Article Summary –
Martin County, NC, has lacked a hospital since 2023, impacting emergency care and the economy. ECU Health plans to revive Martin General as a Rural Emergency Hospital, requiring $220 million in state funding. The closure previously cost the community $33.1 million and strained local emergency services.
A rural NC community in Martin County has been without a local hospital for three years now. But ECU Health has a plan to reopen it as a “Rural Emergency” hospital.
April 6, 2026
Dexter “Drew” Batts, the county manager for Martin County in eastern North Carolina, often recalls the night his childhood friend had a heart attack in 2025.
His friend, a 39-year-old woman who went to school with Batts, lived just nine miles from Martin General Hospital. The local community had depended on this facility for emergency care since 1950.
But on that evening, Martin General was not available. The 43-bed hospital had closed in August 2023 due to “financial challenges related to declining population and utilization trends” by owner Quorum Health.
She was taken to a hospital half an hour away in Bertie County. When they couldn’t help, she was transferred 40 miles to ECU Health Medical Center in Pitt County.
She died there after three days on life support.
“Who’s to say if that longer transport, instead of nine minutes, impacted the outcome,” Batts said during an event by the NC Rural Center, advocating for rural areas. “We don’t know, but we would’ve liked to have found out.”
These grim “what ifs” are common among Martin County residents as they approach their third year without a local hospital.
County officials are hopeful about plans to revive the shut-down facility as North Carolina’s first Rural Emergency Hospital.
Reviving Martin General
The Rural Emergency Hospital (REH) designation was created by Congress through the Consolidated Appropriations Act of 2021 to aid financially struggling rural facilities.
Hospitals converting to REH status must provide 24/7 emergency care and outpatient services, but cannot offer inpatient services. They must have agreements with trauma centers for patient transfer after stabilization. They receive a 5% Medicare payment boost for outpatient services and monthly federal payments of about $285,625.
The program began in January 2023, with over 40 facilities nationwide converting. However, unlike Martin General, all were operational during the switch.
Martin General, closed before North Carolina hospitals could fully participate (state budget authorization occurred months after Quorum’s closure), is the nation’s first attempt to reopen a closed hospital under the REH model.
County officials faced regulatory questions about qualifying closed hospitals and in early 2024, the Centers for Medicare and Medicaid Services confirmed Martin General could reopen as a Rural Emergency Hospital. By early 2025, the county sought proposals from potential operators and began updating the building to meet CMS requirements.
Then a solution appeared locally.
Waiting for funding
In May 2025, ECU Health, a Greenville-based hospital system, announced a plan to take over Martin General.
The project has a significant cost: ECU Health, linked to East Carolina University’s Brody School of Medicine, is seeking $220 million from the state.
About $70 million would go toward the new Rural Emergency Hospital on the Martin General campus, with the rest funding a new inpatient tower at ECU Beaufort Hospital, needed to accommodate patients from Martin County requiring inpatient care.
Brian Floyd, ECU Health’s COO, detailed the plan at the NC Rural Center’s annual summit on March 26.
Floyd explained Martin General’s closure reflects a common trend in rural communities: hospitals starting under county ownership, being acquired by private companies, then eventually closing.
“Private companies can’t make it work,” he noted, “They sell it until it eventually bankrupts. That’s the typical rural closure story. We’re not trying to recreate that.”
Floyd acknowledged that ECU Health’s vision might take years to fully implement and require more investments beyond buildings.
“We’ll raise other operating costs for this,” he said. “That’s why we’ve asked the state to fund the capital.”
The funding request has stalled amid a budget standoff in the state Senate and House of Representatives, currently nine months overdue.
North Carolina is the only state yet to adopt a budget, and lawmakers are not scheduled to reconvene until April 21.
Study tests model’s promise
While ECU Health’s plan progresses, a study published last month in the Annals of Emergency Medicine explores the Rural Emergency Hospital program’s effectiveness, though results are inconclusive.
UNC Chapel Hill researchers used financial data to analyze hospitals that closed, converted to REH status, or remained open.
The study revealed hospitals converting to REH and those that closed shared poor financial health before 2023, with low profits and high financial distress risk. Both ended up worse off than hospitals remaining open without conversion.
Researchers highlighted the analysis’s limitations, noting the REH program’s infancy and the small sample of converting hospitals.
“Rural Emergency Hospitals could help financially struggling rural hospitals maintain emergency care while reducing closure risk,” the authors noted, adding that “findings should be viewed as exploratory.”
At least a dozen rural hospitals in North Carolina have closed or reduced services since 2005, according to data from UNC Chapel Hill’s Sheps Center. Martin General is the latest closure.
Cost of closure
Batts, who became manager of Martin County in May 2025, said Martin General’s closure had a “halo effect” on the struggling economy.
Martin, with about 21,500 residents, is categorized by the N.C. Department of Commerce as a “Tier 1” county, reserved for economically distressed areas. Around 20% of residents live in poverty, much higher than the state average of 13.6%.
Over 8,400 residents, or 39% of the county’s population, rely on Medicaid. Nearly 4,900 residents, or 22%, are enrolled in SNAP.
“Losing that hospital impacted health and economic development,” Batts said during the summit, noting the lost “labor income alone” resulted in a $12 million community loss, with a “total economic activity loss” of $33.1 million.
Research shows rural counties lose jobs and revenue when local hospitals close, reducing family income and resulting in population decline.
Martin General’s closure was personal for Batts. His wife, a nursing manager there, was displaced, later finding work at ECU Health Chowan Hospital in Edenton — a 90-minute drive from their Martin County home.
The closure also affected the county budget. With ambulance services making longer trips to other counties, Martin County’s annual emergency medical services contribution rose sharply from $550,000 to $1.4 million.
“Our budget is limited, making it tough to manage even in normal years,” Batts said. “It has numerous downstream effects.”
Before its closure, Martin General handled over 10,000 emergency visits and provided 100,000 annual diagnostic and outpatient procedures.
Residents now travel to other counties for these vital services, stressing neighboring health systems.
For Floyd and others working to revive Martin General, these numbers highlight the stakes involved.
“These issues aren’t just economic,” Floyd said. “People matter. Their lives matter.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The post ECU Health’s plan to reopen rural NC hospital offers hope to Martin County first appeared on Cardinal & Pine.
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