Allendale County Hospital urges state safety net for rural care

If Medicaid reimbursement falls further, the first losses in Allendale County would be the ones residents can least afford to lose: emergency room access, outpatient care and the county’s only inpatient hospital beds. Allendale County Hospital is urging state lawmakers to create a legal safety net now, before tighter finances force a harder choice about how rural care survives in one of South Carolina’s most medically fragile counties.

The hospital’s pitch centers on a new federal designation, the rural emergency hospital model, created by CMS through a final rule that took effect Jan. 1, 2023. Rural emergency hospitals are built to keep emergency department services, observation care and other outpatient services available, with patient stays averaging no more than 24 hours. To make that option workable in South Carolina, Senate Bill 895 in the 2025-2026 session would change state law so hospitals that convert to that model still fit the state definition of a hospital.

Allendale County Hospital is not asking because it is on the brink today. CEO Lari Gooding has said the hospital is financially stable now and not at immediate risk of closure, but leaders want a fallback if reimbursement drops further. The concern is practical: the facility is a Critical Access Hospital, it provides inpatient, outpatient and emergency room care, and it serves as the only inpatient hospital for a three-county rural swath. In that kind of geography, a longer ambulance ride is not an abstraction. It is the difference between quick treatment and dangerous delay.

The stakes are higher in a county that has already been losing people and financial footing. Allendale County’s population was 8,039 in the 2020 Census and an estimated 7,355 on July 1, 2025. Its 2024 median household income was $32,328, and 12.1% of residents under 65 lacked health coverage. Those numbers help explain why seniors, low-income families and emergency patients would feel any disruption first, especially in a county where many households rely on the local hospital for routine care as well as crisis treatment.

South Carolina has not expanded Medicaid under the Affordable Care Act, a policy backdrop rural hospital leaders say leaves them exposed to low reimbursement and shifting payer mixes. The warning also comes against a grim statewide and national record: South Carolina has lost six rural hospitals since 2010, and more than 140 rural hospitals have closed nationwide in that same period, according to the South Carolina Office of Rural Health. For Allendale County, the legislative question is simple and immediate: whether the state will build a backup before a rural hospital has to fight for survival without one.