Regional Medical Center officials say the current reimbursement system is unfair. The wage index is intended to make adjustments in payments based on geography, but does not always work out that way, said David McCormack, CEO of RMC. According to the Centers for Medicare and Medicaid Services, which administers the Medicare program, the lowest wage index is in Alabama at 0.7247 while the highest is in California at 1.6989. Ever-decreasing Medicare reimbursements have been a part of operating a hospital in the state for many years - so much so that Alabama consistently ranks as the state that receives the lowest Medicare reimbursement per hospital, according to the Alabama Hospital Association.