More than 300 rural hospitals nationwide, including four in Maine, could close if the federal budget includes proposed deep cuts to Medicaid, according to two new analyses released recently. As Congressional lawmakers debate proposals that include the largest cuts to health care in US history, slashing funding for Medicaid and the Affordable Care Act by more than $1 trillion and triggering more than $500 billion in Medicare cuts, rural hospitals brace for impact. Reports from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill and Families USA identify four hospitals in Maine as being at most risk from the congressional bill but also lay bare how vulnerable many other hospitals across the state are, due to the large number of patients who use Medicaid.
The Sheps Center names Northern Light A.R. Gould Hospital in Presque Isle (formerly Aroostook Medical Center) and Maine Coast Memorial Hospital in Ellsworth among 338 hospitals across the country that are either unusually reliant on Medicaid or reported operating losses over the past three years. Both Maine hospitals are included for their recent record of operating losses. Families USA, meanwhile, additionally identifies Cary Medical Center in Caribou and Calais Community Hospital as at risk because they estimate the cuts to Medicaid will reduce their operating margins below zero.
The closure of any of these hospitals would be devastating to their local communities. Residents would be forced to travel much farther to receive critical care, and local economies would lose out on the jobs and federal funding in their communities. With more than 1,100 employees, Northen Light A.R. Gould Hospital is the largest employer in Aroostook County, serving more than 300,000 patients each year. The other hospitals are smaller but still employ hundreds of workers each and serve tens of thousands of patients each year.
Although the reports lists these four hospitals as being the most at risk, they also highlight the risk to a number of other rural hospitals in Maine which receive a significant share of their revenue from Medicaid. These centers will suffer from the federal budget’s deep funding cuts as their patients lose Medicaid coverage and resort to the free care that hospitals are required to provide patients with low income.
Twelve rural hospitals in Maine receive at least as much of their operating revenue from Medicaid as the four hospitals highlighted in the reports. While some are currently operating at healthy margins, others are already running at a loss or barely meeting their operating expenses:
Source: National Academy for State Health Policy hospital cost tool
Hospitals in rural Maine do more than provide medical care — they anchor local economies and sustain entire communities. Medicaid is a critical part of that foundation. Without it, hospitals face impossible choices: cutting essential services, laying off staff, or shutting down altogether.
Mainers are already seeing their access to key services shrink as hospitals stop offering treatments like maternity care. Between 2020 and 2024 alone, five Maine hospitals closed their obstetric units, leading expectant mothers to drive further for care and face higher risks in the event of an emergency during pregnancy. In May, Waterville’s Inland Hospital closed completely.
If Congress moves forward with deep Medicaid cuts, the consequences will be felt far beyond the hospital walls. Rural Mainers could lose access to timely, life-saving care — and communities could lose one of their largest and most stable employers. For the health and resilience of rural Maine, Congress should reconsider and reject these cuts.
