446 Hospitals at Risk of Closing Due to Medicaid Cuts

A Public Citizen analysis identifies 446 hospitals across 44 states and Washington D.C. at high risk of closing or cutting services due to approximately $1 trillion in Medicaid cuts in President Donald Trump's legislation, with 60% of at-risk facilities located in urban areas. Medicaid currently covers about one-fifth of all U.S. hospital spending, and Public Citizen defines at-risk hospitals as those deriving at least 20% of revenue from Medicaid and low-income programs while operating at a loss. Major health systems are already responding with layoffs and service cuts, including Alameda Health System eliminating nearly 300 positions and Trinity Health projecting $1.5 billion in losses, while rural hospitals face a net $87 billion reduction despite $50 billion in targeted support. The cuts, which include work requirements starting in 2027 and state funding limits beginning in 2028, particularly threaten mental health services, maternal care, and rural emergency services.

Scale and Geographic Distribution of At-Risk Hospitals

• ▪A Public Citizen analysis found 446 hospitals across the United States are at high risk of closing or cutting services because of Medicaid cuts in President Donald Trump's bill.
• ▪267 of the 446 at-risk hospitals identified by Public Citizen are in urban areas, representing about 60% of at-risk facilities.
• ▪The Public Citizen analysis draws on hospital financial data from the Centers for Medicare and Medicaid Services from 2022 through 2024, covering about 95% of U.S. hospitals.

Financial Impact of Medicaid Cuts on Hospital Operations

• ▪Public Citizen defined at-risk hospitals as those in which Medicaid and other low-income government programs made up at least 20% of revenue and that have been operating at a loss in recent years.
• ▪President Donald Trump's Medicaid legislation is expected to reduce federal Medicaid funding by roughly $1 trillion over the next decade.
• ▪Trinity Health is projected to lose $1.5 billion due to recent and future government policy changes.
• ▪President Donald Trump's Medicaid legislation could reduce federal Medicaid spending in rural areas by about $137 billion over a decade.
• ▪Alameda Health System in Oakland, California gets 60% of its revenue from Medicaid payments.
• ▪President Donald Trump's Medicaid legislation sets aside $50 billion to support rural communities.
• ▪Alameda Health System announced in December it would lose more than $100 million annually by 2030 due to Medicaid cuts.

Consequences for Patient Access and Healthcare Quality

• ▪Alameda Health System announced in December it would lay off nearly 300 employees due to Medicaid cuts.
• ▪Trinity Health laid off 10.5% of its billing staff in January.

Political Dimensions of the Medicaid Cuts

• ▪The Medicaid cuts include limits on how states raise funds beginning in 2028.
• ▪The Medicaid cuts include work requirements beginning in 2027.
• ▪Senate Republicans represent 146 at-risk hospitals in their states, according to the Public Citizen analysis.
• ▪House Republicans who voted for the Medicaid cuts have 196 at-risk hospitals in their districts, according to the Public Citizen analysis.

Perspective of Public Citizen

• ▪Public Citizen's methodology for identifying at-risk hospitals focuses on facilities where Medicaid and other low-income government programs constitute at least 20% of revenue combined with recent operating losses.

Perspective of Alameda Health System

• ▪Alameda Health System's high dependence on Medicaid revenue at 60% makes it particularly vulnerable to federal funding reductions.

2 sources