Massachusetts hospital systems improved their overall financial standing in 2025, though severe disparities remain as smaller community facilities and safety-net providers continue operating under intense financial strain, according to the agency. Andrew Jackmauh, executive director of the agency, noted that while many health systems made progress following years of pandemic-related stress, bankruptcies, and inflation, financial recovery is far from universal.
Mass General Brigham and Boston Children’s Lead Surpluses
Large health systems and specialized pediatric centers reported the largest financial surpluses in the state for 2025. Mass General Brigham, the state’s largest health system and private employer, registered a total margin of $2.38 billion. Boston Children’s Hospital recorded a total margin of $705 million. These stable institutions generally benefit from higher proportions of commercially insured patients and more favorable reimbursement rates, according to industry analysis.
Acute Care Systems Report Operating Struggles
In contrast, six acute hospital health systems ended 2025 in the red. Boston Medical Center (BMC), which operates as the state’s largest provider of medical care to the poor, recorded the largest single deficit at $144.4 million. David E. Williams, president of the Boston management consulting firm Health Business Group, explained that when investment income is excluded, the median health system is merely breaking even on core patient care operations. Over a quarter of acute hospital health systems finished the year with negative total margins, which Williams described as an indicator of underlying systemic vulnerability.
State Funding and Steward Health Care Fallout
Daniel McHale, senior vice president of health care finance and policy at the Massachusetts Health & Hospital Association, attributed the slight overall financial stabilization to a combination of internal spending controls and targeted state appropriations. In September 2025, Governor Maura Healey signed legislation providing $122 million for acute care hospitals serving high percentages of low-income patients, $77 million for the state’s Health Safety Net fund, and $35 million for community and hospital-licensed health centers. Additional transition funds supported systems absorbing facilities left vacant by the collapse of Steward Health Care. For instance, Boston Medical Center assumed operations of two struggling former Steward locations—St. Elizabeth’s Medical Center, now operating as BMC – Brighton, and Good Samaritan Medical Center, now operating as BMC – South—both of which reported severe operating losses.
Impending Medicaid Changes Threaten Stability
Looking ahead, health policy experts warn that narrow margins leave hospitals ill-prepared for upcoming financial pressures. Upcoming reductions in Medicaid eligibility are projected to strip hundreds of thousands of Massachusetts residents of federal health insurance for the poor and disabled. This shift will likely swell the ranks of uninsured patients at safety-net facilities. That anticipated influx compounds existing deficits in the state’s Health Safety Net, a fund used to reimburse hospitals for uncompensated care that reported a $300 million deficit last year. In June, Undersecretary of Health Amy Rosenthal warned that the funding shortfall could reach $600 million by fiscal year 2028, a gap McHale characterized as potentially unmanageable as Medicaid enrollment drops.
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