayment Program with a focus on service in NHSC-approved facilities for substance use disorder treatment and for facilities within Maternity Care Target Areas. Apply by March 31.