By Jaymie Baxley

Dexter “Drew” Batts, the government manager for Martin County in eastern North Carolina, often thinks about the night his close childhood friend suffered a heart attack in 2025.

The friend, a 39-year-old woman who was a member of Batts’ high school graduating class, lived just nine miles away from Martin General Hospital. Generations of local families in this rural, economically distressed community had relied on the hospital for emergency care since its founding in 1950.

But Martin General wasn’t an option that evening. The 43-bed facility had closed in August 2023. Owner Quorum Health blamed the shutdown on “financial challenges related to declining population and utilization trends.”

Batts’ friend was instead transported to an emergency department about a half-hour northeast in neighboring Bertie County. When the doctors there couldn’t help her, she was taken about 40 miles southwest to ECU Health Medical Center in Pitt County.

She died there after spending three days on life support.

“Who’s to say whether that 30- to 40-minute transport, as opposed to a nine-minute transport, would have made a world of difference,” Batts said during a recent event organized by the NC Rural Center, an organization that advocates for rural communities across the state. “We don’t know, but we would’ve liked to have found out.”

Such grim “what ifs” have become increasingly common among residents of Martin County, which will soon mark its third full year without a local hospital. 

However, county officials say they’re optimistic about a long-gestating plan to resurrect the shuttered facility as North Carolina’s first Rural Emergency Hospital.

Reviving Martin General

The Rural Emergency Hospital, or REH, designation was created by Congress through the Consolidated Appropriations Act of 2021 as a lifeline for small, financially struggling facilities in rural areas.

Hospitals that convert to REH status are required to provide 24/7 emergency care and outpatient services, but they are prohibited from offering inpatient services and must have agreements in place with area trauma centers to accept patients once they’ve stabilized. In exchange, they receive a 5 percent boost to Medicare payments for covered outpatient services, plus monthly payments of about $285,625 from the federal government.

The program launched in January 2023, and more than 40 facilities across the country have converted. Unlike Martin General, however, all of those hospitals were still operating when they made the switch. 

Martin General, which closed before the program was fully available to North Carolina hospitals (the state budget authorizing participation wasn’t signed until months after Quorum shut the doors), represents something different: the first attempt anywhere in the nation to reopen a completely shuttered hospital under the REH model.

County officials spent months working through regulatory questions about whether a closed hospital could qualify, and in early 2024, the Centers for Medicare and Medicaid Services confirmed that Martin General could indeed reopen as a Rural Emergency Hospital. By early 2025, the county had sent out requests for proposals from potential operators and was working to update and repair the aging building to meet CMS’ requirements.

Then a solution appeared in the county’s back yard.

Waiting for funding

In May 2025, ECU Health, a state-affiliated hospital system based in nearby Greenville, announced a plan to take over and convert Martin General. 

The system’s proposal carries a steep price tag: ECU Health, which is connected to East Carolina University’s Brody School of Medicine, is asking state lawmakers to appropriate $220 million toward the project.

Roughly $70 million of that would go toward building the site for the Rural Emergency Hospital on the campus of Martin General, with the remainder financing a new inpatient bed tower at ECU Beaufort Hospital in neighboring Beaufort County. The expansion to that facility is needed to absorb patients from Martin County who require inpatient care.

Brian Floyd, chief operating officer for ECU Health, gave a brief overview of the plan during the NC Rural Center’s annual summit in Raleigh on March 26.

Addressing an audience of about 100 people, Floyd said Martin General’s history illustrated a pattern that has played out repeatedly in rural communities: A hospital starts under county ownership, gets acquired by a private company and then gets sold off again before eventually going under.

“Private companies get in there and realize they can’t make it work,” he said. “They flip it, and then eventually it bankrupts. That’s the story of rural closure if you look at the way that typically works in rural markets. We’re not just trying to recreate that.”

Floyd acknowledged that ECU Health’s vision might take years to fully implement. It would also require investments beyond the physical buildings. 

“I know we’re going to raise other operating cost structures to deal with this,” he said. “That’s why we’ve asked the state to help with the capital to put this in place.”

That funding request has stalled amid a prolonged standoff between the state Senate and House of Representatives over the state budget, which is now nine months late.  

North Carolina is the only state in the nation that has yet to adopt a spending plan, and lawmakers are not scheduled to reconvene until April 21. 

Study tests model’s promise

As ECU Health’s plan takes shape, a study published last month in the Annals of Emergency Medicine offers the first systematic — albeit somewhat inconclusive — look at whether the Rural Emergency Hospital program is working as intended.

Conducted by researchers at UNC Chapel Hill, the study used financial data to examine hospitals that closed, that converted to REH status or that remained open without converting. 

It found that hospitals that converted to the REH designation and hospitals that ultimately closed had similarly poor financial health before 2023, including low profit margins and high financial distress risk. Both types of hospitals ended up financially worse off than hospitals that stayed open without converting.

Researchers were careful to flag the limits of their analysis. The REH program is in its early stages and the sample of converting hospitals remains small.

“Rural Emergency Hospitals could be a viable option for financially struggling hospitals in rural communities to maintain local delivery of emergency care services while lowering closure risk,” the authors wrote, adding that their findings “should be viewed as exploratory.”

At least a dozen rural hospitals in North Carolina have closed or significantly scaled back services since 2005, according to data from the Sheps Center for Health Services Research at UNC Chapel Hill. Martin General is the most recent closure recorded by the center.

Cost of closure

Batts, who became manager of Martin County in May 2025, said the closure of Martin General had a “halo effect” on the county’s already struggling economy.

He noted that Martin, which has a population of about 21,500, is categorized by the N.C. Department of Commerce as a “Tier 1” county — a designation reserved for the state’s most economically distressed areas. About 20 percent of residents live in poverty, significantly higher than the statewide average of 13.6 percent.

More than 8,400 residents, or about 39 percent of the county’s population, rely on Medicaid. Nearly 4,900 residents, or 22 percent, are enrolled in SNAP.

“Losing that hospital had a big impact from a health standpoint, but it was a huge impact from an economic development standpoint,” Batts said during the summit, adding that the  loss of “labor income alone” dealt a $12 million blow to the community, with a “total economic activity loss” of $33.1 million.

That’s in line with other research showing that rural counties lose jobs and revenue when a local hospital closes, causing local families to lose income across the board and driving population loss. 

Martin General’s closure was personal for Batts. His wife, a nursing manager at the facility, was among the employees displaced when the hospital shuttered. She eventually landed a job at ECU Health Chowan Hospital in Edenton — a 90-minute drive from the couple’s home in Martin County.

The closure also reverberated through the county budget. With local ambulances forced to make longer runs to neighboring counties, Martin County’s annual contribution to emergency medical services ballooned almost overnight from $550,000 to $1.4 million.

“Our budget is so limited that we can barely scrape by in a normal year,” Batts said. “It has so many downstream effects.”

Before it closed, Martin General recorded more than 10,000 emergency department visits a year. It also provided annual access to 100,000 diagnostic and outpatient procedures. 

Residents now travel across county lines to receive those crucial services, which adds strain to surrounding communities’ health care infrastructure.

For Floyd and others who are pushing to bring Martin General back, the numbers underscore what’s ultimately at stake.

“These issues are not just economic,” Floyd said. “They are real, and these people matter. Their lives matter.”

Republish This Story

Republish our articles for free, online or in print, under a Creative Commons license.