New analysis classifies 45 of the state’s 73 rural inpatient hospitals as at risk of closing, including 18 at immediate risk.
OKLAHOMA CITY — Nearly two-thirds of Oklahoma’s rural hospitals are at risk of closing, twice the national rate, as the state begins deploying $223.5 million through a new federal rural health program.
The financial data largely predate the Rural Health Transformation Program. But they illustrate the scale of the problem confronting the five-year effort and raise questions about whether investments in technology, workforce and new approaches to care can overcome recurring hospital losses.
The Center for Healthcare Quality and Payment Reform identified 45 of Oklahoma’s 73 rural inpatient hospitals, or 62%, as at risk. Nationally, 700 of 2,249 rural hospitals, or 31%, fell into that category.
Eighteen Oklahoma hospitals, or 25%, were classified as being at immediate risk, compared with 12% nationally. Oklahoma had the third-highest number of at-risk rural hospitals, behind Texas and Kansas.
FOX 25 first reported the center’s Oklahoma findings Tuesday.
What “immediate risk” means
The report does not predict that 18 Oklahoma hospitals are about to close or establish a timetable for individual facilities.
It uses hospital financial reports filed with the federal government to evaluate patient-service losses, revenue from other sources and available reserves. Hospitals at the greatest risk have more debt than assets or lack enough net assets to absorb continuing losses for more than a few years.
Forty-three Oklahoma rural hospitals, or 59%, lost money providing patient services in the most recent year available. Some remain open because local taxes, government grants or other revenue offset those losses.
Seven Oklahoma rural hospitals have closed since 2015, according to the report. Six others converted to the federal Rural Emergency Hospital designation, which provides additional payments but requires them to end inpatient care. Those facilities may continue offering emergency and outpatient services but must transfer patients who need hospitalization.
What the $223 million does
Oklahoma secured $223,476,948.62 for the first budget period of the Rural Health Transformation Program. That is the initial award, not a guaranteed annual amount for all five years.
Congress created the program through the One Big Beautiful Bill Act, providing $50 billion nationally from fiscal years 2026 through 2030. Half is divided equally among states with approved plans. The other half is allocated using factors such as rural population, the condition of rural health facilities, state policy commitments and proposed uses of the money.
Gov. Kevin Stitt designated the Oklahoma State Department of Health to administer the program. Oklahoma’s plan covers new models of care, disease prevention, workforce development, regional collaboration, value-based payments and improved health data.
The money can support telehealth, transportation, connected medical records, recruitment of rural health workers, chronic-disease programs and partnerships through which providers share staff, technology and administrative resources. Oklahoma has begun offering funding for ambulances and community paramedicine, behavioral health, maternal health and regional health care partnerships.
Although direct provider payments are among the federally permitted uses, the program is intended to produce lasting changes rather than simply cover hospital operating losses.
Report points to payment problems
The center argues that the central problem is not simply the availability of grants but how rural hospitals are paid.
Small hospitals must maintain emergency departments, medical staff and equipment even while treating fewer patients than larger facilities. That makes the average cost of each service higher.
The report’s national analysis says private insurance and Medicare Advantage plans frequently pay rural hospitals less than the cost of care. At hospitals classified as at risk, losses on privately insured patients were larger than those associated with Medicaid, uninsured patients or bad debt.
The center recommends requiring Medicare Advantage plans to pay small rural hospitals at least what traditional Medicare pays. It also proposes “standby capacity” payments to cover part of the fixed cost of keeping emergency and other essential services available.
The organization estimates that raising payments enough to prevent closures among all 700 at-risk rural hospitals would cost about $4 billion annually.
Oklahoma’s transformation plan could improve efficiency and bring more care closer to rural patients. But the report provides a stark starting point for measuring its effect: 45 hospitals at risk, 18 facing the most serious financial conditions and a rural hospital system carrying twice the closure risk seen nationally.
