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The federal government will pay hospitals that treat poor and uninsured patients almost $1 billion less next year, a cut that’s more than eight times larger than the one proposed in April.

The Centers for Medicare and Medicaid Services originally said it would cut payments meant to help safety net hospitals by $115 million in 2024. In the final rule released this week, however, that cut grew to $957 million. The pool of money is known as Medicare’s disproportionate share hospital (DSH) payments and uncompensated care payments.

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The agency finalized a bigger cut because it lowered its estimated uninsured rate for next year. CMS explained that even though Medicaid enrollment will shrink as states redetermine members’ eligibility, many of those who didn’t lose Medicaid coverage during the pandemic have since gotten or will get insurance from other sources, like employers — and therefore they will remain insured even when they’re kicked off Medicaid.

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