Letter: North Dakota’s small hospitals rely on Medicaid reimbursement

There are 37 Critical Access Hospitals (CAHs) in the state of North Dakota. The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to health care by keeping essential services in rural communities. It is not uncommon for small rural hospitals to operate on margins of less than 1%, and nearly 50% of rural hospitals across the country operate in the red. New research from Chartis, a research institution that specializes in rural health, examined the impact that Medicaid has on rural hospital finance. The key findings should be alarming to all policy-makers and rural residents.

First, at the median, Medicaid represents $3.9 million to a rural hospital’s bottom line—more than 9% of total hospital net revenue. It is inconceivable that small