Medicaid cuts expected to hit rural hospitals the hardest
Article Summary:
- President Trump’s domestic policy bill contains massive cuts in federal Medicaid spending over the next 10 years.
- One analysis predicts $48 billion in spending reductions in Illinois over a decade.
- The cuts limit states’ ability to raise money through provider taxes to fund their share of Medicaid costs.
- The cuts also limit the way states use Medicaid to direct additional payments to hospitals.
By PETER HANCOCK
Capitol News Illinois
phancock@capitolnewsillinois.com
SPRINGFIELD — Hospital officials in Illinois say they will have to make some difficult decisions in the next few years that could involve laying off staff, cutting back services and even closing some facilities entirely.
That’s the expected result of federal funding cuts built into the recently passed domestic policy bill that President Donald Trump signed into law July 4, a law that will cut federal spending on Medicaid by more than $1 trillion over the next 10 years.
A.J. Wilhelmi, CEO of the Illinois Health and Hospital Association said in an interview with Capitol News Illinois that the financial pressures will fall heaviest on hospitals that serve rural areas, where a larger share of the population is covered by Medicaid.
“The hospitals in these communities are already on the brink, based on some of the increases in labor, drug and supply costs coming out of COVID, a continuation of claim denials by payers and relatively flat reimbursement rates,” Wilhelmi said. “So, all of that is creating significant pressures. And when you add these Medicaid cuts to an already challenging situation, we know that there are several hospitals that close because of these changes.”
Enrollment, reimbursement reductions
The new law contains provisions that are expected to reduce the number of people enrolled in Medicaid, particularly in states like Illinois that expanded eligibility for the program under the Affordable Care Act, the 2010 law commonly known as Obamacare.
Those include work requirements for people who enrolled through the expansion as well as requirements that they verify their continued eligibility for the program twice a year instead of annually.
But the law also includes changes in aspects of the program that most people outside the health care industry never see. Those mechanisms – known as provider taxes and directed payments – affect the way states finance their share of the cost of Medicaid and the way they direct additional payments to certain health care providers such as hospitals.
Like many states, Illinois levies special taxes on certain health care providers, including hospitals. The money those taxes generate is used to draw down additional federal matching funds, then is paid back to the providers in the form of directed payments to increase their overall reimbursement rate and to reward them if they meet certain performance or quality standards.
Currently, IHA estimates the hospital tax generates about $2 billion a year in revenue. This past session, lawmakers passed a bill to increase the assessment in order to fund a 54% increase in hospital payments, subject to federal approval of the state’s plan. But state lawmakers passed that bill before Congress passed Trump’s domestic policy bill, dubbed the “One Big Beautiful Bill Act.”
Prior to passage of the new federal law, the tax rate states could levy was effectively capped at 6% of a hospital’s net patient revenue. But under the new law, for states like Illinois that expanded Medicaid under the ACA, that cap will gradually be lowered by half a percentage point each year starting in 2028 until it reaches 3.5% in 2032.
In addition, Wilhelmi said, the new law imposes a cap on the directed payments that expansion states like Illinois can send to hospitals so that the total does not exceed the maximum allowed under Medicare – the federal health insurance program for seniors, which has a lower reimbursement rate than Medicaid.
“And that will result in a significant reduction in Medicaid reimbursements for hospitals,” Wilhelmi said. “It means literally hundreds of millions of dollars in less reimbursement to hospitals.”
$48 billion impact over 10 years
According to the nonpartisan health policy research organization KFF, federal Medicaid spending in Illinois is expected to be reduced by about $48 billion over 10 years under the new legislation. That includes an estimated $6.73 billion in spending cuts in rural parts of the state.
Democratic Gov. JB Pritzker has been harshly critical of the new law, and particularly the Medicaid cuts contained in it.
“Donald Trump isn’t just cutting health care — he’s also closing hospitals in Illinois and across the country with his latest scheme,” Pritzker said in one social media post while the bill was moving through Congress. “Hard-working Illinoisans will spend more time in overcrowded waiting rooms and lose access to life-saving care.”
Wilhelmi, meanwhile, said there is still time before the cuts begin to take effect, and he is urging state officials to begin work immediately to develop strategies to adapt to the changes.
“I think the state will need to work with stakeholders like IHA and our hospitals, other provider groups, to identify creative options to ensure that the Medicaid program can continue to be that lifeline for vulnerable patients and communities,” he said. “And that will include identifying options to fortify those programs and services, as well as identify working with our congressional delegation on ways to mitigate or further delay these changes.”
Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
