Key takeaways:
- Martin County was already among North Carolina’s most economically distressed communities before Martin General closed in 2023. The shutdown only exacerbated economic issues.
- ECU Health has proposed converting Martin General into a Rural Emergency Hospital under a federal designation. It would be the first hospital to reopen under the rubric.
- To reopen would require about $220 million in state appropriations. It’s unknown what the status of the proposal is in Republican lawmakers’ negotiations.
By Jaymie Baxley
When Martin General Hospital closed its doors in 2023 after 73 years of service, residents of Martin County in eastern North Carolina were left without a local emergency department. At the time the hope was to get the facility reopened quickly with new management.
Three years later, residents still have to travel across county lines to access life-saving care.
Given those circumstances, it was no surprise that a plan proposed by ECU Health to reopen the hospital came up repeatedly when state officials visited Williamston, the county’s seat of government, last week.
Devdutta Sangvai, head of the N.C. Department of Health and Human Services, and Lee Lilley, a Martin County native who leads the state’s Department of Commerce, were in town as part of a “listening tour” organized by Gov. Josh Stein’s office.
The event, held in a room typically used for school board meetings at Martin Innovative Early College, offered an “opportunity to understand the impact and intersection of community and health care,” according to Sangvai.
“As I think about the challenges throughout the state, Martin County is really the exemplar of a community that really wants to solve its health care challenges,” he said. “We know there have been really acute challenges that you’ve had to face, in particular with the hospital, but the one thing I’ve seen here is a consistent and persistent interest in ensuring that there’s adequate health care resources in Martin County.”
Nearly 50 concerned citizens from Martin and surrounding counties turned out for the hourlong session. More than a dozen attendees shared their thoughts on issues ranging from food insecurity to wastewater infrastructure, but one topic bubbled up more than any other: the fate of Martin General.
Tom Franklin, a retired cardiovascular physiologist and former health system administrator who has lived in Martin County for seven years, recalled a recent medical scare involving his wife. He told the officials that her nearest option for care was an emergency department half an hour away in Bertie County.
“We need a lot of help,” Franklin said of the situation. “It just doesn’t make any sense at all that our EMS folks have to carry emergency patients to adjacent counties, and if we have to be hospitalized, we have to go to adjacent counties too.”
A path forward?
ECU Health, the state-affiliated hospital system based in nearby Greenville, has spent the past year promoting a plan to revive Martin General as North Carolina’s first Rural Emergency Hospital — a federal designation launched in 2023 as a lifeline for struggling hospitals in rural communities.
Facilities that convert to Rural Emergency Hospitals 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.
While 50 hospitals across the country have converted, all of those facilities were still operational when they made the switch. None of the hospitals are in North Carolina, which has the second largest rural population in the country, next to Texas, and where 10 rural hospitals (and two non-rural hospitals) have closed since 2005.
Under ECU Health’s plan, Martin General would become the first shuttered hospital in the nation to reopen as a Rural Emergency Hospital.
The proposal, unveiled to the Martin County Board of Commissioners in May 2025, asks state lawmakers to appropriate $220 million toward the project. About $70 million would be used to rebuild the emergency hospital on Martin General’s old campus in Williamston, with the rest funding a new inpatient bed tower at ECU Beaufort Hospital in neighboring Beaufort County.
That funding request has been tied up for months amid prolonged negotiations in Raleigh over the state budget in an environment of reduced federal receipts. The project remains in limbo.
Roy Lilley, uncle of Lee Lilley, is the treasurer for Advancing Community Health Together, a nonprofit formed in 2024 to advocate for the hospital’s return. During the session, he said his organization has raised $89,000 through two fundraisers and secured a $50,000 grant from the North Carolina Community Foundation.
“We are trying to help ourselves, but we need additional assistance from the General Assembly to advance our goals,” Roy Lilley said, adding that he hopes his nephew and Sangvai will “continue to work with the General Assembly to fund the plan put forth by ECU Health.”
Lee Lilley said that he, Sangvai and Stein have “encouraged” lawmakers to approve the appropriation, and they’re “optimistic that there will be funding” in the budget to relaunch emergency department services in Martin County. At the same time, he acknowledged that getting the money is only the first step.
“We stand ready to work with this community on all the work that would be needed to reopen a hospital, as well as to look at the broader health care ecosystem of this area,” he said. “It’s not just the emergency room that’s critical. The wraparound services and the entirety of the health care ecosystem are [also] important to this community, this community’s health and well-being and, from my perspective, the community’s economic viability going forward.”
Sangvai, who noted that he was a hospital CEO before taking the reins at NC DHHS, said his department would move quickly on construction and licensing matters if the funding comes through.
“We’ll be committed to move those things as fast as possible through the department so we don’t become something that’s slowing things down,” he said, adding that the community has a “quality partner” in ECU Health.
“I think we have to really be thankful and not overlook the reality that, when this thing gets to go — and I’m going to continue to remain optimistic about that — you have a partner who really understands what they’re doing and isn’t here to find a way to make a dollar off of Martin County.”
The cost of closure
By most measures, there aren’t that many dollars to be made in Martin County.
The county, which has a population of fewer than 22,000, is categorized by the N.C. Department of Commerce as one of the most economically distressed counties in the state. About 20 percent of its residents live in poverty and about 38 percent receive care through Medicaid.
Martin General’s closure only compounded those challenges.
Opened in 1950, Martin General thrived for decades as Martin County’s only hospital. After outgrowing its original two-story building in downtown Williamston, the facility moved in 1973 to a 22-acre campus on nearby South McCaskey Road.
As Martin County’s population declined beginning in the 1990s, the hospital’s revenues fell with it. Former operator Quorum Health attempted to cut costs by discontinuing maternity services in 2019 and shuttering the intensive care unit in 2021.
Those changes weren’t enough to keep Martin General afloat. Quorum closed the 43-bed hospital’s doors in August 2023, citing “financial challenges related to declining population and utilization trends.”
During a conference organized by the NC Rural Center in April, Martin County Manager Dexter Batts said the closure “had a huge impact from an economic development standpoint.” He estimated that the loss of hospital-related labor income alone cost the county $12 million, with total economic activity losses reaching $33.1 million.
That’s in line with findings from the UNC Chapel Hill Sheps Center for Health Services Research showing that when rural hospitals close the local labor force decreases, along with the local population.
Meanwhile, Martin County’s annual contribution to emergency medical services swelled from $550,000 to $1.4 million as ambulances were forced to make longer runs to neighboring counties — a significant burden for a community with a budget of less than $46 million.
“Our budget is so limited that we can barely scrape by in a normal year,” Batts said.
Gov. Stein did not attend last week’s public listening session, but he did participate in a roundtable discussion with local leaders before the event. He later told reporters that the state is “working and having conversations with other important players to revive the hospital.”
Sangvai closed out the session with a pledge to residents.
“We’re going to do everything we can to help you find a way to get the hospital up and running again,” he said.
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