only get about 5% of payment for self-
Medicaid is a public form of medical
insurance jointly funded by the states
and the federal government. Under
the PPACA, states can expand their
Medicaid programs with federal finan-
cial assistance to include all adults in
families with incomes below 138% of
the federal poverty level.
As of this year, 31 states including
the District of Columbia have expanded Medicaid through provisions of
the PPACA. Nineteen states have not
expanded Medicaid under the federal
law: Alabama, Florida, Georgia, Idaho,
Kansas, Maine, Mississippi, Missouri,
Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota,
Tennessee, Texas, Utah, Virginia,
Wisconsin, and Wyoming.
Failure to expand
Medicaid pushes rural
hospitals to brink
The absence of Medicaid expansion
played a role in this year’s closure of
McNairy Regional Hospital in Selmer,
Tennessee, says Wayne T. Smith,
chairman of the board and CEO of the
facility’s parent company, Franklin,
Tennessee–based Community Health
Systems. The 45-bed acute-care hospital closed in May.
“Several factors impacted the decision, primarily the unforeseen and
significant repairs to the hospital’s
plumbing system and a steady decline
in patient use. As a rural hospital,
McNairy Regional was also challenged
by cuts in federal reimbursement for
services as part of the Affordable Care
Act. The reimbursement changes were
predicated on more people having
insurance, whether through Medicaid expansion or insurance exchanges.
The lack of Medicaid expansion—to
date—has left many of the state’s most
vulnerable citizens without access to
health insurance, leaving hospitals to
address the unsustainable burden of
uncompensated care,” Smith says.
Risky Business for
How rural healthcare organizations are faring in non-Medicaid
expansion states. BY CHRISTOPHER CHENEY
Hospitalsinruralareasofthe country are feeling a sharp financial pinch in states that have not expanded their Medicaid programs under the Patient Protection and Affordable Care Act.
Community hospitals in rural coun-
ties of Tennessee, one of the states that
have opted not to embrace Medicaid
expansion, are facing financial pressure
that could be relieved if more of their
low-resource patients had Medicaid
coverage. “In our health systems, they
manage it. They have figured it out.
Where it’s really hitting is our rural
hospitals,” says Craig Becker, president
of the Tennessee Hospital Association.
“We’ve lost six rural hospitals in the last
year, and we’re going to lose another
one this year.”
In economically disadvantaged Ten-
nessee communities, many nonelderly
adults are either reliant on Medicaid
for their health coverage or fall into the
“self-pay” category, Becker says. “We
www.healthleadersmedia.com 40 HealthLeaders n July/August 2016
> ENCOURAGING EXPANSION. Wayne T. Smith is chairman of the
board and CEO of Community Health Systems in Franklin, Tennessee.
He says the health system wants patients to receive the care they
need, particularly preventive services that could delay or prevent
the onset of chronic diseases, and encourages every state where the
system operates affiliated hospitals to expand Medicaid.