Greenwood Commonwealth

Hospital's Critical-Access Application Suffers Setback But Supporters Hope For Favorable Ruling In Washington

By Tim Kalich, Editor

Greenwood Leflore Hospital’s supposed life-saving application for a critical-access designation has suffered its first major setback.

The regional office in Atlanta for the Centers for Medicare and Medicaid Services has denied the hospital’s request.

The rejection had been initially anticipated when the hospital submitted its application earlier this year, but administrators had been sounding more hopeful after both the Mississippi State Department of Health and the regional Medicare administrative contractor had recommended approval.


In her notice of denial, dated Aug. 24, Linda D. Smith, a CMS official in Atlanta, cited what the hospital knew was an obstacle going into the process: a rule that says a critical access hospital must be at least 35 miles away from another hospital. There are at least three hospitals — in Ruleville, Indianola and Winona — within that 35-mile threshold. Greenwood Leflore Hospital had argued in its application that a shorter 15-mile rule should be applied in its case because of the higher-than-average number of households in the impoverished region that lack transportation.

Smith said, however, that the lower  mileage threshold did not apply because “the distance between the hospitals does not include more than 15 miles of secondary roads.”

“We expected the CMS Regional Office would lack the authority to consider the exception request put forth by GLH,” Gary Marchand said Wednesday. “There are unique transportation challenges in Leflore County as well as service availability within Leflore and nearby counties that support the approval of GLH’s application.”

The application is now being considered by the CMS national office in Washington, where the hospital and its supporters hope that Mississippi’s congressional delegation — primarily U.S. Rep. Bennie Thompson and Sens. Roger Wicker and Cindy Hyde-Smith — will be able to influence the federal regulators to grant a waiver on the distance rule. Two of the hospitals whose proximity disqualified Greenwood’s application — North Sunflower Medical Center in Ruleville and Tyler Holmes Memorial Hospital in Winona — were granted such waivers in the past.

“We have always expected the final decision would be made in the national office, and Congressman Thompson and Senators Wicker and Hyde-Smith are fully engaged and supportive of the GLH application,” Marchand said in a memo Wednesday to the hospital’s employees and medical staff. “We do not anticipate a final decision from CMS before the end of this year.”

All three members of Congress said they remain jointly committed to helping the Greenwood hospital overcome the present hurdle.

“While the road to approval has presented challenges, I remain cautiously optimistic about its success. I believe that enhancing the hospital's capabilities is not only crucial for the quality of health care in our region but also for the economic vitality of our community,” Thompson said.

“I want to reassure our community that I am fully dedicated to pursuing every avenue to secure the critical care hospital status for Greenwood Leflore Hospital.”

Hyde-Smith called the denial out of Atlanta “disappointing.” She said she “will continue to work with the delegation and local officials on the Greenwood Leflore CAH process, in addition to also working in the Senate to address the growing rural health-care crisis in Mississippi and across the country.”

“The people in the Mississippi Delta deserve access to the same services as anyone else in the state,” added Wicker. “I will always work to support Mississippians’ access to quality health care.”

The critical-access designation would provide a significant monetary boost to the financially endangered hospital. Administrators have estimated that the designation would bring in an additional $1.2 million a month in Medicare reimbursements, enough to get the hospital to a better-than-break-even status in terms of cash flow.

Marchand and other hospital officials have said that without the designation, the hospital would have to close.

Even with significant reductions in services and employees that have been enacted since 2022, the hospital continues to post operating losses of more than $1 million a month. It would already be out of cash if not for emergency infusions from Leflore County and the city of Greenwood, which jointly own the hospital.  Over the past year, they have provided more than $8 million in cash and free utilities. Most recently, the stopgap funding has come from draws on a $10 million line of credit obtained by the county to keep the hospital in operation at least into early 2024.