The Downcode Record: What July Actually Cost

The record opens here. Four FY 2027 final rules added $2.04 billion to Medicare post-acute payment in the last week of July. The proposals still open take $5.5 billion out in year one, and the Medicaid provider tax rule another $246 billion over a decade. Every change the desk tracked in July, priced, with the date it starts.

Four Medicare payment systems got their FY 2027 rates in the last week of July, and all four landed within a tenth of a point of each other.

Skilled nursing, 2.4%. Hospice, 2.3%. Inpatient rehab, 2.3%. Inpatient psych, 2.3%.

Four provider types, four cost structures, four separately calculated market baskets, and the answers are functionally identical. That is the formula doing its job: a 3.2% market basket estimate (3.3% for SNFs) less a 0.9 percentage point productivity adjustment, every time.

So the finished half of July is uniform, predictable, and small. $2.04 billion across all four rules, on a national base of roughly a trillion dollars.

The unfinished half is neither uniform nor small (chart below).

The rest of this brief is for subscribers.