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CLEVELAND, Ohio — While the dollar amount of Cuyahoga County’s annual subsidies for MetroHealth has stayed relatively consistent for a decade, it hasn’t kept pace with inflation when adjusted to 2026 dollars, interim chief financial officer Jeff Rooney said Wednesday. Rooney made the observation during a trustee financial committee meeting prior to the full board approving a proposed $2.2 billion 2026 operating budget, which still requires final approval by Cuyahoga County Council. He pointed to a graph showing how the county’s annual health and human services levy funding remained steady at $32.4 million from 2016 to 2023. But when adjusted to 2026 dollars, the amount dropped from $41.8 million to $32.9 million. “While the dollar amount (of the county’s contribution) has held mostly flat, it’s been eaten up by inflation,” Rooney said. MetroHealth System is projecting a $31 million budget shortfall in 2026, which would be the health system’s fourth straight year of operating losses. It has taken steps to deal with financial headwinds in recent months, including closing medical offices and its Behavioral Health Hospital psychiatric emergency services unit, laying off staff and attempting to reduce its ballooning charity care bill. The health system expects these belt-tightening measures will help it cope with smaller annual subsidies from Cuyahoga County in the future. While the county increased MetroHealth’s subsidy to $35 million over the past two years, County Executive Chris Ronayne is proposing a return to around $32 million next year. It’s part of Ronayne’s plan to cut $24 million in health and human services spending over the upcoming two-year budget cycle— including $8.5 million from the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board and $4.5 million from MetroHealth System, which serves as the county’s safety-net hospital. The health system’s increasing spending on charity care -- which has doubled since 2022 -- is a large part of its fiscal trouble. MetroHealth has spent $275 million on charity care in the first nine months of 2025, matching what it spent in all of 2024. Charity care costs rose 40% from the same period last year, said Patrick Woods, executive director and corporate controller. The increase reflects more patients paying out of pocket — or unable to pay at all. Self-pay revenue climbed from 4.9% in 2023 to 6.6% this year. “It’s no secret we’ve had significant issues associated with (charity care),” Woods said. Lagging patient discharges and surgical cases have left MetroHealth’s net patient revenue $55 million below projections. Still, Woods said cost-cutting measures are beginning to show results. The medical system reported a $6.8 million positive operating income for the third quarter of 2025. MetroHealth’s annual budget has grown steadily from $1.6 billion in 2022 to $2 billion this year. Through Sept. 30, 30% of patient revenue for the year came from commercial insurance, 37% from Medicare, 26% from Medicaid and 6.6% from self-pay. Total operating expenses for 2025 are expected to reach $1.6 billion, up from $1.4 billion last year, with revenue projected to rise 8.3%.
