The One Big Beautiful Bill puts Medicaid supplemental payments on a step-down schedule written into federal law. No hospital CFO in an expansion state needs to guess when the cash hole arrives. They can model it today.
Provider taxes in expansion states drop from 6% to 3.5% of net patient revenue between FY2028 and FY2032. State directed payments step down 10 points per year starting January 2028. That is roughly $340B in program changes with specific dates.
The wrinkle: a meaningful share of Medicaid supplemental revenue already has a 12-18 month tail. The cash hole and the receivable lag stack on top of each other. Existing bank lines were not sized for this.
The fintech that does not exist yet: a specialty lender that underwrites the state program, not the hospital. The moat is Medicaid finance expertise, not balance sheet size. The asset shrinks on a statutory schedule, which is actually good for credit risk.
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