CLEVELAND, Ohio — MetroHealth System is stepping up efforts to get more patients signed up for health insurance as the hospital faces a staggering financial challenge: charity care now costs the health system more than $1 million every single day.
The move comes as MetroHealth, Cuyahoga County’s safety-net hospital, battles steep operating losses and uncertainty about future funding. Leaders say the solution lies in connecting more uninsured patients to Medicare, Medicaid, or marketplace insurance plans, reducing the financial burden of uncompensated care.
Why MetroHealth Is Making the Push
MetroHealth officials revealed during a recent board meeting that charity care expenses have doubled since 2022. In 2021, the hospital spent about $176 million on free or reduced-cost care. By 2024, that figure ballooned to $276 million, and halfway through 2025 the system has already spent $184 million.
“MetroHealth is experiencing an unprecedented and unexpected surge in the cost of care for Greater Cleveland’s uninsured,” the health system said in a statement.
Board Chair Dr. E. Harry Walker emphasized that helping patients enroll in coverage will make healthcare costs more equitable, ensuring that federal aid is focused on those with the “biggest and deepest needs.”
The Role of Community Partners
While details of the initiative have not yet been made public, MetroHealth says it will work with local partners to guide uninsured patients through the often-confusing enrollment process. The effort will focus on Medicare, Medicaid, and the Affordable Care Act Health Insurance Marketplace, which allows people to compare and purchase health insurance plans.
What Is Charity Care — and Who Qualifies?
By law, nonprofit hospitals like MetroHealth must provide charity care in order to keep their tax-exempt status. Charity care includes free or discounted services for patients who meet certain income requirements and cannot afford treatment.
MetroHealth currently uses a sliding scale based on federal poverty guidelines to determine eligibility. Some patients qualify for a 100% reduction in medical bills, while others receive partial discounts depending on income level and residency status.
Financial Struggles Continue in 2025
MetroHealth’s financial challenges run deeper than charity care alone:
The hospital reported an operating loss of $33.7 million for the first seven months of 2025.
Total operating expenses in June 2025 were higher than in the same month the previous two years.
Although revenue has increased — from $156.7 million in June 2023 to $171.5 million in June 2025 — it hasn’t kept pace with rising costs.
The share of patients paying out-of-pocket has grown from 5.2% in 2021 to 6.8% in 2025.
Meanwhile, the number of patients covered by Medicaid has fallen sharply, dropping from 43.5% in 2021 to just 26.2% in 2025.
Medicaid Cuts Add More Pressure
Adding to the strain, recent federal policy changes are expected to reduce Medicaid coverage nationwide. Earlier this summer, Congress passed what experts are calling the largest Medicaid cuts in the program’s 60-year history. Analysts warn the cuts — nearly $1 trillion over 10 years — could leave more than 11 million Americans uninsured.
With 30% of Cuyahoga County residents already on Medicaid (the second-highest rate in Northeast Ohio), the reduction in coverage is expected to drive more uninsured patients to MetroHealth’s doors.
Here’s how Medicaid enrollment in Cuyahoga compares with nearby counties:
Ashtabula County: 31%
Cuyahoga County: 30.2%
Summit County: 27%
Lorain County: 23%
Portage County: 19%
Lake County: 16%
Medina County: 12%
Geauga County: 8.9%
The Bottom Line
MetroHealth’s effort to sign up uninsured patients for health coverage is not just about cutting costs — it’s about survival. With daily charity care expenses topping $1 million and federal Medicaid cuts looming, the system faces one of the most difficult financial periods in its history.
For Cleveland-area residents without health insurance, MetroHealth’s new enrollment initiative could provide a lifeline — one that ensures both better access to care and greater stability for the hospital that serves as the region’s safety net.