Greenwood Leflore Hospital has become the face of the Mississippi Rural Hospital Crisis. Dozens of employees have been cut, services have been shuttered and much of the hospital in Leflore County is now empty.
The University of Mississippi is set to absorb GLH as part of its hospital network. But GLH’s decline over the last half-decade is representative of a larger trend in which nearly half of the Mississippi Delta’s hospitals are now under the threat of closure.
GLH, founded in 1906, serves Greenwood, Mississippi, and the surrounding micropolitan area in Leflore County. Around 70% of Leflore County’s population is Black, and the closest hospital to GLH is UMMC Grenada, more than 30 miles away. As GLH has attempted to stay open, it has cut several services like labor and delivery, the intensive-care unit, the wellness center and its after-hours clinic.
Here is an explainer on what is happening with Greenwood Leflore Hospital and its possible paths forward.
What Is Going On With Greenwood Leflore Hospital?
Greenwood Leflore Hospital is in the last stages of transferring ownership from Greenwood and Leflore County to the University of Mississippi Medical Center based in Jackson. Under the terms of the deal, the publicly owned hospital will donate its main campus to UMMC. The Institution of Higher Learning Board of Trustees approved the deal on June 18. Both the Greenwood City Council and the Leflore County Board of Supervisors also approved the deal, and the Greenwood Commonwealth reports that it includes freeing the two bodies of the hospital’s outstanding debts. The transfer has been approved by the U.S. Bankruptcy Court of the Northern District of Mississippi. GLH filed for bankruptcy in April.
Though the deal is effective for Aug. 1, the hospital has had several close calls. One condition of the deal is that the hospital cannot shut down between now and the deal’s closure date. That made the Mississippi Division of Medicaid’s recent moves a serious threat to the hospital’s continued operations. DOM threatened to withhold a $2.4 million payment from the Mississippi Hospital Access Program to the hospital. MHAP is a state-administered program that uses federal funding rules to assist hospitals with their Medicaid managed care reimbursement rates. Hinds County Chancery Court Judge Dewayne Thomas ordered DOM to issue the payment to GLH by June 30. The Commonwealth reported those funds were delivered.
GLH’s issue with DOM began in a separate dispute with the state agency over MHAP overpayments. DOM, through its annual reconciliation process, informed GLH in the summer of 2025 that the hospital’s MHAP payments were higher than its Medicaid utilization data warranted. As a result, it sought to recoup around $5.5 million. The division successfully reclaimed about $2.5 million before the Hinds County Chancery Court granted GLH’s petition to stay additional clawbacks. DOM has claimed in court documents that it needs to claw back another $4.8 million for 2025 and that reconciliations for payments made in 2026 are ongoing.
How Did Greenwood Leflore Hospital Get to This Point?
GLH was in good shape financially after the first major wave of the COVID-19 pandemic and expanded its ICU to treat more ill patients. And though the hospital had around $20 million in 2021, the subsequent COVID-19 delta and omicron variant waves in 2022 drained its cash reserves. A large chunk of available cash had to be protected to pay back a Medicare advance loan as well as maintain the hospital’s self-insured medical malpractice coverage.
Gary Marchand, the hospital’s former interim CEO who now serves as a consultant, has said that around 70-75% of GLH patients are on either Medicare or Medicaid. However, neither program fully reimburses the hospital for services rendered. This difference in the cost of care versus the cost of reimbursement is known as the Medicaid and Medicare shortfall. Put simply, the hospital usually spends more money treating these patients than it receives in reimbursements.
GLH and UMMC entered into negotiations for a long-term lease, but UMMC backed out for reasons that were never made public. Having already cut its labor and delivery services as well as its ICU, the hospital scrambled for alternatives. Leflore County took out a $10 million line of credit, of which the hospital borrowed $7.5 million. It also unsuccessfully applied for designation as a critical-access hospital.
GLH’s fortunes improved somewhat in 2024 and early 2025. It received additional funding from MHAP after Mississippi Gov. Tate Reeves successfully petitioned the Centers for Medicare and Medicaid Services for enhancements to the supplemental program. It was also approved for inclusion in the Rural Community Hospital Demonstration Program, which enhances Medicare reimbursements, allowing GLH to cover the cost of treating Medicare patients.
With those additional measures, Marchand predicted the hospital was on a path to breaking even. Then DOM’s demand for Medicaid repayments in the summer of 2025 threw a wrench in those expectations.
Where Does Medicaid Expansion Fit In?
Mississippi depends heavily on Medicaid funding, and for years, state and local leaders have advocated for Medicaid expansion to provide relief to the state’s rural hospitals. A 2025 report from KFF said an estimated 667,000 people are enrolled in Medicaid, with 58% living in a rural area.
And yet, Mississippi remained one of only 10 states to decline. A 2024 analysis by the Institutions for Higher Learning estimated that expansion would add between 241,000 and 249,000 to the Medicaid rolls over the following five years while incurring little to no additional expenditures over the first seven years of expansion. The federal government shoulders 90% of the cost to Medicaid while Mississippi is responsible for 10%.
However, Mississippi Gov. Tate Reeves remained a staunch opponent of Medicaid and had an ally on that view in former House Speaker Philip Gunn, reducing any chance of a bill surviving the Legislature to zero. That changed when Jason White succeeded Gunn as speaker in 2024, and versions of Medicaid expansion passed both the House and Senate.
But the two chambers reached an impasse because the Senate proposal included a work requirement, which would require the federal government, then headed by President Joe Biden, to issue a waiver. Lt. Gov. Delbert Hosemann announced the Legislature was punting until after the 2024 election.
Following the election of President Donald Trump, talks of expansion during the 2025 legislative session slowed to a crawl and no real movement materialized. Congress passed Trump’s One Big Beautiful Bill Act, which cut more than $1 trillion from Medicaid and the Children’s Health Insurance Program. Estimates are that these cuts could kick 115,000 people off Mississippi’s Medicaid rolls and reduce the state’s Medicaid funding by $2-$4 billion over the next decade.
Only weeks into the 2026 legislative session, Mississippi leaders said Medicaid expansion was dead due to Trump’s cuts.
Follow the Mississippi Free Press’ ongoing coverage of Greenwood Leflore Hospital at this link.
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