Mississippi’s hospitals, including Greenwood Leflore Hospital, are bracing for the potential effects of the One Big Beautiful Act, signed into law last summer by President Donald Trump.
Among the law’s sweeping provisions are a $1.1 trillion reduction in federal Medicaid spending and the end of subsidies that lowered the cost of health insurance for those enrolled in plans through the Affordable Care Act marketplace, which will likely increase the number of Mississippians without health insurance.
The end results for Mississippi’s hospitals will be an increase in uncompensated care and a decrease in supplemental payments to hospitals that are currently on par with the average commercial rate but will be dropped down, in staggered steps, to the Medicare rate, meaning hospitals will receive less access to federal dollars.
The more immediate impact, however, will be an increase in uncompensated care from uninsured patients.
Under the federal Emergency Medical Treatment and Labor Act, any hospital that receives Medicare funds is required to treat patients who show up to the emergency room, which has traditionally been a last-resort option for care for those without insurance.
Dawne Holmes
“As levels of uncompensated care rise, you tend to see people delaying treatment until a person may end up needing more urgent care,” Dawne Holmes, chief financial officer for Greenwood Leflore Hospital, said in an emailed statement. “Emergency room usage could be impacted for emergent and non-emergent care.”
According to a report released earlier this week by the Centers for Medicare & Medicaid Services, 307,054 people in Mississippi signed up for health insurance coverage through the federal Health Insurance Marketplace, created by the Affordable Care Act. That’s a 9% decrease from the 338,159 Mississippians who signed up for health insurance on the Marketplace in 2025.
Those who chose to go without health insurance — at least through the Affordable Care Act — can’t solely be blamed for the loss of federal subsidies, said Richard Roberson, president and CEO of the Mississippi Hospital Association (MHA), an organization advocating for its 65 member hospitals throughout Mississippi.
However, within the next few months, the impacts from the elimination of the subsidies will be more clear, Roberson predicts.
“I think it’s reasonable to say because, frankly, we saw the percentage of uncompensated individuals go down when enrollment went up, and I think the inverse will happen when enrollment goes down,” he said. “The percent of people without insurance will go up and the cost of uncompensated care will continue to go up.”
Yet, he said, the most pressing concern for MHA and its member hospitals will be the decrease in supplemental payments to Mississippi’s hospitals through the Mississippi Hospital Access Program (MHAP).
In 2015, Mississippi’s Division of Medicaid established MHAP as a means to provide supplemental payments to hospitals from Medicaid reimbursements. In 2023, the state’s Division of Medicaid was approved to increase the Medicaid reimbursement rate that’s close to the average commercial rate, meaning hospitals received larger reimbursements.
As a result, state funding for MHAP increased from $553 million annually between the 2016 to 2022 state fiscal years to more than $1.5 billion annually between the 2024 and 2026 state fiscal years, according to a April 2025 report from the Center for Mississippi Health Policy.
However, under the Big Beautiful Bill, supplemental payments from MHAP will be brought back down to 110% of the Medicare rate, done annually by 10% reductions each year, beginning by the 2029 federal fiscal year.
Mississippi hospitals are expected to collectively lose $160 million each year during the rate reductions until it evens out, and then the state’s hospitals are expected to lose $600 million to $700 million a year from the lowered supplemental payments, Roberson said.
“Those funds have allowed hospitals to think strategically over the last couple of years about what services to add and can we bring back on physicians that we lost that maybe we couldn’t afford before?” Roberson said. “Now it’s harder to do that when you know these funds that you’ve been getting for two years are about to start going away.”
Because of this, hospitals that had been planning to reintroduce various health service lines, such as labor delivery, may have to put a pause on those plans.
“Any loss in payment is a blow to a small rural hospital that services a high Medicare and Medicaid population,” Greenwood Leflore Hospital’s Holmes said in an emailed statement.
“We offer core services to our community, including general and vascular surgery, orthopedics, ENT surgery, gastroenterology/endoscopy, diagnostic liver testing, neurology, radiation oncology, infusion, laboratory testing, rehabilitation and wellness, radiology diagnostic testing, interventional radiology, cardiopulmonary diagnostic testing, and retail pharmacy. We have no plans at this time to reduce any of these services. Following a survey by the Mississippi State Department of Health, we will also be opening swing bed services.”
John F. Lucas III
Dr. John F. Lucas III, a surgeon, expressed a similar sentiment about a potential loss in payments.
“When there’s a cut in the federal payments, i.e. Medicaid and or Medicare, it disproportionally affects the viability of Greenwood Leflore Hospital compared to areas where there’s a lot of industry,” he said. “We’re at a significant disadvantage in the Delta because of the number of the uninsured… (and) because of the lack of industry and other well-paying jobs” that offer health insurance, Lucas added.
Within the Big Beautiful Bill, Congress did create the $50 billion Rural Health Transformation Fund (RHTF) to help states modernize health care access. Under this federal program, Mississippi’s rural hospitals will receive at least $100 million a year for five years, or through the 2030 federal fiscal year.
It’s unclear so far what the allocation process of these federal monies to Mississippi’s hospitals will look like or whether there’s even a guarantee that this money will be used to support the state’s rural hospitals, according to a fact sheet from MHA. The gains the state’s hospitals will get from RHTF — $100 million annually — also are lower than the expected loss of $160 million annually from the lowered supplemental payments.
Despite the current uncertainties, “we’re hopeful for the Rural Health Transformation Fund, that it will be used to incentivize those rural hospitals, allow hospitals that want to remain independent to remain independent, that if they want to be a part of a system, be part of a system, but really just for them to be able to have the resources to provide their community with their community needs,” Roberson said.
This coverage is supported by a grant from Press Forward Mississippi, part of a nationwide philanthropic effort to strengthen local news so communities stay informed, connected and engaged.
- Gerard Edic is a corps member with Report for America, a national service program that places journalists into local newsrooms. Contact him at 662-581-7237 or gedic@gwcommonwealth.com. You can support his work with a tax-deductible donation at bit.ly/3G7iXiy.
