Senate Republicans are taking Medicaid cuts even further than their House counterparts with legislation that targets hospital payments.

The Senate’s deep cuts to Medicaid in the tax and spending megabill are setting off alarm bells among some Republicans, complicating leadership’s effort to get the legislation passed by July 4. It seeks to clamp down on two tactics states use to boost Medicaid funding to hospitals: state-directed payments and Medicaid provider taxes.

The Senate's revisions to the 'One Big Beautiful Bill Act' (OBBBA) extend beyond mere fiscal adjustments, reshaping Medicaid and threatening the survival of rural hospitals.