Greater Regional recognizes future Medicaid cuts

During the first Greater Regional board of trustees meeting since cuts to Medicaid were signed into law, multiple individuals outlined how these cuts will affect the rural hospital.

On July 4, President Donald Trump signed into law the One Big Beautiful Bill Act which, among other provisions, cuts Medicaid’s budget by 12%, or $793 billion, over the next 10 years.

These cuts will mostly affect rural communities and rural hospitals which are more likely to home individuals who rely on Medicaid. The program serves millions of low-income and disabled Americans, and rural hospitals are the most vulnerable to budget cuts, with 380 rural hospitals at risk of closure according to an analysis by FamiliesUSA.

The same study said 20 independent rural hospitals in Iowa are at risk of closure or significant cuts, losing $16,196,208.

Greater Regional leadership assured the hospital was not in a problematic state and would remain open. CEO Monte Nietzel remained confident in the hospital’s financials.

“We’re in a strong financial position at Greater Regional, which we want to be,” Nietzel said. “We’re very diligent how we handle our finances. We will be debt-free a year from now, and we have not increased taxes in 22 years, and we won’t.”

Assistant Director of Accounting Randi Cass gave the financial report to the board in place of CFO Matt McCutchan, and outlined a few programs which could receive cuts.

Iowa’s Medicaid Directed Payment Program, a major source of income for Greater Regional, is under review at the federal level. Cass said, based on information given to the hospital, the program is likely to be cut.

Part of the goal for Iowa’s Directed Payment Program is to bridge the gap of health care rates from providers. The program pays providers for negative funds the hospital accrued, balancing the cost of taking care of patients who wouldn’t otherwise afford coverage.

Greater Regional will still receive funds from the program for “a few years” according to Cass, but the program is likely to end in 2026 with no new issuing schedules.

“Cuts to Medicaid are going to cause us some hardships in the future,” Cass said. “It’s now more difficult for patients to qualify for that Title 19; it’s starting to show up in our bad debts. These patients still don’t have any money, or at least as much money as the government thinks they do. They’re still having trouble paying their medical bills.”

Affordable Care Act subsidies are also set to expire, with Cass saying the hospital will “lose more Iowans to uninsured issues,” creating more debt for the hospital.

Cass also gave an end-of-fiscal-year report which reiterated the hospital’s strength in oncology and women’s health. Net income was 13% higher this year, citing the strength of the Medicaid Directed Payment Program which will undoubtedly receive cuts.

Teresa Newman, Director of Rural Health Resources for UnityPoint, gave her report on the wider health care system in which Greater Regional is an affiliate partner. Within the report, Newman remained confident in the Medicaid cuts being minimal until 2028.

“Some of our analysts at UnityPoint Health Des Moines, they are predicting we will not feel the impact of these cuts until January of 2028,” Newman said. “The messaging we’re receiving from corporate is to not panic. We have time, time to develop some strategic initiatives to hopefully make up for some of those potential cuts. It is a concern to UnityPoint Health, just like it is to all hospitals and critical access hospitals.”

In other Greater Regional news...

Greater Regional is looking for responses to their community health needs assessment. Union County residents can take a survey to help Union County Public Health identify pressing health issues.

The survey can be found at www.surveymonkey.com/r/6HFH27Z. A version of the survey for Spanish speakers can be found at es.surveymonkey.com/r/NG2YJVK.

Iowa Capital Dispatch and The Associated Press contributed to this story.