OAKLAND — Rural hospitals nationwide have been evaluating the future since the One Big, Beautiful Bill became law in July. Changes to Medicaid that will impact their revenue have led some medical facilities to cancel planned programs or projects, seeking savings before the changes take effect in 2027.
Garrett Regional Medical Center is doing the opposite, hoping to expand its services despite the current health care landscape uncertainty.
“To me, it feels like something that we’re compelled to do because our mission is that we’re going to care for people in our community in an authentic way,” Mark Boucot, president and CEO of Garrett Regional, told The Baltimore Sun.
The hospital is pursuing plans to build a radiation oncology wing — an addition estimated to cost $15 million. Last month, a $1 million federal grant for the planning phase of the project was approved by President Donald Trump, a Republican, as part of the deal to reopen the government.
Boucot spoke about the project and why Garrett Medical is hoping to add, while others look to subtract.
“We’ve always been trying to do something innovative and different,” Boucot said. “What we’re trying to do is complete the full suite of cancer care services to be able to provide all of the care needed for our community, so that people don’t have to travel an hour away.”
For years, an oncology wing was a dream. But about a year ago, executives began to consider how they could make it a reality. They eventually submitted an application to the office of U.S. Rep. April McClain Delaney, a Democrat, for Community Project Funding.
Each member can request CPF allocations for 15 projects in their district.
It’s part of Congress’ annual process of funding the federal government. The oncology expansion was among the projects chosen by McClain Delaney’s office, which were announced in July.
“Garrett Regional Medical Center serves over 46,000 patients across Garrett County and in nearby areas, meeting the needs of our rural communities whose health care is too often left behind,” McClain Delaney said Nov. 25.
“A cancer diagnosis is already devastating for any family, and traveling hours for treatment is the last thing our rural families need during a time of unspeakable heartache. This radiology/oncology expansion isn’t just an investment; it means significantly shorter commutes for families balancing a cancer diagnosis, and it will bring lifesaving care closer to home for our most vulnerable.”
In August, hospital staff packed into a basement conference room to welcome the freshman lawmaker. Boucot gave a presentation on the expansion and announced that two plaques in the cancer center would honor McClain Delaney and her husband, former Western Maryland U.S. Rep. John Delaney, for their dedication to the center. Delaney helped the hospital obtain a grant to build its cancer center when he was a member of Congress.
“Anytime we can get these advanced services, specialty services to rural communities in the state of Maryland, that’s fantastic,” Jonathan Dayton, executive director of the Maryland Rural Health Association, told The Sun. “People will have less travel, less wait time, and ultimately, hopefully a better health outcome in the end.”
Republicans passed the funding package that included the expansion planning grant money earlier this month.
Each Maryland Democrat opposed it, citing a lack of health care provisions and funding guardrails.
The Big, Beautiful Bill is Trump’s hallmark legislative achievement — a mishmash of tax cuts and deduction increases, border and defense spending, agriculture policy updates, and steep cuts to the Supplemental Nutrition Assistance Program and Medicaid.
Hospitals reacted negatively. The health care cuts included lowering the provider tax rate, which essentially offsets some hospital operating costs with government funds. Though it was a Republican bill, the health care changes caused heartburn for some GOP lawmakers, fearing it could devastate rural health facilities.
They included a $50 billion rural hospital fund to ease the impact. But a number of facilities have since halted projects due to financial uncertainty.
“There is a growing level of concern, and I think that’s being raised across the country,” Dayton said, though he added that the hospital fund is a reason for optimism. “We’re at a precipice now where it’s time to be innovative in some of our solutions.”
“We have to be different,” Dayton added. “We have to think outside the box.”
Situated on the edge of Western Maryland, a 12-minute drive from the West Virginia line, Garrett Medical sounds like the template for a hospital that would be harmed by the impending changes. But that’s not the case. Boucot said Garrett Regional is one of the most efficient, low-cost hospitals in the state, and has worked to build its cash reserves.
“What is becoming the new normal for everyone else is already our reality,” Boucot said. “We’ve already acclimated to being a low-cost provider.”
“Other people are redesigning themselves to be able to operate with a new revenue stream that’s different and lower than what they used to be,” Boucot added. “And we’re already there.”
It’s also bolstered by being part of the broader West Virginia University Medicine health system, which boosts the facility’s credit-worthiness for potential loans.
That’s not to say the project is guaranteed to succeed. Tuesday, Boucot met with Dr. Douglas Jacobs, of the Maryland Health Care Commission, to discuss a certificate of need for the project with the state, which could determine whether the expansion moves forward — “the state can shoot us down and say no,” Boucot said. The hospital would file for the certificate in March of next year.
Other factors could complicate the plan. Health care costs are rising, and millions of Americans are waiting to see whether Congress will extend the Affordable Care Act premium tax credits — another policy conundrum that could have an adverse impact on national hospital revenues down the line.
“There’s always risk in everything that you do,” Boucot said. “How could we at least not try?”