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What CEOs are planning for
In interviews published Sept. 23, leaders of five systems laid out their agendas for next year. Temple Health in Philadelphia is planning for an expected 45% reduction in supplemental Medicaid payments and is responding by adding access points, growing its workforce and automating workflows. Asante, a safety-net system in rural southern Oregon, expects 2027 to bring substantial implementation of HR 1 and a significant Medicaid cut. It plans to lower administrative costs, protect bedside resources and expand primary care, imaging and surgery.
MaineHealth is redesigning care delivery so patients receive care in the right setting and its economic model aligns with outcomes. Meritus Health in Maryland plans to open a personal health institute in 2027 aimed at reaching more than 10,000 community members with genetic screening and assessments. Aspirus Health in Wisconsin named culture as its top priority amid tighter reimbursement and expanding regulation.
The supplemental payment cliff
The Medicaid concern is concrete. Grandfathered state-directed payments are scheduled to begin phasing down in 2028 under HR 1, unless Congress delays the change. These programs have become a major source of support. In second-quarter results reported in August, Universal Health Services raised its expected full-year net benefit from supplemental Medicaid funding to about $1.5 billion, and HCA recognized $400 million in incremental net benefit, largely from a newly approved Florida program. Systems that have come to rely on such payments face a structural gap, not a one-year dip.
From strategy to execution
Several CEOs said the hard part will not be choosing a direction but delivering on it. That rings true for most organizations. Plans built on growth, cost reduction and new care models all depend on management capacity, clear accountability and data that show progress early.
- Size the exposure. Quantify supplemental Medicaid revenue by program and year, and model the phase-down under several timelines.
- Sequence initiatives. Limit the number of enterprise priorities so leaders can staff and track each one.
- Protect the front line. Target administrative cost first, as Asante plans to do, to avoid eroding bedside capacity.
- Set leading indicators. Track access, throughput and cost per case monthly, not only annual margin.
Archive entry for Sep 23, 2026, added Nov. 11, 2026.