Four rural Tennessee hospitals have closed and dozens are at risk because of the state's decision not to join the Affordable Care Act in 2013 and tap into promised federal funds, according to an article on the Memphis Daily News website.

Hospitals are “stressed to the max” financially, Tennessee Hospital Association Executive Director Craig Becker said, noting “there’s a marked difference” between the financial situation for Tennessee hospitals and those in states that accepted federal Medicaid expansion.

A white paper by the Tennessee Justice Center, a nonprofit that focuses on healthcare for the poor, reports that 54 hospitals are at risk of closing.

Tennessee is projected to miss out on $2.3 billion in Medicaid funding for 2016, according to the study, and hospitals would go without $70 million in reimbursements in 2016 because the state isn’t participating in the Affordable Care Act.

Read the article.