A plan to convert Columbia Memorial Health's Hudson campus into a critical access hospital with just 25 medical-surgical beds has turned into one of the sharpest healthcare fights of New York's governor's race, with nurses warning of overcrowded emergency rooms and candidates trading blame over who is responsible for the squeeze on rural hospitals. Columbia Memorial Hospital typically has 30 to 50 admitted patients at any given time, and the facility currently operates with a budget exceeding $150 million.
Albany Med Health System filed the plan to curtail services at Columbia Memorial Health, which is located in Hudson, New York, according to Gothamist. Albany Med describes the move as a redesignation that would better match actual community needs, and says in its own materials that a shift to the critical access hospital model would bring the facility down to 25 medical/surgical beds, as outlined on Albany Med's website. The health system says CMH is currently licensed for 192 beds but only averages 40 to 50 patients each day, while CMH leaders separately told WAMC the hospital has capacity for 147 medical-surgical beds with similar average overnight usage — two different baseline figures that have not been reconciled.
What Would Change, and What Albany Med Says Would Stay
Albany Med has pledged there would be no closure, no layoffs, and no loss of essential services under the plan, per its own materials. The area's only emergency department would remain in Hudson, and 25 inpatient beds would be dedicated to patients needing additional care, while expanded behavioral health services are also part of the concept. Albany Med's account describes mental-health capacity rising from 23 to at least 35, while the Daily Gazette reports a separate plan for 45 mental-health beds.
The concept also includes a $25 million expansion of Greene Medical Arts in Catskill for same-day surgeries and additional specialties, and Albany Med anticipates hiring more than 100 professionals across that clinic and the Hudson hospital. Albany Med has said Columbia Memorial is not using the 70 beds for which it is staffed, and argues the hospital's average daily acute-care inpatient census has stayed below 25 percent of its certified bed capacity since the pandemic, according to Spectrum News. That reporting also notes Albany Med's claim that more than 90 percent of CMH surgeries are ambulatory procedures that do not require admission, while WAMC reports that CMH said 84 percent were performed on an outpatient basis.
Nurses and Neighbors Push Back
Sara Dragula, a nurse at Columbia Memorial Hospital's emergency room, has said patients sometimes wait because inpatient beds are full, and warns the emergency room could become more crowded under the plan, per Gothamist. Dragula told WAMC that the ER frequently faces long waits to get patients out and into beds, sometimes having to stash people in hallways, a description she gave in a report from WAMC. Critics cited by Gothamist say patients in Columbia and Greene counties may need to drive about an hour north to Albany for services under the restructuring, and transfers from regional facilities to Albany Med have increased steadily since 2020, with Columbia Memorial Hospital transferring close to 2,900 patients to Albany Med between 2020 and summer 2025.
The Save CMH Coalition, which includes hundreds of residents and medical professionals, opposes the planned changes and organized hospital rallies in mid-July and September, according to Gothamist. The coalition worries that approval of the application could make critical healthcare inaccessible to patients. Sarah Rebekah Garber, a nurse practitioner in the area, has said many elderly patients may forgo care because they cannot travel to Albany or Kingston, and argues the country needs to invest in rural healthcare. Columbia Memorial Hospital stopped providing obstetrics services in 2019, three years after it was bought by Albany Med Health System in 2016, per the Daily Gazette.
Why Critical Access Status Matters Financially
Critical access hospital designation is designed to help keep rural hospitals open by making them eligible for more federal funding, and critical access hospitals are generally limited to 25 beds, with patients staying an average of four days, per Gothamist's reporting. Federal guidance from the Centers for Medicare & Medicaid Services describes the designation as generally capped at 25 inpatient or swing beds, and requires a facility to sit in a state with a Rural Hospital Flexibility Program while being located more than 35 miles from the nearest hospital, or more than 15 miles in mountainous or secondary-road areas, according to CMS. Albany Med says the redesignation could raise reimbursement from 50 to 70 percent of care costs today to approximately 101 percent, though that figure comes from Albany Med's own materials and has not been independently verified. Critically ill patients would continue to be stabilized at CMH and then transferred to Albany Medical Center for advanced critical care, Albany Med says, and the health system has promised to retain all currently provided hospital services while arguing the plan would free up investment in new and enhanced services, per a spokesperson. The application is pending before the state Department of Health, and Albany Med separately plans to expand a clinic in Greene County. Albany Med is also undertaking an expansion of its flagship hospital emergency department, Gothamist reported.
A Statewide Funding Squeeze Behind the Local Fight
The Hudson dispute is unfolding against a backdrop of sweeping federal changes. Congress passed H.R. 1, also called the One Big Beautiful Bill Act, which allowed health insurance subsidies to lapse and expanded Medicaid restrictions, according to Gothamist's reporting. Industry executives say those Medicaid rule changes have accelerated healthcare closures and consolidations statewide, leading to more people being uninsured and, in turn, lower hospital payments. The Iroquois Healthcare Association, which represents dozens of hospitals and health systems in upstate New York, says H.R. 1 created added financial challenges for hospital systems. Kevin Kerwin, of the association, has said members are fighting to reach a zero-percent margin and that hospital finances are fragile as supply chain and labor costs continue to increase.
New York could lose up to $10 billion annually in federal healthcare funding under these changes, according to estimates cited by Gothamist, even as healthcare spending makes up just over a quarter of the state's operating budget. New York separately stands to receive more than $200 million through a rural health funding program tied to H.R. 1.
Candidates Spar Over Rural Hospitals Ahead of Election Day
With New York's governor election set for November 3, Gov. Kathy Hochul and Republican challenger Bruce Blakeman have both laid out plans to address rural healthcare, and the candidates are trading blame over the hospital cuts. Hochul traveled to Chautauqua County in August to tout state funding for a hospital project in Fredonia — where the planned Northern Chautauqua Hospital is expected to include 20 private medical, surgical and observation beds and a 17-bay emergency department, per NY State of Politics — while criticizing the Trump administration over hospital funding. Hochul has said New York would receive about $10 billion less in healthcare dollars and has pushed for a $500 million fund for distressed hospitals, which was included in the state budget, framing it as state funding to address what she calls a federal healthcare shortfall.
Blakeman has said he would root out fraud and make targeted investments in rural healthcare, telling Gothamist the state should focus on healthcare fraud, primarily in Medicaid, while wanting quality services for people who need state healthcare programs. He has said people complain that healthcare is too expensive and services are terrible. Monroe County Assemblymember Josh Jensen, the lead Republican on the Assembly Health Committee, pointed to millions in rural healthcare funding in H.R. 1 and said the law's changes will challenge hospitals, while arguing that consolidation is not necessarily harmful to rural patients because they retain access to high-quality care. Bill Van Slyke, a former Columbia Memorial Hospital board member and communications consultant, has said the healthcare system must balance provider cash flow with affordable care for customers, warning that the current funding model cannot sustain all stakeholder profits while meeting community needs.
A Quinnipiac University poll found healthcare was the top issue for 11 percent of upstate New York voters, ranking behind the economy and cost of living but still significant enough to shape the race. New York's smaller and rural hospitals face steep cuts amid broader healthcare industry consolidations, and the Columbia Memorial consolidation plan has already prompted protests that show no sign of fading before voters head to the polls.
