As Kentucky's health care systems braces for billions of dollars in Medicaid cuts over the next several years, hospitals and providers are discussing how to move forward while still keeping Kentuckians healthy. Earlier this week, the Mobile Healthcare Association held its national conference in Louisville, where providers pitched mobile clinics as a way to get preventative care into communities that might feel Medicaid cuts the most.
Byron Gabbard, the chief financial officer for Appalachian Regional Healthcare, operates 14 hospitals across eastern Kentucky and West Virginia, and in many counties it is one of the biggest employers. Gabbard said the company is facing a $1 billion shortfall over the next decade as federal Medicaid cuts fall into place. He said he sees ARH expanding more into mobile clinics to fill health care voids.
"It really starts with the implementation of the One Big Beautiful Bill in 2027," Gabbard said, referring to some Medicaid-specific portions. "We've got to find out what's next and … I do think mobile plays a big, big role in that."
During and after the COVID-19 pandemic, mobile health care expanded across the country. Multiple mobile clinics have opened in Kentucky over the last few years, including through Owensboro Health, Kentucky State University, NorthKey Community Care and Kentucky Children's Hospital. ARH, too, has made a foray into mobile health. Amid the 2022 catastrophic flooding in eastern Kentucky, West Virginia's Marshall Health loaned ARH a mobile behavioral health clinic. The hospital network used a $400,000 grant to purchase their first mobile clinic, which began operating this summer.
Elizabeth Wallace, the executive director of the Mobile Healthcare Association, acknowledged that expanding mobile health options won't replace hospitals. But she hopes they can decrease the need for emergency care by catching problems quicker and getting further into communities.
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.
For Kentucky hospitals, a big chunk of that decrease will be through new limits on state-directed payments, which close the gap between Medicaid and private insurer reimbursement rates. The Kentucky Hospital Association, which represents more than 100 hospitals and health care systems across the state, says limits on state-directed payments could force service cuts or close hospitals that already persist on slim margins, endangering tens of thousands of jobs.
Lt. Gov. Jacqueline Coleman, who spoke at the conference Tuesday, described her own health scare, when she decided to undergo a double mastectomy after a breast cancer screening. She said she worried, especially with funding cuts on the horizon, that such preventative and emergency medicine isn't available to all Kentuckians.
"I was lucky, because we caught it early, luckier than so many people, but my mind immediately asked, 'What if?'" Coleman said. "What if I wasn't proactive in scheduling preventative screenings? What if I didn't have access to health insurance? What if I lived in the rural part of a state and had to drive two and a half hours for treatment?"
Coleman 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. That was assessed based on hospital profitability, risk of financial distress compared to peer hospitals and the share of Medicaid patients served.
As state administrations lawmakers grapple with how to address the impending funding changes, they are facing a tight deadline to apply for a new pot of money created in the July reconciliation bill — the $50 billion Rural Health Transformation Program.
"We're looking at the Rural Health Transformation Program and knowing that this pot of money is not going to replace all the money that's coming out of the health care system, but it is an opportunity," Wallace, with the Mobile Healthcare Association, said.
Beginning in the upcoming fiscal year that starts in October, $10 billion per year will be distributed across all approved states, with awards decided by the end of the year. The Driving Health Forward campaign, funded by the Leon Lowenstein Foundation, is calling for each state to dedicate 5% of its RHT funding toward expanding mobile health care.
Gabbard, with Appalachian Regional Healthcare, said he hopes mobile health can fill gaps that already exist. Some of their small outlying clinics have struggled to reopen in the aftermath of the 2022 flooding and some rural areas could never sustain a full-time clinic.
"To be able to stand up bricks-and-mortar clinics in all the places that we need them is just unreasonable and unsustainable," Gabbard said. "So we really feel like mobile can fill in a lot of those gaps."
He said updating aging equipment has also been difficult. For example, replacing antiquated 2D mammogram machines with new 3D models, that Gabbard said cost roughly $400,000 each, isn't sustainable for some rural locations.
"In some cases, the volumes in those markets aren't enough to sustain the operations of those units," Gabbard said. "We feel like mobile, sending that out to those communities and beyond is a good way to deal with that."
State government and politics reporting is supported in part by the Corporation for Public Broadcasting.
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