Franklin Advocate
Hospital Fighting Status Change
By Paul Keane
MEADVILLE – Major changes could be coming to the Franklin County hospital if congressional or state changes aren’t made before Jan. 15, 2026.
Franklin County Memorial Hospital leaders have been working with state and federal officials to try and get a decision from the Centers of Medicare & Medicaid Services (CMS) to overturn a ruling from Jan. 15 of this year moving the facility from a Critical Access Hospital (CAH) to a Rural Emergency Hospital (REH). The designation would make a huge difference in the amount and kind of services the local hospital could offer to residents.
The letter from CMS was part of the normal recertification for the hospital. The change in status seems to result from requirements that a CAH facility be located a certain number of miles away from similar services.
In the Jan. 15, 2025 letter, Melissa Foreman, RN, CCM, CPHQ — the Acute and Continuing Care Branch Manager for the Center for Clinical Standards and Quality — stated the following: “During the recertification review, Franklin County Memorial Hospital is located less than 35 miles from King’s Daughters Medical Center in Brookhaven, of which there is not 15 miles of secondary roads available between the hospitals and therefore found to be noncompliant with the distance requirement to remain a CAH.”
The letter also asks for documentation that would change the mileage requirements be submitted by Feb. 14. “If no documentation exists, your facility will need to convert to another provider type in the Medicare program by Jan. 15, 2026 to avoid termination of the Medicare provider agreement between Franklin County Memorial Hospital and the Secretary of the Department of Health and Human Services.”
In order to obtain or maintain a CAH designation, the facility must be located more than a 35-mile drive on primary roads (or, in the case of mountainous terrain or in areas with only secondary roads available a 15-mile drive) from a hospital or another CAH. To determine the driving distance, federal highways — including interstates, intrastate, expressways of any other numbered federal highway with two or more lanes each way or a number state highway with two more lanes each way.
It was believed for many years that one reason FCMH had the CAH designation was due to the fact that it was more than 15 miles along rural roadways to Jefferson County Hospital. Roughly three years ago, that facility changed its status to an REH.
The local facility is roughly 32 miles away from King’s Daughters, meaning the 35-mile rule could not be used for CAH designation.
The local facility has enjoyed the CAH designation since 2009, but now it is in jeopardy if something isn’t worked out before Jan. 15, 2026.
Since receiving that letter, FCMH Administrator Michael Boleware, Hospital Board Attorney Lane Reed and countless other local people have been working to hold onto the CAH status, which has been in place since 2009.
A change from a CAH to an REH will mean the hospital won’t provide acute care and there will be no in-patient services available.
Boleware said that if an elderly patient with something as simple as pneumonia could stay in the facility for 24 hours but then would have to be moved to another facility for extended care. The change in status could also affect employment in a negative way.
“Prior to becoming a Critical Access Hospital in 2009, there were 64 employees at the hospital,” Boleware said. “Now, we have 229 employees. We’ve been able to grow because of the CAH status. “It gives you the ability to grow and grow slowly as you increase services and also increase your patient volume. That’s what we’ve been doing for the last 15 years — enjoying slow growth.”
Being designated as an REH would cut into patient volume, meaning the local facility would have to find ways to be more efficient.
“An REH facility is volume driven,” Boleware said. “In an area like Franklin County, where is that volume going to come from? “We’re trying to be innovative. We have been meeting with department heads for months trying to find out what more we can do in regards to labs being done in-house, more radiology services and more respiratory services. We’re trying to think outside the box and find ways that we can be innovative while being as efficient as possible.”
Local officials have also been speaking with congressional leaders — including U.S. Sens. Cindy Hyde-Smith and Roger Wicker — and have even met with White House officials in an attempt to either have the decision overturned or at least an extension given until the issue can be resolved. So far, according to those officials, every attempt has “run into a brick wall.”
The office of Hyde-Smith provided the following response: “I am very concerned about the Franklin County hospital losing its Critical Access Hospital designation, which has allowed the hospital to remain financially stable as it provides a multitude of health care services to Meadville and the surrounding communities,” Hyde-Smith, said. “I do not want to see the community to suffer from a lack of access to that care. I continue to work with my colleagues in the Senate, the Trump Administration, CMS and the Governor’s Office to find a path forward that would allow the hospital to retain its CAH designation. We’re not there yet, but this remains a top priority for me.”
Hyde-Smith serves on the Senate Labor, HHS and Education Appropriations Subcommittees and has worked to use the appropriations process to address the CAH designation issues, the statement point out. It also says the Senator has aggressively reached out to CMS, including CMS Administrator Dr. Oz, regarding the local facility and other rural facilities in Mississippi.
The statement further says the senator is continuing to encourage the Senate Finance Committee to consider a legislative fix for the CAH issue, which also affects other rural health care providers across the country.
Wicker said he is willing to continuing working on behalf of the local hospital. “Senator Hyde-Smith and I are working with elected officials and the hospital to retain Franklin County Memorials’ current designation,” Wicker said. “It is imperative rural communities in Mississippi have access to quality health care. Hospitals in Mississippi must have the resources they need to serve our constituents well."
“We’ve been working on this issue for nine months now,” Boleware said. “We’ve met with CMS, White House and congressional leaders and staff. There are many avenues for a waiver and we’ve explored nearly all of them.
"One thing that we constantly hear is that a waiver for us would open the floodgates for other hospitals. We say that it would be only a leak in the faucet.”
Boleware said the process of fighting for the designation has been challenge at best. “We’ve beat our heads for nine months with this issue,” he said. “We’ve had multiple meetings with our senators, our congressmen and everyone we could meet with. It seems like everywhere we go, there is a roadblock.”
The REH designation, established by CMS in 2023, is intended to help rural hospitals remain open and financially sustainable by focusing on emergency and outpatient care. Under the REH designation, though, the local hospital would not be able to provide general inpatient services. Under this model, FCMH would continue to provide:
- 24-Hour Emergency Services
- Outpatient diagnostic, imaging, laboratory and rehabilitation services
- A comprehensive Ventilator/Tracheostomy Weaning Program
- Inpatient Swing Bed services for patients requiring short-term rehabilitation or skilled nursing care following hospitalization
While the hospital would no longer provide general inpatient admissions if it receives the REH designation, the programs that will be continued will allow the facility to care for patients locally during recovery, rehabilitation and long-term respiratory hospitalization. This includes Inpatient Swing Bed Services, which provides short-term rehabilitation and skilled nursing care for patients recovering after hospitalization — for example, following surgery, stroke, or injury. These services are focused on helping patients regain strength and independence so they can safely return home, and are not intended for active treatment of conditions such as pneumonia or urinary tract infection.
Boleware said plans are to continue the Ventilator/Tracheostomy Weaning Program but that things might have to be scaled back somewhat. “One thing that would change is there may not be one respiratory therapist for each patient,” he said. “That is not a definite, but it is something we would have to look at doing.
“Let me say, though, that our staff can handle more than one patient at a time. I have the utmost confidence in our staff and our therapists to work with multiple patients and still provide the same quality care.”
There is hope that money from the “Big Beautiful Bill” could assist in the issue. A total of $50 billion was allocated to the state for rural healthcare transformation, with $25 billing being awarded to facilities through a competitive grant program and other other $25 billion being administered by Gov. Tate Reeves.
Boleware and Reed both said the competitive grant program is not an option at this time due to the fact that guidelines for applying for a grant have yet to be established. With the current shutdown of the federal government, there is no timetable for when those guidelines and applications will be available, but it is not expected to happen before Jan. 15, 2026.
The administrator said while he has helped move facilities into CAH status, this is the first time he’s dealt with a facility being given an REH designation. “I’ve been working with hospitals for 30 years now, and I have more questions than answers,” he said. “If not every day then every two or three days things are changing. “We are going to keep working to find a solution to this issue because we want to continue providing quality care in as many areas as we can for local everyone in this area.”
Both Reed and Boleware said they felt like a solution would need to come through the Senate. Residents are being urged to contact federal officials to show support for the local hospital. Senator Hyde-Smith can be contacted at 202-224-5054 or at her Jackson office at 601-965-4919. Wicker can be contacted at 202-224-6253 or at his Gulfport office at 228-604-2383.