In other parts of the country, the drama surrounding rural hospitals is also unfolding. Other Mississippi rural hospitals, notably those in Amory or Batesville, are also at risk of closing if they don’t find a new operator. While Clarksdale leaders are concerned, they remain confident that the hospital’s medical centers will be open. They also stated that Curae Health Inc., the current owner of the lease, is taking steps to bring in someone to replace Curae Health Inc. Curae Health, an Tennessee-based non-profit health system, acquired the leases from Community Health Systems, Inc. on August 24 and filed for Chapter 11 bankruptcy at the U.S. Bankruptcy Court, Middle District of Tennessee. Coahoma County officials were informed on October 12 that the company was planning to close the hospital’s doors on December 10, due to rising expenses. It is difficult to run a rural hospital these times. It’s more difficult to run a rural hospital when you look at the demographics. Brock Slabach is the senior vice president of member services at National Rural Health Association. He stated that hospitals have difficulty financing the services that are essential for a healthy community. “I know that in Mississippi, especially in Mississippi’s demographics, there are patients who have trouble paying their bills. This presents a problem for providers as it is a high-need and low reimbursement proposition, and hospitals end up in the middle,” said Brock Slabach, senior vice president for member services at the National Rural Health Association. Data from the North Carolina Rural Health Research Program show that 87 rural hospitals in the United States have closed since 2010, with the majority of them being in the South. Five of those five hospitals were closed in Mississippi. According to Healthline Media, there are many reasons rural hospitals could close down. These include small populations, uninsured patients and high unemployment, as well as run-down facilities and problems recruiting doctors. Slobach stated that Medicaid expansion is one of the most controversial issues in Mississippi regarding rural hospital shoring up. Mississippi is not among the 14 states that have opted to expand Medicaid. The Affordable Care Act gives states the ability to expand Medicaid eligibility – a state and federal program that provides low-income individuals with health care – to all persons with household incomes below a specific level. According to Census data, states that extended Medicaid eligibility saw a decline in the uninsured rate of people below 100 percent and an increase for those living at or above 400% of poverty between 2016 and 2017. Those who did not expand saw an increase in both. According to 2017 Census data, 19.8% of Mississippians are below the poverty line. This is a decrease of one percent from 2016, but still higher than the national rate of 13.4 per cent. Advocates argue that Medicaid expansion would expand coverage to Mississippi’s poorest residents, which is 10 percent of the state population. Mississippi Today reports that opponents argue that long-term benefits outweigh the risks of covering such a large population. D-Clarksdale State Rep. Orlando Paden also echoed Slobach and Baria’s comments, saying that he is concerned about two things: the well-being and economic impact of this hardship. Paden stated that “we have a high incidence of diabetes, heart disease, stroke victims, and people with heart conditions… The hospital is necessary for their continued care.” “Clarksdale is unique in that it serves people in Quitman and Tallahatchie counties. We have to continue that.” Paden also spoke out about the 484 job at risk. HealthLeaders Media reported that Curae Health released a statement stating that declining revenues and financial difficulties were factors in the decision to file bankruptcy. According to bankruptcy filings, Curae Health claims that keeping Clarksdale open would pose significant risks for the Batesville or Amory hospitals. The hospital’s performance was significantly below average, with a negative cumulative cash flow of $2.5 million over three months. Officials at the hospital claim that this was not true. They allege Curae Health forced them into implementing MEDHOST, an electronic medical record system. This delayed billing. Medical hospitals can find it difficult to update electronic medical records data. According to case filings, Curae owes MEDHOST $3.4million. “… Insufficient monthly receipts are one of the charges against Curae. This is to allow the hospital to continue its operations. “But, (Curae Health), had started counting this. They had also instituted an electronic medical record called Medhost… where there would have been a delay in billing or collecting,” Dr. Richard Brownstein, Clarksdale hospital doctor, told Coahoma County supervisors October 17. Erika R. Barnes, Stites & Harbison PLLC, Nashville filed an emergency motion Oct. 22 on behalf of Coahoma county. She argued that it is unclear how much money debtors actually lose on a post-petition base or if the cash flow issue stems from the new billing system. Barnes provided evidence that the hospital earned $35,048 before interest, taxes and depreciation between August 24 and September 30, and had $4.6 million in total operating revenue and $4.5 million in expenses. Barnes also claimed that the decision to close the hospital should be challenged. He noted that Tim Brown, Curae Health, Inc.’s CFO, stated at an Oct. 1 creditors meeting that it was their goal to keep hospitals “thriving” and surviving. Twelve days later, Clarksdale employees received a WARN notice. Employers with 100 employees or more are required to notify them 60 days before closing a plant or a mass layoff. A hearing was scheduled for Oct. 23rd at 2 p.m. in Nashville. It would determine whether to close the Clarksdale hospital and reject all unexpired leases or contracts to receive relief, or transfer the operations to another operator, as well as assume and assign the Coahoma County contracts and leases requested by the new operator. Barnes filed an objection stating that there are three potential buyers. This includes a Mississippi doctor and a Mississippi lawyer, as well as an out-of state investor and another Mississippi Delta health care facility. Paul Pearson, the Coahoma County board president, did not share details but stated that “it was positive”. Pearson also noted that Trilogy Healthcare Solutions, a Ridgeland-based company that provides consulting services for a fee, will be managing the hospital until the county finds an interested buyer. According to Jerry Autrey, Batesville mayor, there are currently two possible buyers and a stalking-horse bid (usually a bidder who sets a floor price) interested in taking over Panola Medical Center. Although he was not sure about the cash flow for Panola Medical Center’s operations, he said that he was told by Batesville that the hospital kept Clarksdale (and Amory) afloat. “I was told that the revenues were used to support other hospitals. But I don’t know if that’s true. It’s hearsay. He said that Panola Medical operations were doing well, but some of their profits were going to other hospitals. Clarksdale and Batesville are not the same as Amory. The issue in Amory’s situation isn’t if someone will buy their hospital but rather who that someone will become. According to the Monroe Journal (a sister publication of the Daily Journal), the Gilmore Memorial Hospital in Amory will be up for auction Nov. 15. North Mississippi Health Services has been approved to be the stalking horse bidder. This includes an opening bid of $10.5million in cash and the assumption Gilmore’s financial obligations and liabilities. Potential bidders must qualify by filing with the bankruptcy court before Nov. 12. If there are no bidders, North Mississippi Health Services will win the bid by default. This decision was disapprovalled by Sen. Hob Bryan (D-Amory). The Monroe Journal published an Op-Ed on October 10 that stated that the hospital would not thrive under the North Mississippi Health Services leadership and that services will eventually move to Tupelo which is approximately 30 miles north from Amory. Monroe County Supervisor Joseph Richardson stated in a telephone call that they don’t have any control over the operation of the facility. However, he said they are monitoring developments and are concerned. No matter if Clarksdale’s income declined more than others, all three towns face the same dilemma: find someone to take control of their hospitals or deal with the consequences. Slobach, who was a Columbus doctor, is familiar with the three hospitals. He says it’s hard to believe that they are facing such financial difficulties. Local officials believe that their towns will be able to build a hospital despite the current developments. Mayor Autrey stated that losing the hospital would be devastating and put the town on the bottom end of the stick. “It’s just like schools. If you don’t have great schools, it would hurt. You would lose jobs…. It’s not going anywhere.” Pearson, the County supervisor, stressed that the hospital is not closing. We are not closing the hospital. “I can assure you that.”