Hospitals are putting major expansion projects on hold and bracing for service cuts as new limits on Medicaid state-directed payments threaten to squeeze already tight finances.

Making matters worse, many hospitals will see their revenue and margins decline as millions of Americans lose health coverage and uncompensated care costs rise under the recently enacted budget reconciliation package, dubbed the One Big Beautiful Bill.

The law restricts new Medicaid state-directed payments, financial arrangements allowing states to make supplemental payments to healthcare providers for services covered under managed care contracts. It caps such payments at 100% of Medicare rates in Medicaid expansion states and 110% in non-expansion states, while gradually cutting existing payments above those le

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