Some hospitals are operating on a razor-thin margin. Any disruption can lead to the elimination of services or complete closures. With declining Medicare reimbursement and cuts to Medicaid, uncompensated care will increase and budgets will not be sustainable. Over the past 25 years, Pennsylvania has seen 78 closures or reductions in core services statewide, 26 of which were in rural counties. The Pennsylvania Health Access Network (PHAN) has identified eight criteria that describe a hospital’s likelihood to be impacted should cuts or changes to the Medicaid program occur.