Rural hospitals across Georgia are being forced to make a decision on what is most economically feasible for their community.

They aren’t getting much help from the federal government, either.

The Affordable Care Act is about to phase out the Disproportionate Share Hospital program, which sets aside money for hospitals that treat a large amount of patients on Medicaid or without insurance.

Georgia relies heavily on the DSH since the state, along with 18 others, voted not to expand Medicaid. Obamacare was drafted and passed under the assumption that all states would expand Medicaid, so Georgia is faced with losing a critical program that reimbursed hospitals for the care they provided.

To add to the confusion, the new administration under President Donald Trump tried, and failed, to pass a replacement healthcare bill this summer, leaving the ACA in place.

“Those 19 states that haven’t expanded Medicaid, even those who say they want to expand it, we have a new president, and I don’t think he would even approve it if they wanted to,” said senator Dean Burke.

Since it seems help from the federal government is becoming increasingly less likely, Burke said hospitals across Georgia will have to start looking at other options to stay afloat. In January, Bainbridge Memorial Hospital and Manor, the City of Bainbridge and Decatur County signed a memorandum of understanding for a loan agreement that would keep the hospital recover from millions of dollars of debt and continue to serve patients.

Burke said communities have to look at what makes economic sense for them. Some cities and counties are too small to even support a hospital, but that doesn’t mean another form of care couldn’t be available in those areas.

“We have a lot of rural counties. How do they afford a hospital?” Burke asked. “It’s impossible.”

A new access model for patients will be a big topic of discussion at Georgia’s next legislative session, Burke assured. It might take some experimentation, but plans are already underway. The House Rural Development Council, formed this year to tackle the economic and health-related struggles of South Georgia, met in Thomasville and Bainbridge last month to hear from local officials. The council is tasked with developing methods to encourage rural growth.

Specifics on how they will do that remains to be seen, though.