Critical Access Hospitals in Texas: The Full List for 2026

Key Takeaways

• The Flex Monitoring Team list of Texas critical access hospitals holds 92 hospitals. The Rural Health Information Hub shows 93, so you will see both numbers in print.
• Seven in ten sit at exactly 25 beds. That is the federal cap under 42 CFR 485.620, so most of these hospitals are built right up to the line.
• The rest are much smaller. Twenty-eight run below the cap, twelve run 15 beds or fewer, and the smallest runs 10.
• Texas is still gaining critical access hospitals. Seven of the 92 were certified in 2023 or later, and three of those in 2025.
• Every one of them owes the same staffing floor. Under 42 CFR 485.631, a registered nurse, clinical nurse specialist, or licensed practical nurse is on duty whenever the hospital has one or more inpatients.

Table of Contents

• How Many Critical Access Hospitals Are in Texas?
• What Is the Full List of Critical Access Hospitals in Texas?
• What Does the List Show About Rural Hospitals in Texas?
• Why Does This List Keep Changing?
• What Does This Mean for Staffing a 25-Bed Hospital?
• What to Do This Week
• Frequently Asked Questions

Texas has among the most critical access hospitals of any state, spread across the Panhandle, West Texas, East Texas, and the border counties. Most people looking for the list want one of two things: to find a specific hospital, or to see how their own facility compares to its peers.

This page is the list itself, followed by what the numbers in it actually say. If you want the definition and the rules behind the designation first, start with what a critical access hospital is.

How Many Critical Access Hospitals Are in Texas?

Ninety-two, or ninety-three, depending on which source you read. Both were checked on 4 September 2026.

The Flex Monitoring Team, which tracks these hospitals for the federal Flex Program, publishes the national list of certified critical access hospitals. Its Texas list holds 92 entries. The Rural Health Information Hub, a federally funded rural health information service, shows 93 on its Texas state guide, on a page last updated 20 July 2026. Neither is wrong. Published counts of these hospitals rarely agree, because they are drawn from different snapshots of federal certification data taken on different days, and a single conversion or closure moves the number.

The practical answer is that Texas has about 92 to 93 of them, and any page giving you a precise figure without a date attached is telling you less than it appears to. The list below is the Flex Monitoring Team’s, because that is the one that names every hospital.

What Is the Full List of Critical Access Hospitals in Texas?

All 92 hospitals, sorted alphabetically. Beds and certification dates are as the Flex Monitoring Team lists them. On a phone, use your browser find-in-page to jump straight to yours. Hospitals appear under their official federal listing name, which is often not the name a town uses day to day, so search your city if the name does not match.

Names and cities appear as the source lists them, with all-capitals entries set in title case so the table reads cleanly.

What Does the List Show About Rural Hospitals in Texas?

Four things stand out once you total the columns.

Most of them are built to the cap. Sixty-four of the 92 carry exactly 25 beds, which is the maximum a critical access hospital may hold. The average across all 92 is 22.6 beds. Most of these hospitals were designed around that ceiling rather than drifting toward it.

The small ones are very small. Twenty-eight hospitals run below 25 beds, eighteen run under 20, and twelve run 15 or fewer. The smallest carries 10. A 10-bed hospital and a 25-bed hospital each appear here as one line. They are not the same staffing problem, and a rule of thumb built for one will not fit the other.

Texas is still gaining critical access hospitals. Certification dates run from 1999 to 2025. Seven hospitals joined in 2023 or later: four in 2023, none at all in 2024, and three in 2025. Conversion is a live option rather than a historical event.

Most of the list is long established. Sixty-seven of the 92 were certified before 2006, in the wave that followed the program’s creation. For more than two thirds of these hospitals, critical access is simply what they have always been.

Why Does This List Keep Changing?

Hospitals move on and off it, which is why a dated list matters more than a precise one.

Seven hospitals have joined the list since 2023. A hospital seeking the designation today has to qualify on the mileage test in 42 CFR 485.610, because the necessary-provider route closed to new entrants on 1 January 2006. Hospitals leave the list by closing, or by converting to a different designation. Texas also has four Rural Emergency Hospitals, per the Rural Health Information Hub, which is a newer designation for facilities that stop providing inpatient care and keep emergency and outpatient services.

There is also a review coming, though not for years. In QSO-26-15-CAH, issued 21 August 2026, CMS set out how state survey agencies should check that a hospital still meets the rural location and distance rules. Those reviews start in 2033 and repeat every ten years after that. Nothing in the memo changes anything this year.

What Does This Mean for Staffing a 25-Bed Hospital?

The bed counts above set the same problem for every hospital on the list. Under 42 CFR 485.631, a registered nurse, clinical nurse specialist, or licensed practical nurse is on duty whenever the hospital has one or more inpatients. That is a 24-hour, 365-day obligation, and it does not shrink when the census, meaning the number of patients in the building, falls to one.

A hospital averaging 22.6 beds covers that floor from a small roster. One resignation or one badly placed callout is felt immediately, because there is no second unit to borrow from and no float pool to draw on. It also means the regulatory minimum does not move with the census. One inpatient obliges the same minimum licensed cover as twenty-five do, so the floor never drops below a single licensed nurse on duty. What a hospital actually staffs sits above that floor, and that does move with the census. The staffing models that fit a roster this size are compared in nurse staffing models, and the callout half of it in how to handle nurse callouts.

SimpleScheduleAI is an AI-native nurse scheduling service built for hospitals on this list. We build the schedule, our scheduling team checks it, and your nurse manager approves it. We are not right for a hospital that wants software it configures and runs itself.

See how AI nurse scheduling works, how it works, or the wider picture in critical access hospital scheduling and nurse scheduling software.

What to Do This Week

1. Find your hospital in the table and check its bed count. The number on the federal list is what your designation is built on, and it is worth knowing it matches what you actually staff.
2. Scan the Beds column for the hospitals your size, and compare yourself to those. A 14-bed hospital and a 25-bed hospital share a list and very little else.
3. Check your certification year. If it predates 2006, most of your scheduling practice probably predates your current roster too.
4. Count how many nights this month had exactly one person covering the staffing floor. Under 42 CFR 485.631 that person is not optional, so each of those nights was one callout from a problem.
5. See what a schedule built around that floor looks like. Start at how it works.

Frequently Asked Questions

Q: I cannot find my hospital on the list. Why not?

Hospitals are listed under the official name on their federal certification, which is often not the name a community uses, and several appear under a hospital district rather than the hospital itself. Search your city in the City column instead. A hospital genuinely absent from the list has either converted to another designation or was certified after this list was published.

Q: Can a critical access hospital in Texas have more than 25 beds?

No. 42 CFR 485.620 caps the designation at no more than 25 inpatient beds, and 64 of the 92 Texas hospitals sit at exactly that number. Beds may be used for inpatient or swing-bed services, but they come from the same 25.

Q: What is the difference between a critical access hospital and a rural emergency hospital?

A rural emergency hospital gives up inpatient care and keeps emergency and outpatient services. Texas has four of them alongside its critical access hospitals, per the Rural Health Information Hub. It is one of the routes a hospital can take off this list.

Sources

[1] Flex Monitoring Team, Critical Access Hospital Locations list, Texas rows, retrieved 4 September 2026. flexmonitoring.org.

[2] Rural Health Information Hub, Texas State Guide, rural healthcare facility counts, checked 4 September 2026 (page last updated 20 July 2026). ruralhealthinfo.org.

[3] 42 CFR 485.620, bed cap and length of stay. ecfr.gov.

[4] 42 CFR 485.631, staffing and staff responsibilities. ecfr.gov.

[5] CMS, QSO-26-15-CAH, Critical Access Hospital Evaluation of Compliance with the Rural and Distance Requirements, 21 August 2026. cms.gov.

Pradeep Pandey is the co-founder of SimpleScheduleAI. He serves as Deputy General Manager of Operations at Apollo Hospitals and holds an MBA from IIM Trichy (Operations and Marketing). His work focuses on workforce optimization and scheduling operations for Critical Access Hospitals and other small rural facilities. LinkedIn →