Overview of Rural Hospitals in California

With 60 hospitals, nearly 4,900 licensed hospital beds, and over one million emergency visits provided in 2024, California’s rural hospitals provide health services in a vast area of the state.

Introduction#

Rural residents often face significant challenges obtaining healthcare, including high costs for insurance, shortages of medical providers, long distances to travel for care (over three-fourths of California’s rural census tracts are in primary care shortage areas), and inadequate connectivity that interferes with telehealth. Population differences can amplify these access challenges, as rural residents tend to be older and experience more serious health conditions.  

Rural healthcare facilities face challenges too, among them dependence on public funding, difficulties recruiting and retaining an adequate workforce, and financial challenges including risks of closure. The July 2025, H.R.1 Reconciliation Bill included $50 billion nationally over five years for the Rural Health Transformation Program (RHTP), through which California received $233.6 million for the first program year. The California’s Rural Health Transformation Program (CalRHT), is a statewide strategy to strengthen access, quality, and sustainability across rural and frontier communities to improve health outcomes. The plan envisions a connected, resilient rural health system that delivers person-centered care through a skilled workforce, modernized infrastructure, and locally responsive partnerships.  

To examine the role, capacity, and contributions of rural hospitals — and to inform understanding of the potential consequences of the anticipated cuts to coverage and funding — this data brief compares rural and urban hospitals with general acute care licenses¹ across a range of measures. The analysis uses the Federal Office of Rural Health Policy (FORHP) designations of rural. See the “How HCAI Created This Product” section below for details on the assignment of rural status.   

Visualization#

HCAI publishes a number of visualizations that allow for a deeper exploration of HCAI data and rural health, such as:

• Hospital Financial Health
• Physician Supply and Preventable Hospitalizations by County, 2023.
• Patient Characteristics by County and Facility – HCAI

Additional visualizations that highlight data for specific rural geographies can be found on HCAI’s Data and Reports page.

---

Critical Access Hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). (The two CAHs classified as urban by the FORHP rural designations were Community Memorial Hospital — Ojai and Healdsburg Hospital.)

Notes: For measures described as “Share of All”, rural and urban shares will total to 100%. For measures described as “Percentage of xx”, these are specific to the rural or urban columns; for example, “Percentage of Hospitals that Provided ED Services” means that 98% of rural hospitals provided ED services and 81% of urban hospitals did. Emergency Department (ED) visits include both those resulting in admission and not resulting in admission; they do not include as visits patients who left the ED without being seen or those who scheduled clinic visits in the ED locale. Population reflects U.S. Census Bureau, American Community Survey 5-Year Estimates, 2024, Table B01003 (Total Population), Table B01001 (Age/Sex), and B13002 (Women Who Had a Birth in the Past 12 Months), 2024, with Federal Office of Rural Health Policy rural and urban designations applied at the census tract level.

^*Net income margin is net income divided by the sum of all revenue, multiplied by 100
**Operating margin is operating revenue (net patient revenue and other operating revenue) minus operating expense, divided by the sum of all operating revenue, multiplied by 100.

Glossary#

Payer Categories

Payers are the companies, programs, and organizations that oversee insurance plans and reimburse healthcare providers. Payer categories used in this report are based on the standard regulatory definitions used in Hospital Annual Financial Data reporting, sourced from the HCAI Accounting and Reporting Manual for California Hospitals. 

• County and Other Indigent Programs: Programs that cover indigent patients under Welfare and Institutions Code Section 17000, those funded in whole or in part by County Medical Services Program (CMSP), California Health Care for Indigents Program (CHIP) and/or Realignment Funds, and other programs that covers care for indigent patients. Includes fee-for-service and managed care programs. This is a combination of the “County Indigent Programs – Traditional,” “County Indigent Programs – Managed Care,” and “Other Indigent” payer categories in the Hospital Annual Financial Data (HAFD).
• Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Fee-for-Service (FFS) and Medi-Cal Managed Care . This is a combination of the “Medi-Cal – Traditional” and “Medi-Cal – Managed Care” categories in the HAFD.
• Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Traditional Medicare (Medicare Fee-for-Service) and Medicare Advantage. This is a combination of the “Medicare – Traditional” and “Medicare – Managed Care” categories in the HAFD.
• Commercial and Other Third-Party: This payer category—called “Other Third Parties” in the Hospital Annual Financial Data—includes product types for which the coverage premium is paid by a private entity or other third-party payer. It encompasses payers such as employers, Workers’ Compensation and Short-Doyle. Both fee-for-service and managed care products are included. This is a combination of the “Other Third Parties – Traditional” and “Other Third Parties – Managed Care” categories in the HAFD.
• Other: Includes all payers who do not belong in any of the other categories, including uninsured patients and self-paid patients.

---

Footnotes#

¹ Hospitals licensed as general acute care may have some licensed beds not classified as acute care, including long term care, chemical dependency, rehabilitation, and psychiatric beds.
²Critical Access Hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS); criteria for this designation generally include: have 25 or fewer general acute care beds and are more than 35 miles from the closest hospital and provide emergency care services 24/7. Note that in 2025, Glenn Medical Center lost its CAH status and the federal funding that accompanied it, closing in September 2025 due to financial pressures. Despite restoration of CAH status, the hospital had not re-opened as of April 2026.
³The one rural facility that did not provide emergency services in 2024 was a specialized facility for the developmentally disabled (Porterville State Hospital).
⁴ US Census, ACS 5-Year Estimates, 2024, Table B13002, Women Who Had a Birth in the Past 12 Months, analyzed at census tract level for rural and urban residence status (using FORHP rural designations).
⁵Rural hospitals are well represented on the HCAI Maternity Care Honor Roll (exceeding the statewide percentage of maternity hospitals on the honor roll in 2025); see the honor roll for hospital specifics.