Protecting Rural Patients and Communities: Access to Care and Hospital Consolidation in the North Country
Executive Summary
Hospitals are extremely important to the health and economy of the rural North Country region of New York state, but hospitals have reduced essential healthcare services over the last decade. To protect quality patient care, hospitals across the North Country must preserve services and maintain access to care as they face threats from impending Medicaid cuts and hospital consolidation around regional healthcare systems like the University of Vermont Health Network. Hospitals must prioritize access to care over income and preserve a baseline level of care when evaluating the need for services like pediatric, trauma, maternal, and mental healthcare.
Financial incentives and lax oversight over hospital bed closures have propelled those closures and reduced access to care over the last decade. Between 2013 and 2024:
- Half of the region’s hospitals are now considered “Critical Access,” earning a higher Medicare reimbursement rate for services, but also meaning the loss of 226 beds.
- Nearly half of pediatric hospital beds have been lost—by far the largest reduction in capacity in the state. Over half of children under age 18 live more than an hour away from a hospital with inpatient pediatric beds.
- There are no Level I or II Trauma Centers in the North Country—the closest options are often hours away. Emergency rooms in the region that can triage and transfer patients are often overcrowded and underequipped, forcing them to divert patients, increasing time to treatment and risk to patients. This is likely to be exacerbated by impending Medicaid cuts.
- North County hospitals reduced maternal health beds by 13% – three hospitals reduced beds and four completely closed maternity units. This increases the emotional and financial burden on families, since hospitals in the region are so far apart. Pregnant patients now travel farther to give birth – increasing the strain on hospitals that haven’t expanded maternity capacity or are outside the region.
- The North County is one of the few regions in New York that has expanded much-needed mental health services, adding 10 beds overall. More recently, with the help of New York State grant funding, Claxton Hepburn Hospital has transformed into a 40-bed adult and child inpatient mental health facility, with plans to expand psychiatric services even more.
The North Country stands to lose even more services as more New Yorkers lose health coverage due to the One Big Beautiful Bill Act, ramping up costs for hospitals. New York needs to do more to protect hospitals and patients from these cuts, as well as increase transparency during the closure process and provide sufficient financial incentives for hospitals to fully staff and operate services that would otherwise be at risk of closure.