Medicaid cuts could close Virginia’s rural hospitals, Warner warns

U.S. Sen. Mark Warner, Virginia’s senior Democratic senator, has a stark warning about the fallout from possible government spending cuts.

“Depending on how deep the Medicaid cuts go, we could see virtually every hospital west of Roanoke close down,” Warner said Tuesday during a call with reporters.

House Republican leaders hope to cut $1.5 trillion in spending to offset the cost of President Donald Trump‘s tax cuts. In March, the nonpartisan Congressional Budget Office released an analysis that indicated those budget goals can’t be met without cutting spending on Medicaid, a joint federal and state program that helps cover medical costs for low-income Americans.

In Virginia, more than 1.9 million people rely on Medicaid for health care, according to Virginia’s Department of Medical Assistance Services. In 2019, Virginia expanded Medicaid, which meant adults with incomes up to 138% of the federal poverty level were eligible. About 630,000 of the Virginians on Medicaid are those are covered by Medicaid expansion.

For standard Medicaid, the federal government covers a little more than 50% of the cost. For expanded Medicaid, on the other hand, the federal government covers 90% of the cost. Currently, Virginia’s private acute-care hospitals foot the remaining 10% of the cost of expansion.

“In 2025, hospitals will pay $572 million to the state to cover that 10% state share for Medicaid expansion costs,” said Julian Walker, spokesperson for the Virginia Hospital & Healthcare Association (VHAA).

When the General Assembly passed the Medicaid expansion in 2018, it contained trigger language that would end Medicaid expansion in the commonwealth if the federal government elects not to fund 90% of the cost.

“Virginia essentially would withdraw from the program or stop participating in the program,” Walker said.

Carilion Clinic, which is based in Roanoke, declined to comment on this story. A spokesperson for Tennessee-based Ballad Health, which serves Southwest Virginia, did not respond to a request for comment.

However, Walker pointed to a piece of data in a 2024 report by the VHHA: In 2022, 36% of all rural hospitals in Virginia operated in the red, according to a 2024 report by the VHHA.

Nearly three-fourths of patients at those hospitals are on Medicare or Medicaid, according to the report.

If the federal government cuts Medicaid, there is still a federal law that mandates that patients receive emergency services regardless of  ability to pay.

“Medicaid reimbursements are inadequate, but that reimbursement is still some compensation for care,” Walker said.

Medicaid cuts, Walker added, would “pose the risk of significant harm to patients, to the economy, to health care access and to health care providers.”