Many Rural WT Hospitals Operating In The Red

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Texas lost 21 rural hospitals since 2010 according to rural health advocacy group TORCH.

For rural residents, a emergency trip to the hospital was already frighteningly cost prohibitive.

After hurdling down rough caliche roads to reach the two-lane blacktops, EMS responders and patients find the journey to care gets more tenuous with each passing year, as the costs become too great for small counties to maintain services.

According to public information, rural hospitals in Andrews, Brady, Colorado City, Del Rio, Eden, Fort Stockton, Lamesa, Sweetwater, and Winters operate at a steep negative margin. According to statewide data, 69 rural hospitals report a two-year average negative margin.

As reported by WFAA News of Dallas in June, John Henderson, CEO of the Texas Organization of Rural and Community Hospitals (TORCH) says one-third of these rural hospitals have less than 10-days of cash on hand.

“Rural hospitals are scared and getting attention because our operating margins are so thin. 44 percent of rural Texas hospitals had negative margins in 2023. We will be the first provider type to feel the effects,” Henderson said.

For residents of the 17 counties where these hospitals closed, it just means less readily available healthcare.

Many of these hospitals remained open in some capacity but changed designation, resulting in less staff, fewer beds, and loss of emergency services.

Designations Dictate Hospital Services

Rural hospitals are given many designations for Medicaid reimbursement.

Locally, most rural hospitals are Critical Access Hospitals (CAH) or Sole Community Hospitals (SCH).  

A CAH must be at least 35-miles away from another hospital, and have no more than 25 beds for acute inpatient care, or “swing beds” for patients out of acute care.

These facilites can be reimbursed at 101-pecent of Medicare’s share of “reasonable costs” for inpatient care and services like ambulance or emergency care.

Experts agree that hospitals like those in neighboring counties are at risk of closure due to cuts in Medicare and Medicaid.

Many Rural Hospitals Can’t Provide Labor Healthcare

Of the 157 rural hospitals that remain, only 40 percent still handle delivery and obstetric care. Others only perform deliveries on an emergency basis.

Expectant mothers in McCulloch County would have to travel 71 miles to San Angelo, 53 miles to Coleman, or 51 miles to Llano to give birth in a dedicated labor and delivery facility..

Injured oil field workers must travel to Abilene, Midland, Odessa, or San Angelo in order to receive level three trauma care.

The closest level two trauma facilities are in Amarillo, Austin, El Paso, Lubbock, or Wichita Falls. Distances that require helicopter travel in serious cases.

Many Texans are used to traveling these great distances in Texas, some are even proud of it. But when a life hangs in the balance, the problem becomes clear: rural Texans are being denied the care they need, advocates say, noting this denial of care may come from outright closure, or more gradually through redesignations.

According to TORCH, “Four hospitals in Texas have transitioned to a new federal designation of Rural Emergency Hospitals, ceasing inpatient care to avoid closure.”

Rural Emergency Hospitals are paid a standard monthly amount — $285,625 in 2025, but are ineligible for larger value-based reimbursements through Medicaid.

For the local hospitals mentioned above, all but one (Sweetwater at 0.3 percent) reported Medicaid, CHIP, and Indigent Services accounting for negative margins.

Rural hospitals that have closed since 2010:

2010

Bastrop Hospital, Bastrop County.

2012-2013

Weimer Hospital, Colorado County – re-opened in 2016 but later closed (see 2016)

Renaissance Hospital, Kaufman County.

Shelby Regional, Shelby County.

Cozby-Germany, Van Zandt County – later reopened in 2015, but closed again in 2019 as Texas General Hospital.

Central Texas Hospital, Milam County – reopened in 2014 as Little River Healthcare, closed again in 2018 (see 2018)

2014

Lake Whitney Medical, Hill County

Good Shephard, Cass County

East Texas Medical Center, Upshur, Franklin, and Red River counties

2015

North Texas Regional, Wise County – acquired by Wise Health in 2013, closed inpatient services in 2015 but continues with urgent care facility, no emergency room

Hunt Regional, Hunt County – closed inpatient services but continues as ER.

Bowie Memorial, Montague County – reported 44 beds, reopened as Central Hospital of Bowie, 2017, closed again, now open as Rural Emergency Hospital, no inpatient services, 24 hour emergency center.

2016

Nix Community, Frio County – 18 beds reported.

Weimar Medical Center, Colorado County – 38 beds reported, reopened with ER and outpatient services, inpatient resumed early 2017, closed again in 2017 (see 2017)

2017

East Texas Medical Center, Trinity County.

Weimar Hospital, Colorado County – prior closures in 2012 and 2016, no reports of re-opening.

2018

Stamford Memorial, Jones County – 25 beds reported, outpatient only, no inpatient or ER.

Little River, Milam County – 35 beds reported across two locations.

2019  

Chillicothe Hospital, Hardeman County – 21 beds reported, outpatient only.

Hamlin Memorial, Jones County – 25 beds reported, outpatient only.

Texas General Hospital, Van Zandt County, 52 beds reported, outpatient only.

Sources:

Data from CHQPR “Saving Rural Hospitals” 

Data from TORCH on closures and birthing hospitals here.

ABC WFAA in Dallas on rural hospitals.

Note on Bowie Memorial here.