Scott Hulver

KFF graphic featuring a quote from Zachary Levinson, KFF Project Director, Project on Hospital Costs. It says, “The Administration’s change to reimbursement for drug administration services represents a step forward in implementing site neutral payment reforms but is modest compared to some of the more sweeping options raised by MedPAC and others.”

⚡ KFF’s Zachary Levinson writes about the site-neutral payment reform included in the CMS’s 2026 final outpatient prospective payment system rule under traditional Medicare. #QuickTake https://on.kff.org/4odNESQ

State Awards From Most of the Rural Health Funds Could Vary Only Modestly Despite Large Differences in Rural Needs | KFF This brief provides estimates of how $37.5 billion of the $50 billion rural health fund could be distributed across states if all states are approved for funding. Awards from the $37.5 billion could r...

Yesterday was the last day for states to apply for the $50B Rural Health Transformation Fund.

Final awards will be released in January; we've estimated how most of the fund could be distributed across states (if all states are approved, etc.) www.kff.org/state-health...

It's also unclear how much will go to rural areas. The policies and some other factors that states are scored on don't appear to have a rural focus, and some of the permitted uses are not limited to rural areas.

www.kff.org/other-health...

Key Takeaways from CMS's Rural Health Funding Announcement | KFF This brief describes five key takeaways from CMS's Notice of Funding Opportunity for the $50 billion Rural Health Transformation Program. It includes information about how CMS intends to review state ...

𝐍𝐞𝐰 𝐛𝐫𝐢𝐞𝐟 looking at CMS's funding announcement on the rural health fund.

One tidbit: CMS has exercise a large amount of discretion designing its allocation plan; 20 of the 23 allocation factors (allocation $25B) were not referenced in the reconciliation law.

www.kff.org/other-health...

What Role Do Immigrants Play in the Rural Workforce? | KFF This data note examines the role that immigrants play in the rural workforce, particularly in industries disproportionately filled by immigrants, including health care, agriculture, construction, and ...

New analysis by @kff.org finds that immigrants make up 3X the share of physicians and surgeons in rural America than their share of the rural population/total workforce (14% vs. 5%). They also play outsized roles in agriculture, construction, and service occupations.
www.kff.org/racial-equit...

A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Law | KFF The new reconciliation law includes a $50 billion rural health fund. This brief describes the rural health fund, explains what the law says about the allocation of funds, and highlights outstanding qu...

The temporary $50 billion rural health fund in the Republican tax and spending bill gets distributed from 2026 to 2030. But, 63% of the Medicaid cuts hit after 2030.
www.kff.org/medicaid/iss...

Five Things to Know About Medicare Site-Neutral Payment Reforms | KFF This brief examines key facts around proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site-neutral payment reforms.”

CMS just released its 2026 proposed rule for hospital outpatient payments. Among its proposals: lowering reimbursement for drug administration services at hospitals to the physician reimbursement rate.

Check out our brief to learn more about site neutral policies. www.kff.org/medicare/iss...

Medicare DSH = Disproportionate Share Hospital Payments
Medicare UCC = Uncompensated Care Payments

These are two of many ways that Medicare targets funds to hospitals.

House Reconciliation Bill Could Trigger $500 Billion in Mandatory Medicare Cuts If enacted into law in its current form, and Congress takes no further action, [the House reconciliation bill's] increase in the deficit would trigger mandatory cuts, also known as sequestration, unde...

Along with Medicaid/ACA cuts, the BBB will trigger mandatory Medicare cuts - about $45B in 2026

If cuts are proportional across providers, hospitals could see ~$17B lower Medicare payments in 2026 (larger than Medicare DSH + UCC payments)

Historically Congress has stopped triggered cuts before EOY

Within health care, some subsectors are particularly large - ambulatory health care services and hospitals are the 5th and 6th largest employers in the US.

www.kff.org/key-facts-ab...

The Senate added $50B for rural hospitals. While cutting $155B in rural Medicaid spending.

In addition to 17M losing coverage, more people could be affected.

Hospitals are one of the largest employers and may need to layoff workers given cuts to Medicaid, etc. Fewer hospital workers could lead to reduced quality of care or access for everyone. www.kff.org/key-facts-ab...

Reconciliation Language Could Lead To Cuts in Medicaid State-Directed Payments to Hospitals and Nursing Facilities | KFF The Senate Finance Committee’s reconciliation language would reduce existing state-directed payments to hospitals and nursing facilities over time until they are at or slightly above Medicare rates.  ...

The Senate's proposed limits on state-directed payments are estimated to lower federal spending by almost $150B over 10 years according to CBO's new estimates, which would likely reduce payments to hospitals and nursing facilities in most states.

www.kff.org/medicaid/iss...

10 Things to Know About Rural Hospitals | KFF This brief explores data about rural hospitals’ financial health and stability at a time when Congress is considering potential federal budget cuts. It examines the prevalence of rural hospitals, thei...

About 2/3 of rural hospital closures occurred in states that did not expand Medicaid between 2014 and 2024.

Unclear if the Senate's $25B rural fund would cover losses from Medicaid/ACA cuts but it's only for 5 years and rural hospitals have historically struggled to adapt to financial challenges.

The Senate's new reconciliation language would increase some Medicare payments to hospitals in Alaska and Hawaii. Recently, hospitals in Alaska had some of the highest operating margins, in aggregate. Margins in Hawaii were also above the national average.

www.kff.org/health-costs...

One of the biggest flashpoints for the "One Big Beautiful Bill Act" has been its impact on roughly 1800 rural hospitals, which is why Senate Republicans are proposing a new $15 billion rural health fund. However, there are still questions and concerns about the bill 👇 (1/7)

Reconciliation Language Could Lead To Cuts in Medicaid State-Directed Payments to Hospitals and Nursing Facilities | KFF The Senate Finance Committee’s reconciliation language would reduce existing state-directed payments to hospitals and nursing facilities over time until they are at or slightly above Medicare rates.  ...

Senate Finance language could lead to cuts in #Medicaid state-directed payments for hospitals and nursing facilities in at least 29 states. See new @kff.org analysis: www.kff.org/medicaid/iss...