More than half of rural Mississippi hospitals at risk of closing

JACKSON, miss — More than half of Mississippi’s rural hospitals are at risk of closing immediately or in the near future, according to the state’s top public health official.

Dr. Daniel Edney, the state health officer, spoke to state senators during a Monday hearing about the financial strain on Mississippi hospitals. Edney said 54% of rural hospitals in the state – 38 – could close. The potential closures threaten to exacerbate poor health outcomes in one of the country’s poorest states.

“It’s an intolerable situation from an economic perspective — losing 54 percent of our hospitals in the state — let alone from an access to care perspective,” Edney said.

Rural hospitals were under economic pressure before the COVID-19 pandemic, and the problems worsened as the costs of providing care rose. The high number of low-income uninsured people in Mississippi means hospitals are forced to receive more unpaid care. At the same time, labor costs are weighing on hospitals as they struggle to pay competitive wages to retain staff.

“A hospital’s income statement costs have skyrocketed,” said Scott Christensen, chairman of the board of the Mississippi Hospital Association. “State hospital balance sheet liabilities have reached unsustainable levels given what we are facing.”

The crux of the problem facing Mississippi hospitals is that revenues have not kept up with rising costs, Christensen said.

The pressure is most acute in the Mississippi Delta region, an agricultural plain where poverty remains entrenched. Greenwood Leflore Hospital has been cutting costs by cutting services and downsizing for months. But the medical establishment was unable to rule out the risk of an impending closure. Hospital chiefs say they will be bankrupt before the end of the year without a cash injection.

At Greenwood Leflore and other hospitals across the state, maternity care units have been on the chopping block. Mississippi already has the highest fetal death rate in the nation, the highest infant mortality rate and the highest premature birth rate, and is among the worst states for maternal mortality.

About 60% of births in Mississippi in 2020 were funded by Medicaid, according to the Kaiser Family Foundation.

A growing number of health care deserts are emerging in the Delta, but financial pressures are also weighing on hospitals in more prosperous parts of the state, experts said during the hearing. But hospitals in poor communities often treat patients who don’t have insurance and can’t afford to pay for care out of pocket. Expanding Medicaid coverage would reduce costs resulting from unpaid care.

Governor Tate Reeves and other Republican leaders have killed proposals to expand Medicaid, which primarily covers low-income workers whose jobs do not provide private health insurance. Opponents of the expansion say they don’t want to encourage the use of government assistance for people who don’t need it.

As a short-term solution, the Mississippi Hospital Association has suggested that the state Division of Medicaid work with federal authorities to raise the Medicaid reimbursement rate cap to a higher level. The move would reduce the cost of providing care to people already covered by the state’s current Medicaid plan.

Democratic Sen. Hob Bryan, who called the hearing, said the financial outlook for Mississippi hospitals is a “market failure” that deserves full-time attention.

“What we need is someone, somewhere in state government, who is responsible for determining what we want health care to look like now and in five and 10 years,” Bryan said. “Unless I am terribly confused, there is no one in your state government who has this charge.”

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This story has been corrected to show that the number of rural hospitals closing is 54% of all rural hospitals, not of all hospitals.

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Michael Goldberg is a member of the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places reporters in local newsrooms to report on underreported issues. Follow him on Twitter at twitter.com/mikergoldberg.