Byron Gabbard, the chief financial officer for Appalachian Regional Healthcare, told Goodman that the company is facing a $1 billion shortfall over the next decade as federal Medicaid cuts fall into place. In response to these cuts, he told Goodman that he sees ARH expanding into mobile clinics to fill the voids. ARH operates 14 hospitals across Eastern Kentucky and West Virginia.
“It really starts with the implementation of the One Big Beautiful Bill in 2027,” Gabbard told Goodman, referring to the Medicaid-specific portions of the bill. “We’ve got to find out what’s next and … I do think mobile plays a big, big role in that.”
Mobile clinics already exist in Kentucky, including through Owensboro Health, Kentucky State University, NorthKey Community Care and Kentucky Children’s Hospital. ARH, too, has one mobile clinic. “The hospital network used a $400,000 grant to purchase its first mobile clinic, which began operating this summer,” Goodman writes.
“According to KFF, a nonpartisan health policy research organization, the number of people who don’t have health insurance could increase by 210,000 people in Kentucky alone — a five percentage point increase — over the next decade, thanks to changes in the large tax and spending bill passed in July. Over the 10 years it will take for the bill’s Medicaid cuts to go into effect, KFF estimates they will cost Kentucky $22 billion in federal spending,” she reports.
For Kentucky hospitals, a large portion of those Medicaid cuts will come from new limits on state-directed payments, which allow increased reimbursement rates for hospitals and health care providers.
The Kentucky Hospital Association told Goodman that the new limits on state-directed payments could force service cuts or close hospitals that already operate on slim margins, endangering tens of thousands of jobs.
Medicaid covers about one in three Kentuckians, or 1.44 million people. Click here to see how many people are on Medicaid in each Kentucky county.
Lt. Gov. Jacqueline Coleman, who spoke at the Sept. 16 conference, cited a study out of the University of North Carolina’s Sheps Center for Health Services Research that found 35 rural hospitals in Kentucky — more than any other state in the nation — would be at risk under the coming Medicaid cuts, Goodman reports. That was assessed based on hospital profitability, risk of financial distress compared to peer hospitals and the share of Medicaid patients served.
To soften the blow of these cuts, states can apply for a new pot of money created in the July reconciliation bill — the $50 billion Rural Health Transformation Program.
However, Wallace, with the Mobile Healthcare Association, told Goodman that this will not replace all of the cuts that are coming to the Medicaid program.