Schneider Regional requests $112.2M ceiling for FY2026; asks $4.8M to restart cancer center

Schneider Regional Medical Center (SRMC) told the Senate Committee on Budget, Appropriations and Finance on Aug. 11 that its proposed fiscal year 2026 operating budget should total $112,200,000 to fund operations of Roy L. Schneider Hospital, the Myra Keating Smith Community Health Clinic and the Charlotte Kimmelman Cancer Institute as it reopens.

The request, presented by Chief Executive Officer Tina Commission, would cover operating costs, the local Medicaid match and an estimated $36.2 million in uncompensated care SRMC projects for FY2026. Commission said the hospital has included a $4.8 million line-item request to bridge CKCI’s first-year gap while patient volume and billing ramp up.

SRMC said the territory’s payer mix and persistent underpayment by public programs drive most of the shortfall. “Sixty percent of the patients that we serve are either covered by Medicare or Medicaid,” Commission told senators. She added that self-pay accounts represent roughly 15% of encounters and that those cases produced about $21.8 million in billed charges in FY2024, most of which went unpaid.

Why it matters: SRMC described an operating environment where rising national health‑care costs, a high uninsured rate and low local reimbursement create a structural deficit. The hospital said it is taking steps—recruiting clinicians, expanding profitable service lines such as GI and dialysis, and engaging a revenue‑cycle firm on contingency—to increase collections while asking the legislature for targeted support to stabilize operations and reopen CKCI.

Key budget details and requests
- SRMC presented a conservative FY2026 operating budget ceiling of $112,200,000 (RLSH + MKS + CKCI). That includes projected net patient revenue targets SRMC expects to collect; SRMC projected $74.3M net patient revenue in FY26.
- Uncompensated care: SRMC estimates $36,200,000 in uncompensated care for FY2026 (cases where no payer covers costs).
- Local Medicaid match: estimated at $3,600,000 for FY2026; SRMC says the central government must fund that match.
- CKCI first-year gap: SRMC estimates CKCI will cost roughly $8.9M to operate in year one and expects about $4.1M in collections; the hospital requested a $4.8M FY26 line item to close the first‑year shortfall and open services in early 2026.
- Facilities maintenance: SRMC requested a $1.5M FY26 line item for repairs and capital replacements at the 40‑plus‑year RLSH campus (generators, HVAC, sterilizers and other critical systems).
- IT / EMR modernization: SRMC described a multi‑year, enterprise electronic medical record (EMR) and infrastructure project estimated at roughly $11M for both public hospitals over three years; SRMC requested an initial FY26 line allocation of $3.0M toward its share and urged joint funding with Juan F. Luis Hospital to reduce cyber risk and improve billing.

Operational context and recent developments
- Collections and cyberattacks: SRMC said it had improved collections to roughly $5–6M per month before two ransomware incidents in 2024 and that the attacks reduced collections in FY25, producing an estimated $6.9M–$7.9M revenue loss across FY24–FY25. SRMC reported year‑to‑date net patient revenue of roughly $46.8M as of June 2025 and cash collections of about $36.4M through July 2025.
- Staffing and costs: Salaries and wages (FY26 budgeted) are shown at about $52.9M and fringe at $18.2M (roughly 63% of SRMC’s operating budget). SRMC told the committee that recent minimum‑wage changes and contract/step adjustments will add roughly $6.2M to FY26 personnel costs; the hospital has active collective bargaining and expects negotiated increases.
- CKCI rebuild: Daryl A. Smalls, executive director of the Territorial Hospital Redevelopment Team (THRT), told the committee CKCI is approximately 80% complete. He said major mechanical and electrical systems are installed and that shipment and installation of the linear accelerator and CT simulator are scheduled for October 2025, with commissioning and training to follow so that clinical service can start shortly after.

Hospital finances and payables
- SRMC reported total accounts payable and accrued liabilities of approximately $44.6M as of early June 2025. The hospital said it received $6.5M from the legislature under Act 8985 (part of a $10M appropriation) and is awaiting an additional $3.5M that requires a central‑government drawdown.
- SRMC said it paid $7.3M to the Government Employees’ Retirement System (GERS) in FY24–FY25 but still carries a remaining employer obligation to GERS of about $12.9M.

Service lines, access and community needs
- SRMC reported robust outpatient and surgical volumes and presented examples of high‑cost uncompensated cases (ICU-level care for uninsured patients, complex trauma, diabetic sepsis) to illustrate how quickly uncompensated costs accumulate.
- The hospital described new or expanded services: GI endoscopy, an enlarged hemodialysis program (it is treating patients transferred after closure of a private dialysis center), a behavioral health clinic, and plans to reopen interventional cardiology and radiation oncology at CKCI.

What SRMC is doing to reduce the gap
- Aggressive revenue-cycle work: SRMC engaged a national billing/coding/collections firm on a contingency basis to recover lost and outstanding claims and help rebuild upstream revenue workflows.
- Expense reductions: an overtime reduction initiative (29% cut in overtime hours since January 2024), contract reviews and eliminations, and targeted hiring to reduce reliance on expensive temporary clinical staff.
- Foundation and philanthropy: SRMC’s foundation reported about $2.7M in fundraising since it was reconstituted; the hospital said philanthropic support will be used to leverage grant reimbursements and buy down capital costs.

Ending
SRMC told the committee it has reduced some liabilities, is rebuilding collections and clinical volumes, and is prepared to open CKCI as soon as construction, equipment commissioning and staff orientation are complete. The hospital asked the legislature to consider targeted line items for CKCI ($4.8M for year one), facilities maintenance ($1.5M), and initial IT/EMR funding ($3.0M for SRMC’s share) in addition to funding the local Medicaid match and uncompensated‑care obligations so the hospital can maintain services to the territory while it improves financial performance.

Speakers quoted include Tina Commission, Chief Executive Officer, Schneider Regional Medical Center, and Daryl A. Smalls, Executive Director, Territorial Hospital Redevelopment Team. Schneider Regional Medical Center is committed to improving its financial position and reopening specialized care at CKCI, Commission said.