Some rural hospitals in Mississippi are fighting to keep their doors open. The question now is, how.

Earlier in November, the Associated Press reported Pioneer Community Hospital in Newton will close because a change in federal classification would mean a loss of income. The hospital had been considered a critical access designation, a label applied to rural hospitals that means higher payouts for Medicare patients, according to the Rural Assistance Center, a government website aimed at helping these hospitals navigate government policy. 

However, the Centers for Medicare and Medicaid Services have requested certain hospitals re-apply for certification.

When the hospitals re-apply, administrators worry their hospitals may not meet new, tougher demographic and distance standards, which would mean less income.

But even if some rural hospitals close, state lawmakers may be ready to ease laws restricting the practice of nurse practitioners and small clinics, which could help take care of rural medical needs. Additionally, rural hospitals themselves may evolve by offering services in new areas and dropping old areas in order to keep their doors open, said Steve Vaughn in an interview with the Picayune Item last week. 

Vaughn, the administrator for the Pearl River County Hospital and Nursing Home in Poplarville is already talking about a plan B, in case the federal government does not re-certify his hospital. In the case of the PRCHNH, Vaughn said the hospital would focus more on geriatric care and offer fewer services in other areas.

But there are other alternatives besides federal action that could keep the Poplarville hospital open and functioning as it is now. 

One possibility would be to expand Medicaid. 

Architects of the Affordable Care Act intended for all Americans to either get health insurance through their work or through insurance cooperatives. In addition, states were encouraged to expand Medicaid. Although it is a federal program, each state operates its own system.

Gov. Phil Bryant has said for years he would oppose any expansion of Medicaid—even though more people insured through Medicaid could mean more paying customers for the hospital. Bryant opposes expanding the insurance program because while it is 100 percent federally funded through 2016, the program will require a five percent state buy-in in 2017 with slight increases annually until the state would pay for 10 percent of the expanded program by 2020.

But because Mississippi did not expand Medicaid, and because insurance through the Mississippi insurance marketplace is still too expensive for some people, there are a number of people who are without health insurance. 

According to Enroll America, a nonprofit healthcare coalition that tracks enrollment, 17 percent of Mississippians do not have health insurance. In fact, their data indicates a 5 percent drop in the uninsured since the Affordable Care Act became law, from 22 to 17 percent. 

State Sen. Angela Hill, a Republican, said she doubts the state legislature will make a move to expand Medicaid this year. The next legislative session begins in January. 

However, she did praise rural hospitals.

“What I want to do is encourage the community to support their rural hospitals,” Hill said. “My family uses this hospital and I am encouraging other people, if there is a need the hospital can meet, to use that hospital.”

Besides rural hospitals, Hill said she is going to support legislation next year that she believes will improve access to healthcare in rural areas. Specifically, she believes small clinics could be of value in rural areas, if some state regulations were eased.

“I would like to see some of the restrictions and barriers on developing rural clinics in Mississippi be streamlined,” she said. “I would like to see credentialing for managed care practitioners, like nurse practitioners, have the same timelines as they have in other states. It’s taking an extremely long time to get doctors certified in this state.”

In addition, Hill said Mississippi is the only state in the union that requires a distance rule requiring nurse practitioners to practice medicine within a certain distance to a doctor.

“Since 1972 we have had a law that a doctor has to be so close to a nurse practitioner, and we’re the only state in the union that has this rule. And with telemedicine and communications, there’s no need to have this distance rule.”