Boone Health says proposed Mexico critical-access hospital remains a goal amid state funding uncertainty

Brady DuBois, chief executive officer and president of Boone Health, told the Mexico City Council on Oct. 13 that the health system remains committed to pursuing a critical-access hospital in Mexico but that “a lot of unknowns” in state and national health-care funding have slowed the project’s timeline.

DuBois told council members and the public that the project team signed a letter of intent with Mexico about a year earlier and has been conducting due diligence since then. He said recent federal and state legislative changes, and a projected state budget gap estimated at roughly $1.4 billion to $1.7 billion a year, have created uncertainty that must be modeled into the project’s pro forma.

The Boone Health CEO cited several concrete points staff are building into financial scenarios: a Washington University public-health study that shows about 27% of Audrain County residents are enrolled in Medicaid; Missouri’s recent Medicaid spending level (about $15.8 billion in the prior year); and an anticipated decline in the hospital assessment used to draw federal match from roughly 5.6% toward 3.5% over a multiyear period. “When you start looking at all the different financial variables and the unknowns,” DuBois said, “we're just trying to nail down the unknown variables to build into the pro forma.”

DuBois described how payer-mix shifts matter for margins: he said Medicaid typically covers roughly 85% of the cost of care while self-pay patients may cover only 3%–5% of costs, and that local changes in enrollment or commercial coverage would materially change projected revenue for a small hospital. He also described construction and supply pressures, including tariff-driven increases in the cost of steel, glass, pharmaceuticals and some medical equipment, and said that those factors can add millions to a project’s cost.

On project timing and partners, DuBois said Boone Health has narrowed strategic-partner discussions to three finalists; he said the health system expects to select a partner at a Boone Health board meeting on Nov. 24, plans a public announcement in early December and is targeting a definitive agreement by the end of the first quarter of 2026. “All three organizations are really, really strong organizations,” he said, noting two of the three have experience with critical-access hospitals in Missouri.

DuBois said that depending on the construction approach, total build costs being discussed range from about $40 million (modular/turnkey models cited by other systems) to about $80 million for traditional construction, and that estimated construction completion from groundbreaking is in the 24- to 35-month range for the designs under consideration. He emphasized that regulatory approvals and permitting would add time before groundbreaking.

Council members asked about workforce and local integration; DuBois and Boone Health staff said they are recruiting advanced-practice providers and physicians, and that retaining local clinicians who live in or near Audrain County is a priority to sustain services when the hospital opens. A resident who spoke during public comment described a family heart attack that required a long drive for definitive care; DuBois replied that on-site diagnostics and telemedicine could shorten time to diagnosis and treatment in many cases.

DuBois closed by reiterating Boone Health’s interest in Mexico and Audrain County while underscoring remaining risks: “We just got a lot of unknowns right now that we gotta get answered,” he said. He offered to continue monthly updates and make himself available to council and community groups as the process continues.

Mexico City officials did not take any formal action on the hospital project during the meeting; DuBois’s presentation was an informational update and followed by questions and public comment.