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Member Research & Reports

Member Research & Reports

UNC Study: Rural Hospitals in States That Did Not Expand Medicaid May Face Financial Vulnerability

Policy makers may need to formulate strategies for maintaining access to care for rural populations in Medicaid nonexpansion states, finds a new study by three researchers associated with the University of North Carolina at Chapel Hill. The study appears in the most recent issue of Health Affairs.


[Photo: (l-r) Dr. George Pink, Dr. Kristin Reiter, and an October 2014 map showing the closing of rural hospitals]

Co-authors are Dr. Kristin L. Reiter, associate professor of health policy and management at the UNC Gillings School of Global Public Health and research fellow at UNC’s Cecil G. Sheps Center for Health Services Research; Dr. Marissa Noles, a former research associate at the UNC Sheps Center; and Dr. George H. Pink, Humana Distinguished Professor in the Department of Health Policy and Management at UNC, deputy director of the North Carolina Rural Health Research Center and a senior research fellow at the Sheps Center.

Their study aimed to describe the amounts of uncompensated care provided by rural hospitals in the year before any state Medicaid expansions went into effect.

More than half the rural hospitals in the study were located in states that had chosen not to expand Medicaid as of the date of data analysis. This means that a large proportion of rural hospitals could experience little to no growth in Medicaid revenues in coming years, while the costs of providing care for which full payment is not received will remain relatively unchanged.

Hospitals in states that have expanded Medicaid may see some reductions in charity care as patients gain access to Medicaid coverage. Hospitals in states where Medicaid is not expanded likely will not see a similar conversion of unpaid care to covered care.


The article, “Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid,” was published online Oct. 5 in the journal Health Affairs.

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