Tessa Quinn
Critical Access Hospitals (CAHs) are an essential part of the healthcare system in the United States, providing healthcare services to rural and underserved communities. CAHs are typically located in states with a large rural population and aim to address the basic healthcare needs of their communities. As of 2023, there are around 1,353 CAHs in the US, located across 45 states. The state with the highest number of CAHs is Texas, with 88 hospitals, followed by Iowa and Kansas. These hospitals are crucial in ensuring that residents of rural areas have access to affordable and convenient medical services, including emergency care.
| Characteristics | Values |
|---|---|
| Number of Critical Access Hospitals (CAHs) in the U.S. | 1,353-1,377 |
| States with CAHs | 45 |
| States without CAHs | Connecticut, Delaware, Maryland, New Jersey, and Rhode Island |
| State with the highest number of CAHs | Texas (88 hospitals) |
| States with the second and third highest number of CAHs | Iowa (82 hospitals), Kansas (81 hospitals) |
| Region with the largest number of CAHs | Midwest (46%) |
| CAH patient services | Primary care services (general medical and surgical care, laboratory testing, radiology), specialty services (obstetrics), emergency care, transfer agreements with larger hospitals |
| CAH staffing | At least one MD or DO physician (not required to be onsite), advanced practice providers (physician assistants, nurse practitioners, clinical nurse specialists), nursing staff (not required to be onsite if there are no inpatients) |
| CAH beds | 25 inpatient beds, with a maximum average length of stay of 96 hours per patient for acute inpatient care, plus up to 10 psychiatric and/or rehabilitation beds each |
| CAH funding | Medicare Rural Hospital Flex Program (MRHFP) state grants, 340B drug pricing program, technical help, educational resources, grants, Medicare reimbursement |
| CAH recognition | Top 20 Critical Access Hospitals recognized by the National Rural Health Association (NRHA) |
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What You'll Learn
Critical Access Hospitals (CAHs) are located in 45 states
Critical Access Hospitals (CAHs) are an integral part of the healthcare system in the United States, providing essential medical services to rural communities. CAHs are located in 45 states across the country, with approximately 1,350 hospitals in operation as of 2023. These hospitals are typically small healthcare facilities that serve rural, underserved communities, where there is often a higher proportion of uninsured or underinsured individuals and older adults. CAHs are designated by the Centers for Medicare and Medicaid Services (CMS), which outlines specific requirements for hospitals to obtain CAH status.
The presence of CAHs in 45 states highlights their widespread impact on rural healthcare. States with larger rural populations, such as Texas, Iowa, and Kansas, have the highest number of CAHs. These hospitals play a crucial role in ensuring that residents in these areas have access to basic medical services without having to travel long distances. CAHs often address the primary healthcare needs of their communities, offering general medical and surgical care, laboratory testing, radiology, and emergency services.
The establishment of CAHs was a response to the wave of rural hospital closures in the 1980s and 1990s. The Medicare Rural Hospital Flexibility Program, created by Congress in the Balanced Budget Act of 1997, provides state grants to support CAHs. This program recognises the unique challenges faced by rural healthcare facilities and aims to improve access to healthcare in these underserved areas. CAHs are subject to specific regulations and requirements, including maintaining an average length of stay of 96 hours or less per patient for acute inpatient care and providing 24-hour emergency care services.
CAHs have some flexibility in staffing compared to general acute care hospitals. While a CAH must have at least one MD or DO physician, advanced practice providers such as physician assistants, nurse practitioners, and clinical nurse specialists can be part of the independent medical staff. This flexibility ensures that CAHs can adapt their staffing to the needs of their rural communities. Additionally, CAHs may have transfer agreements with larger hospitals to facilitate the transfer of patients requiring more specialised care.
The impact of CAHs extends beyond providing basic medical services to rural communities. Their presence also contributes to more accessible and affordable healthcare in these areas. CAHs can participate in the 340B drug pricing program, which allows eligible healthcare facilities to purchase medications at reduced costs. This, coupled with their location in rural areas, makes healthcare more affordable and convenient for individuals who may be more susceptible to preventable illnesses. Overall, CAHs play a vital role in improving healthcare access and outcomes in underserved communities across 45 states in the United States.
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CAHs are essential to providing healthcare to rural communities
Critical Access Hospitals (CAHs) are essential to providing healthcare to rural communities in the United States. CAHs are small healthcare facilities that offer essential medical services, including emergency care, to underserved communities. They are an integral part of the healthcare network in rural areas, ensuring that residents can access basic medical services close to home. As of April 2025, there were 1,377 CAHs located across 45 states in the US, with Texas, Iowa, and Kansas accounting for 19% of all CAHs.
CAHs were established in response to a wave of rural hospital closures in the 1980s and 1990s. They are designated by the Centers for Medicare and Medicaid Services (CMS), which grants CAH status to qualifying hospitals. CAHs are defined by their rural location and distance from other hospitals, typically being located more than 35 miles from the nearest hospital. They must meet certain requirements and conditions of participation, including providing 24-hour emergency care seven days a week and maintaining an annual average length of stay of 96 hours or less per patient for acute inpatient care.
CAHs offer primary care services such as general medical and surgical care, laboratory testing, and radiology. They may also provide specialty services like obstetrics, but their primary focus is addressing the basic healthcare needs of their communities. CAHs have more staffing flexibility than general acute care hospitals, with federal requirements allowing them to close and have no nursing staff on duty if there are no inpatients. CAHs must still meet state licensure laws and the requirements for the services they choose to provide, such as obstetrical services.
CAHs are important because they offer more affordable and accessible healthcare to individuals in rural areas, who are often underinsured or uninsured and more susceptible to preventable illnesses. They can access technical help, educational resources, and grants, and they can collect reimbursement from Medicare. CAHs also typically have transfer agreements with larger hospitals to ensure that patients with complex or specialized medical needs can be transferred to facilities that can provide more advanced care.
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There are about 1,353 CAHs in the US
Critical Access Hospitals (CAHs) are an essential part of the healthcare system in the US, particularly in rural areas. CAHs are medical facilities that provide essential healthcare services to underserved communities in these areas. As of 2023, there were about 1,353 CAHs in the US, located across 45 states.
CAHs were established in response to a wave of rural hospital closures in the 1980s and 1990s. They are small healthcare facilities that offer basic medical services, including emergency care, to residents in rural areas. These hospitals are often the only option for individuals living far from urban centres to access affordable and convenient healthcare. CAHs are particularly important as people in rural areas are more likely to face poverty and are more susceptible to preventable illnesses such as depression and diabetes.
The state with the highest number of CAHs is Texas, with 88 hospitals, followed by Iowa and Kansas. These three states alone account for 19% of all CAHs in the country. The Midwest region has the largest number of critical access hospitals at 46%, while only making up 21% of the US population. This demonstrates the vital role that CAHs play in providing healthcare in less populated areas.
CAHs have their own set of Medicare Conditions of Participation (CoP) and a separate payment method. They are granted greater staffing flexibility and are not required to have a physician onsite at all times. CAHs must, however, provide 24-hour emergency care services seven days a week and maintain an annual average length of stay of 96 hours or less per patient for acute inpatient care. They often have transfer agreements with larger hospitals to ensure patients requiring specialised care can be transferred when necessary.
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CAHs must meet certain conditions to receive CAH status
Critical Access Hospitals (CAHs) are small healthcare facilities that provide essential medical services, including emergency care, to underserved communities. They are located in rural areas to ensure that residents have access to basic medical services closer to their homes. As of April 2025, there are 1,377 CAHs spread across 45 states in the United States.
CAHs are granted certain benefits, such as cost-based reimbursement for Medicare services, to reduce their financial vulnerability and improve healthcare access in rural communities. To obtain CAH designation, hospitals must meet several conditions, including:
- Being located more than 35 miles from another hospital (exceptions may apply in the case of mountainous terrain or secondary roads, where the distance requirement is 15 miles)
- Maintaining an annual average length of stay of 96 hours or less for acute care patients
- Developing agreements with acute care hospitals related to patient referral and transfer, communication, and emergency and non-emergency patient transportation
- Complying with state licensure laws and Medicare Conditions of Participation (CoP), which offer greater staffing flexibility, such as allowing advanced practice providers like physician assistants and nurse practitioners to be an independent part of the medical staff
- Participating in the Medicare program and having a current license as an acute care hospital or a health clinic/center previously operating as a hospital
- Meeting the requirements for the services they choose to provide, such as obstetrical services, by adhering to the relevant conditions of participation as a general acute care hospital
- Maintaining patient records that include identification and social data, informed consent forms, medical history, health status, and other pertinent information necessary to monitor the patient's progress
- Ensuring that patient diets, including therapeutic diets, are ordered by a qualified practitioner or a qualified dietitian/nutrition professional in accordance with state law
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CAHs must meet state licensure laws
Critical Access Hospitals (CAHs) are small healthcare facilities that provide essential medical services, including emergency care, to underserved communities in rural areas. They are located in 45 states across the United States, with Texas, Iowa, and Kansas accounting for the highest number of CAHs. CAHs are essential to ensuring that residents in rural communities have access to basic medical services closer to their homes.
CAHs are designated by the Centers for Medicare and Medicaid Services (CMS), which grants CAH status to qualifying hospitals nationwide. This special designation was established in response to the wave of rural hospital closures 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) to help fund CAHs.
CAHs must meet specific requirements to obtain and maintain their status. One crucial aspect is complying with state licensure laws. Each state has the regulatory power to pass laws and take actions necessary to protect the health, safety, and welfare of its citizens. State licensure laws establish the minimum qualifications and standards that healthcare providers must meet to obtain a license to practice independently within that state.
CAHs must adhere to their respective state's licensure laws, especially when those laws are stricter than the Medicare Conditions of Participation (CoP). While the specific requirements may vary from state to state, CAHs must generally meet the standards for the services they choose to provide. For example, if a CAH offers obstetrical services, it must comply with the relevant conditions of participation as a general acute care hospital.
To maintain their state licensure, healthcare providers in CAHs may need to renew their licenses periodically. This process may involve paying annual fees, fulfilling continuing education requirements, and self-reporting any disciplinary actions. By meeting state licensure laws, CAHs ensure that they are providing care that meets the state-determined standards and protects the health and safety of their patients.
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Frequently asked questions
There are around 1,353 critical access hospitals in the United States, located across 45 states.
Critical access hospitals (CAHs) are medical facilities that provide healthcare services to rural, often underserved communities.
Texas has the highest number of CAHs, with 88 hospitals, followed by Iowa (82 hospitals) and Kansas (81 hospitals).
CAHs offer essential medical services, including emergency care, to their communities. They may also offer specialty services such as obstetrics.
The National Rural Health Association recognises the top 20 critical access hospitals in the country, based on the Chartis Rural Hospital Performance INDEX™.
