The association also encourages the state to participate in a federal program called the Upper Payment Limit. It provides supplemental funding to make up the difference between Medicaid rates and the maximum federal limit for Medicare. The association states it could generate up to $275 million for rural health care. It requires that the health care authority approve a partnership between rural hospitals and nursing homes.

“I believe our lawmakers don’t want to see this happen and are trying to come up with creative solutions,” Greiner said. “But we’ve not seen any proposals. This Legislature has historically not been in favor of any tax increase. Tobacco is the least unpopular. We are 60 days away from cuts going into effect, and no hard plan has been seen. We have no alternative to prepare. With hope there will be a resolution.”

If there isn’t, expect a wave of closures, he said.

“We are just in shock,” he said. “These buildings have been taking care of families in communities since the ’60s. You think this is someone else’s problem, even with 100 closing in the last 20 years. There is going to be an awakening in the profession. This is not a matter of shave a little here and shave a little there. This is literally liquidating.”