Critical Access Hospitals

  • Provide critical healthcare access for rural Americans
  • Exempt from certain fines
  • Get more generous reimbursements from Medicare
  • Half the hospitals in New Hampshire are Critical Access Hospitals.
  • Only 12 states have a higher percentage.
  • Must take Medicaid patients – which means much less revenue – and they can’t grow past 25 beds.

Medicare Payments

  • In the early 1980s, Medicare began to pay less than what hospitals charged.
  • Hundreds of rural hospitals closed, so Medicare decided to pay Critical Access Hospitals closer to what the hospital wanted.
  • The federal government allowed states to designate Critical Access Hospitals, and under looser rules.
  • Because Medicare beneficiaries have to pay the difference between what Medicare pays and what the hospital charges, Medicare beneficiaries who go to Critical Access Hospitals are essentially paying more than double than beneficiaries in urban areas, according to a recent report from the Office of the Inspector General.
  • Most Medicare beneficiaries have a backup insurance policy that makes up the difference on these high charges. But in New Hampshire, about 26,000 people on Medicare don’t have backup insurance.


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