1. The train wreck that almost happened! Medicaid Rate Cut HB307 passage Private DSH EDS conversion HB307/HB1055 Implementation DCH Shutdown/Lockdown

2. The train wreck that almost happened! Major Events! Rural Proposal to Gov People HomeTown CEO Day – Ryan Teague Dinner Ryan Teague – Josh Belinfante GHA/Alliance vote to Tax CAH’s GHA Vote reversal HB307 passage Private DSH funded by Senate

3. The train wreck that almost happened! -Results Outcome Exempt CAH’s Protect Medicaid providers with Medicaid Rate Increase Implementation Very Complex Cash flow consequences Consequences Rural hospitals made whole nearly vs. 16% Medicaid Cut

4. The train wreck that can happen - 2012 EDS implementation New Governor and administration Many new legislators - Census HB1055 Implementation – Cash shortage Federal Health Care Reform Cut Medicare $500 billion $2.6-$4 Billion Budget Shortfall Stimulus Money goes away

5. The train wreck that can happen – Long Term 2016 before state budget gets back to 2009 level Georgia rural unemployment will not reduce with any speed due to permanent closures Major increase in deductibles and co-pay Major loss of rural legislators due to census and legislator fatigue Obamacare – Medicare cuts