Georgia’s rural hospitals tighten budgets ahead of Medicaid, ACA changes

Local residents consider Evans Memorial invaluable given the town’s distance from other hospitals: Savannah is more than an hour away and Augusta and Macon are both two-hour drives.

But without changes to federal funding plans, Evans faces a $3.3 million budget shortfall next year, CEO Bill Lee said Monday.

Lee, his fellow administrators and even nurses and physicians made their case to U.S. Sen. Raphael Warnock. The Democrat toured Evans Memorial as part of a multi-stop swing through the state to raise awareness of the impact President Donald Trump’s federal spending plan — known as the “big beautiful bill”— will have on Georgians.

Evans Memorial and nearly 70 other hospitals across Georgia rely on revenue from Medicaid payments for low-income patients and government-subsidized insurance policies created under the Affordable Care Act.

Both those programs face significant changes under the Republican tax and spending legislation, which passed in early July.

It cuts Medicaid spending by 15% and alters how ACA recipients apply for coverage. In addition, special ACA subsidies offered during the COVID-19 pandemic that attracted several hundred thousand new participants are to expire in December without congressional action.

Analysis by KFF Health News projects 93,000 Georgians will lose Medicaid coverage and 1.2 million state residents will encounter higher ACA premiums unless Congress enacts changes. At Evans Memorial Hospital, about $3.4 million of its $20 million in revenue comes from Medicaid payments and a significant number of other patients have ACA policies, Lee said.

Credit: Adam Van Brimmer

Credit: Adam Van Brimmer

The “big beautiful bill” does include $20 billion in relief funds specifically for rural hospitals. State governments, not the medical facilities, apply for and distribute those dollars.

So as Evans Memorial Hospital readies its 2026 budget, administrators are looking for places to cut, Lee said. The most likely areas are the intensive care unit, which opened in 2022 after COVID-19 exposed the dearth of critical care beds across the country, and the physicians’ staff. Evans is served by 95 doctors, with about 20 on-site daily.

“I am a firm believer this isn’t about partisan politics; this is about relevance and survivability,” Lee said.

Warnock on Monday praised “the folks in this building who do heroic work every single day.

“And often they are doing it against great odds, and sadly, those odds have been increased by the GOP bill that was recently passed,” Warnock told reporters in a press conference following the tour. “When I think about the work that these folks have to do in this building, that bill is not beautiful at all.”

Warnock called on congressional Republicans, such as U.S. Rep. Buddy Carter of St. Simons Island, to “course correct” on their health care decisions. Carter’s district stretches the length of the Georgia coast and covers 15 counties, 13 of them rural, including two that border Evans County. Carter, a retired pharmacist, supported the GOP bill and said the Medicaid changes target waste, fraud and abuse and that the legislation’s tax breaks increase health care accessibility and affordability.

“Georgia’s senators have never treated patients — as a pharmacist, I have, and I understand the importance of providing accessible, affordable, and quality health care to Georgians,” he said.

Credit: Adam Van Brimmer

Credit: Adam Van Brimmer

On the state level, Republicans have taken action in recent years to bolster rural hospitals. Gov. Brian Kemp has championed several initiatives, including grant programs and tax credits, that have passed through the GOP-led General Assembly and stemmed the rural hospital closures.

Yet federal cuts put additional pressure on the state government to cover the gap, Evans Memorial’s Lee said, leaving he and his fellow rural hospital administrators “struggling to figure out what the next chapter looks like.”

Kathy Akins, an Evans Memorial nurse of more than 30 years, summed up the uncertainty when asked to name her greatest concern given the current environment.

“What keeps me up at night is keeping my rural hospital alive,” she said.