By Jaymie Baxley
For the past 19 months, officials in rural Martin County have been working on an experimental plan to resurrect the community’s shuttered hospital.
Martin General, the 43-bed facility that for seven decades served generations of residents in the Eastern North Carolina county, closed its doors in August 2023.
The hospital was later placed into bankruptcy, a move that operator Quorum Health attributed to “financial challenges related to declining population and utilization trends.” Ownership of the hospital eventually reverted to the county, which had been leasing the building to Quorum.
The closure has forced residents of Martin County, which was home to about 22,000 people at the 2020 Census, to travel more than 20 miles to neighboring Beaufort County for emergency care. Concerned citizens have repeatedly voiced their frustration with the situation at meetings of the Martin County Board of Commissioners.
“There was, understandably, anger in the community about the closure,” Dawn Carter, health care consultant for Martin County, said in an interview, adding she had been “brought to tears multiple times” by residents’ stories about their struggle to find care.
Over the past year and a half, Carter has helped the county plow through an extensive checklist of requirements that, once completed, will allow Martin General to reopen — albeit in a more limited capacity.
The goal is to reestablish the facility as a Rural Emergency Hospital, a designation created through the U.S. Congress’ Consolidated Appropriations Act of 2021 as a lifeline to small hospitals that are at risk of going under. Hospitals that participate in the program receive millions in federal funding to continue providing 24/7 emergency care, but they are prohibited from offering inpatient services.
At least 38 facilities have converted to Rural Emergency Hospitals since the program launched in January 2023, according to data from the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill. But all of those hospitals were still functioning when they made the switch.
Carter said Martin General is on track to become the first closed-down hospital in the nation to reopen as a Rural Emergency Hospital.
Now the county needs to find someone to operate it.
Search begins
After holding a public hearing on a resolution to sell or lease the hospital property on Feb. 12, the Martin County Board of Commissioners sent out requests for proposals from potential operators.
Residents will have multiple chances to weigh in before a selection is made, a process that Carter said will likely take “weeks and months” to complete.
“Once the proposals are in and we have a chance to group and review them, there will be an opportunity that the proposals will be made available to the public,” she said. “There will be subsequent public hearings on the proposal. If the county decides to enter into an agreement with one particular operator, then that agreement is also subject to public review, so there will be lots of public input as we move through the process.”
Carter said requests were sent to “everybody who had expressed interest at some point in time” in taking over Martin General.
“We definitely have interested parties,” she said. “I can’t predict, at this point, how many proposals that we are going to end up getting. Some people that had expressed interest along the way have changed their minds, but I am pleased that we do continue to have interest.”
It remains to be seen if the search for a suitable operator will be affected by proposed cuts to federal funding for Medicaid.
Less than five months after Martin General closed, North Carolina became the 40th state to expand eligibility for Medicaid. The measure opened up the government-funded health insurance program to low-income adults who had previously made too much money to qualify.
More than 630,000 people have joined the rolls since expansion took effect, reducing financial strain on struggling hospitals — particularly those in rural towns — that lose money providing uncompensated care to patients without insurance.
The budget passed by Republicans in the U.S. House of Representatives on Feb. 25 directs Energy and Commerce, the committee that oversees Medicaid, to cut spending by $880 billion over the next decade to offset the cost of President Donald Trump’s pledge to extend trillions of dollars in expiring tax breaks.
Jay Ludlam, deputy secretary of the state’s Medicaid program, recently warned state legislators that the cuts could force North Carolina to discontinue expansion — immediately stripping coverage from beneficiaries who only recently became eligible for it.
“The Medicaid uncertainty at the federal level is a concern across rural communities because of the impact on rural health care,” Carter said. “But I think that we’re fortunate that we continue to have interest despite that.”
‘All hands on deck’
Commissioner David “Skip” Gurganus said reopening the hospital is the “number one issue for Martin County.”
“I had no idea, and still don’t really understand, what it’ll look like to get health care reestablished in Martin County,” he said during the board’s meeting on Feb. 12. “Here’s what I do know for a fact: A team of people have worked tirelessly to try to bring this thing to the point that it’s at. You have not seen them work — and for the most part, I have not seen them work — but I can assure you that they have worked.”
Benjamin Eisner, interim manager for Martin County, explained that the county had to wait 60 days after Martin General filed for bankruptcy to find out if the trustee, a bankruptcy and insolvency practice based in Delaware, wanted to “keep the hospital building or not.” He said the county then spent four months working with the State Attorney General’s Office to sort through and distribute the medical records that were left behind.
“It’s been an all-hands-on-deck situation,” Eisner said.
The federal Centers for Medicare and Medicaid Services — which regulates most of the nation’s health care facilities — confirmed last year that Martin General could reopen as a Rural Emergency Hospital, but the county needed to first update and repair the aging building to ensure it met the agency’s requirements for the designation. While there are still some minor issues with the facility that must be addressed, Carter said she’s “confident” that CMS will sign off.
“It’s been a hard row to hoe,” said Commissioner Joe Ayers, chairman of the board. “We’re getting there. We see the end of the road.”
The county’s efforts have not gone unnoticed by residents. In recent months, Carter has observed a shift in the community’s perspective on the situation.
“I feel like folks have gained an understanding that we are not dragging our feet, as much as it may feel like it with how long this is taking,” she said. “They understand that it’s been a process and have expressed gratitude that we are moving forward with the process.”
Martin County is far from the only rural community to lose its local hospital in recent years.
According to the Sheps Center, 152 rural hospitals across the U.S. have either closed or drastically scaled back their services since 2010. Twelve of those facilities are in North Carolina, the center reported.
In addition to being the first hospital in the nation to reopen as a Rural Emergency Hospital, Martin General would be the first hospital in North Carolina to receive the designation. Because the program is not open to facilities that closed before 2023, it cannot be used to bring back the state’s other shuttered hospitals.
Addressing attendees of last month’s board meeting, Gurganus acknowledged that the return of Martin General is still not guaranteed.
His advice to citizens? Pray on it.
“I believe in prayer. I believe that it helps. I believe that it has a profound effect on our lives, and I believe that it can have a profound effect on our county,” he said. “If you subscribe to the same belief, I would ask you to start tonight, if you haven’t already, and continue every night to ask God for guidance to lead us to health care for our citizens in Martin County.”
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