Boone Health CEO says hospital still coming to Mexico, despite unknowns

By Don Munsch; Editor

                Brady Dubois said Boone Health plans to stay the course and help bring a hospital with critical access care components to Mexico.

                But as is sometimes true in medicine itself, there are complications afoot.

                Those complications are what Dubois, chief executive officer and president of Boone Health, described as variables that must be worked through.  Dubois visited Mexico on Oct. 13 to give an update on the hospital to local leaders. 

                He spoke to the media at city hall and then briefed the city council later in a joint session that included the Audrain County Commission and Audrain County Health Department Board of Health.  The city, commission and health department signed a letter of intent with Boone Health in October 2024 to bring a hospital back to Mexico.  The hospital closed here in 2022. 

                At the medica session at city hall, Dubois said, “Things looked different six months ago than they do right now, and the challenge that’s really out there is understanding what it’s going to look like when the doors open (a few years from now).  What is that landscape going to look like where we can plug those variables in?”

                Later, at the join session meeting members of three entities asked questions about the hospital project after Dubois spoke.

                Dubois said in his discussion that health care now is not for the “faint of heart,” as he discussed the federal legislation that is now trickling down to be implemented by state legislation, explaining that the state will be affected by the budget deficit and unknowns coming.

                “When you have a budget deficit, what are your options” How are you going to close that?” he said.

                Discussions are still going with consultants and others to conduct a pro forma, bu there are so many variables that are in the realm of the unknown because there are a “significant change in the health care landscape.”

                He said that according to a Washington University Public Health report, Audrain County has 27% of its residents currently enrolled in Medicaid. Dubois wondered how many people will stay on Medicaid and how many would become self pay.  He wondered how all these and other matters-including Affordable Care Act plan rates- would play out with how health care will be paid for in the state and how Boon’s financial modeling will be affected.  He said Missouri could face a $15-$17 billion impact – that is, less funding – over a 10-year period, and that funding difference is attributable to the federal legislation passed this summer.  Later, in an email, he said estimates are still being refined by the state and interested parties, but the average range of expected impacts is $15-17 billion over 10 years if nothing changed.

                He also discussed total construction expenses, as well as tariffs and other costs figuring in, but he also wondered, five years from now, what will the reimbursement rates be for health care services provided along with pricing for pharmaceuticals and equipment. 

                “Good, bad or indifferent, you cannot just pick up a pharmaceutical plant and plop it in Indiana and start producing drugs overnight,” he said.  “It doesn’t happen.”

                He pointed out how some drugs are almost exclusively manufactured in other countries and have tariffs ranging from 15% to 100%, and there are no similar drugs on the market that can do the same thing.

                Dubois said Boone is excited about coming to Mexico but expects a “bumpy” ride.  Variables need to be worked out.  On the state legislative front, he would like to see some clarity on the funding deficits, and depending on how that’s worked out, it will help Boone finish its pro forma for its financial planning.

                “How the gaps in Medicaid funding are projected to be addressed by the state in coming years will be impactful,” he said later in an email.

                He said construction for the hospital could range from $40-$80 million, later adding in an email that that’s “depending on the model selected to best meet the needs of Audrain and surrounding communities.”

                He told leaders that three finalists for Boone Health’s partner in the hospital project have vast experience with critical care access hospitals.  He didn’t name the prospective partners but said all three have “tremendous” reputations.  All three prospects are “stellar organizations,” Dubois said.

                “We could not handpick three better organizations to deal with,” he said, adding that he expects to decide the partner in November, publicly announce the partner in early December and then form a definitive agreement in the first or second quarter of 2026.  All three partners would be new to Audrain County, and all are “substantially larger” than Boone.

                We’re excited about being here, we’re excited about the opportunity,” Dubois said.  “We’ve just got a lot of unknowns right now that we’ve got to get answered, but we believe that people here in Audrain County and the city in Mexico are some of the best people in Missouri and we want to be their health care provider, and we want to work through this.”