Letter: What we have requested from our legislators

As healthcare reimbursement policies continue to evolve, I would like to highlight the unique and growing challenges faced by rural healthcare providers like Texas County Memorial Hospital (TCMH) and ask for your continued advocacy on our behalf.

Over the past five years, we have seen significant fluctuations in Medicaid enrollment among our patients. In 2020, 17.3% of our patients were enrolled in Medicaid. During the height of the COVID-19 pandemic, that number rose to 22.4%, but has since declined to 19.6% in 2024. Many patients cite the burden of additional paperwork and complex enrollment processes as barriers to continued coverage.

Medicaid reimbursement rates also present a substantial financial challenge. In 2022, TCMH billed Medicaid nearly $19 million, yet we were required to write off almost $12 million. Across all payer groups, we routinely write off between 65% and 68% of billed charges—an unsustainable model for a small, independent hospital.

Additionally, our provision for uncollectable accounts has varied widely—from $8.2 million in 2020, down to $2.8 million in 2022 (when access to Medicaid was more streamlined), then back up to $5.3 million in 2024. While some suggest a form of socialized medicine already exists, the reality is that we provide federally mandated care regardless of ability to pay—often with no reimbursement—unlike most other industries.

Compounding the issue, many of our Medicare patients are being steered toward Medicare Advantage plans, which often negotiate even lower reimbursement rates. These plans, aggressively marketed by celebrities and athletes, are costly to taxpayers—more than $1,000 per enrollee per month according to insuredandmore.com. Companies like Humana, which reported $2.7 billion in profit last year, benefit greatly while patients face restrictive networks, high out-of-pocket costs, limited nationwide coverage, and yearly plan changes. Prior authorizations and administrative hurdles further delay or prevent access to necessary care.

The closure of rural hospitals across the country is alarming and further underscores the need for targeted support. Congressman Graves’ reintroduction of the Save America’s Rural Hospitals Act is a step in the right direction. We sincerely appreciate any support for this legislation and ask that rural independent hospitals like ours be considered separately from large health systems. We operate on tight margins, without the benefit of system-wide subsidies.

Recent patient cases highlight our vital role in the community: a mother whose condition worsened after delivery received lifesaving care and was safely transferred to a tertiary facility; and just yesterday, a 43-year-old stroke patient received immediate, effective treatment and was stabilized before transfer. Without TCMH, these stories could have ended very differently.

Grant funding has also become increasingly uncertain. We have submitted applications to USDA, HRSA, and FEMA, but have received little more than auto-responses indicating funding is suspended. These grants are critical for maintaining and upgrading equipment essential to patient care. Delays hinder our ability to plan and serve effectively. Any updates or assistance on the status of federal grant availability would be greatly appreciated.

Lastly, I would welcome the opportunity to speak with someone on your team regarding appropriations. In 2013, we expanded our facility with USDA funding and still carry $13.4 million in debt. We are now seeking $4.5 million in funding for the much-needed expansion of our obstetrics and intensive care units. If this could be included in a future appropriations bill, it would greatly ease our financial burden—freeing up $85,000 each month for operations and patient services.

Thank you for your time and continued support of rural healthcare. We look forward to the opportunity to work together in ensuring access to quality care for all Missourians.