Date of Award

5-1-2026

Embargo Period

12-31-2027

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Dunc Williams

Second Advisor

Kit N. Simpson

Third Advisor

Tim Putnam

Abstract

Hospitals within the United States are facing increasing financial vulnerability due to declining reimbursement, specifically from Medicaid. This study evaluates the impact of Medicaid reimbursement on hospital financial performance as well as the implications of recent federal legislation, H.R.1 (One Big Beautiful Bill Act). A retrospective, longitudinal quantitative design was utilized with hospital Medicare Cost Report data from 2011 to 2024 from the National Academy for State Health Policy (NASHP) Hospital Cost Tool. Descriptive statistics, comparative analysis, trend evaluations, and regression analysis were conducted. A model estimating the effect of a 20% reduction in Medicaid reimbursement on hospital margines was simulated. Findings from the research indicate that hospitals operate at a loss on Medicaid services with a mean Medicaid operating margin of -32.7% but are overall profitable with net profit margins averaging 5.1%. Medicaid margins have remained negative throughout the study period with the lowest margin in 2020 and partial recovery in later years. Simulation results demonstrate worsening Medicaid operating losses and shift from positive to negative overall hospital margins with a 20% reduction in Medicaid reimbursement. Hospitals with a higher Medicaid payer mix are more vulnerable to these financial pressures and declining reimbursement. The study findings highlight the potential risks to hospital financial viability, long-term sustainability, and access to care.

Rights

Copyright is held by the author. All rights reserved.

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Available for download on Friday, December 31, 2027

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