Maryland Hospital Global Budget Revenue Tracker

Updated 25 September 2026

Maryland is the only state where every payer pays the same regulated rate for the same hospital service, and where each hospital's total annual revenue is approved before the year begins. The Health Services Cost Review Commission sets those budgets. This tracker follows what each hospital was approved to collect, what it actually collected, and how the state's quality programs moved money between them.

Regulated hospital revenue, FY2026
$24.7 billion
Hospitals reporting regulated revenue, FY2026
61
Change in regulated revenue, FY2017 to FY2026
+44%
Change in inpatient admissions, same period
-15%

Choosing a hospital selects it, zooms the map to it and opens its record in the panel beside the map. Clicking a jurisdiction on the map filters to it.

Figure 1
Location of each hospital reporting regulated revenue in FY2026. Circle area is proportional to regulated revenue. Hospital location is the site of the facility and is not a measure of where patients live: 83.4% of Johns Hopkins revenue came from Maryland residents in FY2026, against 98.6% at Saint Agnes, 4.6 miles away. The Maryland resident share is reported for every hospital in the panel. Four pairs of facilities sit on a shared campus and would be drawn as one circle; each is displaced about 275 metres from the shared point so that both can be seen and selected. Published coordinates are unchanged. Source: HSCRC Revenue and Volume reports; CMS Provider Data; Maryland Office of Health Care Quality facility listings. Coordinates from the US Census Geocoder.

What the map shows

Hospitals reporting regulated revenue, FY2026

Sixty one facilities reported regulated revenue in FY2026, from $7.0 million to $3.5 billion each. They are not all acute general hospitals: the count includes freestanding emergency departments and rehabilitation and psychiatric facilities. The ten largest hold 49% of regulated revenue in the state. Of the 54 whose approved budget HSCRC has published, thirty eight finished FY2026 within 1% of it.

Data repository. Every figure on this page is generated from the published dataset. Source code, tables and release history are held in the project repository. github.com/farzinahmadi/maryland-hospital-data

Facility level

Hospital records

The same 61 hospitals at full precision, filtered together with the map. Column headings sort. Selecting a row loads that hospital's record into the panel above.

Hospital names change across reporting years and are reconciled in the crosswalk table. Seventy five name variants in the financial reports could not be resolved to a facility and are published unchanged in REVIEW_unresolved_hospital_names.csv.

Statewide

Revenue and volume under a global budget

A global budget fixes a hospital's revenue before the year begins, so revenue does not follow admissions. Between FY2017 and FY2026 regulated revenue rose 44% while inpatient admissions fell 15%. The series end at FY2026, the most recent fiscal year for which HSCRC has published a full twelve months; partial year files are not loaded.

Figure 2
Regulated revenue and inpatient admissions
Index, FY2017 = 100
Regulated revenue rose 44% while inpatient admissions fell 15%. Inpatient revenue per admission rose from $17,444 to $30,333 over the same period. Source: HSCRC Revenue and Volume reports, FY2017 to FY2026.
Figure 3
Regulated revenue by payer
Billions of dollars, revenue from Maryland residents
Medicare fee for service Medicare Advantage All other payers
Medicare Advantage accounted for 6.9% of Medicare revenue from Maryland residents in FY2017 and 27.9% in FY2026. HSCRC reports the Medicare splits for Maryland residents only, so this figure covers Maryland-resident revenue alone and sums to 22.9 billion dollars in FY2026 rather than the 24.7 billion above; the difference is revenue earned from patients resident outside the state. Medicaid is broken out separately for the first time in the FY2026 file and is contained within the remaining payer category in every year shown. HSCRC reported Kaiser Permanente separately in its partial year FY2026 file and not in the final one, so Kaiser is not separated here either. Source: HSCRC Revenue and Volume reports, FY2017 to FY2026.
Figure 4
Outpatient share of regulated revenue
Percent of regulated revenue earned in outpatient settings
The outpatient share of regulated revenue has stayed between 40.4% and 42.5% across the period, ending at 41.4%. The remainder is earned in inpatient settings. Source: HSCRC Revenue and Volume reports, FY2017 to FY2026.
Figure 5
Operating margin, all acute hospitals
Percent of net operating revenue, statewide
Operating margin on regulated activities ranged from 4.9% to 9.7% over the period shown, against 0.0% to 4.0% across all activities. Eighteen of twenty three annual reports yielded usable tables. The series begins at FY2005 because that is the earliest fiscal year recoverable from the reports that parse: the FY2003 to FY2006 reports themselves yield nothing, and FY2005 and FY2006 survive only as restatements inside the FY2007 report. The line breaks at FY2013: that report parses, but it does not carry the statewide figures the margin is computed from. Source: HSCRC Hospital Financial Condition Reports, FY2005 to FY2025.

Reference

How Maryland pays its hospitals

Maryland has set hospital rates for every payer since 1977 and has paid hospitals under global budgets since 2014. The notes below describe how a budget is set, what moves it during the year, and where the figures on this page come from.

1. Rate setting, 1977

One price per service, paid by every payer

In most states a hospital and an insurer negotiate the price of each service privately, and the price differs by insurer. Maryland sets a single rate for each service at each hospital, paid by Medicare, Medicaid, commercial insurers and self paying patients alike. Five states received a federal waiver to operate such a system. Maryland is the only one that retains it.

2. Global budgets, 2014

From price per service to revenue per year

Rate setting governs the price of a service but not the number of services delivered. In 2014 the unit of regulation changed: each hospital is now assigned a total annual revenue in advance. Revenue does not fall when admissions fall, and does not rise when they rise.

3. The Commission

Who sets the budgets

The Health Services Cost Review Commission is an independent state agency established in 1971 and governed by seven commissioners appointed by the governor. Its statutory objectives are to constrain hospital cost growth, maintain hospitals' financial capacity to deliver care, and improve the equity of hospital financing. It meets monthly and publishes its materials.

4. Scope

What a global budget does and does not cover

The budget covers regulated hospital services. It does not cover physician practices, most hospital owned outpatient clinics, retail pharmacy or post acute care. In FY2025 Maryland hospitals reported $22.4 billion in regulated gross revenue and $25.2 billion in total gross revenue; the difference, about 11%, is unregulated activity. These two figures are gross revenue taken from the Financial Condition Reports for FY2025. They are a different measure, from a different source and a different year, than the FY2026 regulated revenue reported at the top of this page, and the two should not be read as a change over time.

5. The annual cycle

When budgets are set

Hospital fiscal years run from 1 July to 30 June. The update factor, which determines the permitted growth in each hospital's budget, is drafted in the spring and approved by the Commission in June, taking effect on 1 July. Rate Year 2027, whose final recommendation was published in June 2026, is the update in effect for the year that began on 1 July 2026. May and June are the months in which public comment on it is taken.

6. Federal agreement

From the Total Cost of Care Model to AHEAD

The Maryland Total Cost of Care Model ran from 1 January 2019 to 31 December 2025. Maryland entered the AHEAD Model on 1 January 2026 as a first cohort state. AHEAD retains hospital global budgets and adds a primary care payment track. Connecticut, Hawaii, Rhode Island and New York begin in 2028; the model runs through 2035. Vermont also took part and withdrew in July 2026. This paragraph describes the position as of 25 September 2026.

Glossary of terms used in HSCRC documents
Global budget. The total revenue a hospital may collect in a fiscal year, set in advance.
Update factor. The permitted annual growth in global budgets, approved each June.
Regulated and unregulated. Regulated activity falls under the global budget; unregulated activity does not.
Rate center. A category of hospital service carrying its own rate. Revenue and volume are reported by rate center.
ECMAD. Equivalent case mix adjusted discharge, the workload unit used to compare hospitals treating different case mixes.
EIPA. Equivalent inpatient admission, an earlier workload measure used in the financial condition reports.
PAU. Potentially avoidable utilization, hospital use considered preventable through care delivered elsewhere.
MHAC. Maryland Hospital Acquired Conditions, a revenue adjustment based on complications arising during care.
RRIP. Readmissions Reduction Incentive Program, a revenue adjustment based on 30 day readmissions.
QBR. Quality Based Reimbursement, a revenue adjustment based on clinical process and patient experience measures.
TCOC. The Maryland Total Cost of Care Model, in effect 2019 to 2025.
AHEAD. The federal model that succeeded it in January 2026, designed for adoption by additional states.

Reference

Where these decisions are made

HSCRC conducts most of its analytical work in standing workgroups that meet before matters reach the Commission. Meeting materials, schedules and recordings are published on the Commission's site.

  • Payment Models. Structure of global budgets and the annual update.
  • Performance Measurement. The quality programs that adjust hospital revenue.
  • Total Cost of Care. Spending across the system rather than hospitals alone.
  • Standing groups also cover free care refunds, emergency department length of stay and community benefit reporting.

Workgroups meet monthly or bimonthly and reserve time for questions from attendees; written comments are accepted outside meetings. The Commission itself meets monthly at 4160 Patterson Avenue, Baltimore, and online, and posts materials before each meeting.

Dataset

Published tables

Every figure on this page is rebuilt from HSCRC's own published files by a documented pipeline. Each release carries a build report recording row counts, validation warnings and the name of every source file used.

Revenue and volume

What each hospital collected, as reported to HSCRC.

Statewide totals, one row per fiscal year10 rows · 29 columns
One row per hospital per fiscal year598 rows · 28 columns
Split into inpatient and outpatient1,129 rows · 25 columns
The underlying monthly filings, by rate center308,207 rows · 37 columns
Approved budgets and adjustments

What each hospital was permitted to collect, and the programs that moved it.

Approved mid year and year end targets, by rate year461 rows · 7 columns
MHAC, PAU, RRIP and QBR adjustments, by hospital and rate year1,805 rows · 9 columns
Hospital finances

Margins and the statements behind them, from the published reports.

Hospital by fiscal year, from the Financial Condition Reports1,332 rows · 52 columns
Statewide totals from the same reports21 rows · 47 columns
Earlier years, extracted from the Disclosure Reports540 rows · 56 columns
Reference and provenance

What you need to join the tables and to check the extraction.

Names, CCN, jurisdiction and system for every facility66 rows · 18 columns
Rate center service code definitions82 rows · 11 columns
Which report yielded which table, and which did not23 rows · 7 columns
Names that could not be resolved, published unresolved75 rows · 7 columns
Cells where one report gives two values, published for review400 rows · 10 columns
Get the data

Everything above in one archive: 14 tables, 314,749 rows, 18 MB. Each table is a CSV with a header row. A data dictionary defines every column, a manifest carries row counts and checksums, and a source manifest names every HSCRC document the tables were built from.

The compiled data are licensed CC BY 4.0; the pipeline, the documentation and this page are MIT licensed. The pipeline is public, so any figure on this page can be traced back to the filing it came from.

Download the dataset Browse the repository Data dictionary Source manifest

Citation

Cite the dataset rather than this page.

Ahmadi, F. (2026). Maryland Hospital Global Budget Revenue: a compiled dataset from Health Services Cost Review Commission filings (Version 0.1.2) [Data set]. Zenodo. https://doi.org/10.5281/zenodo.22947752

Dataset

Notes on use

  1. Only complete fiscal years are shown. Every series ends at FY2026, the most recent year for which HSCRC has published a full twelve months. Partial year files are not loaded, because a partial year cannot be compared with a complete one.
  2. Payer volume exceeding total volume is flagged, not corrected. Some rows report a payer's volume as larger than the total volume for the same cell. These values are as published by HSCRC and are retained with a flag rather than corrected; the affected row counts are in the build report.
  3. Regulated revenue is not total health care spending. It excludes physician services, prescription drugs, post acute care and all unregulated hospital activity.
  4. Four rate center codes are undefined. EK2, EM2, LA2 and unqualified OID appear in the reported data and are not defined in any HSCRC document consulted.
  5. Presence in the data is not a measure of operating status. The source files record first and last reporting year but carry no status field. Aberdeen fell from $120M in FY2022 to $42M in FY2026 because the inpatient hospital converted to a freestanding facility, not because demand for it fell.
  6. Financial reports are incompletely machine readable. Eighteen of twenty three annual reports yielded usable tables. FY2003 to FY2006 produced none, and FY2008 is a scanned image without a text layer, recovered from the FY2009 report's restatement.
  7. Budget adherence compares two published constructs. Realized regulated revenue from the Revenue and Volume reports is set against the approved year end target from the rate order file for the matching rate year, which covers the same twelve months. The two are treated as commensurable; across hospitals the median difference is close to zero, which supports that treatment without proving it. The one percent band used on this page is a reporting choice, not an HSCRC threshold.
  8. Some inpatient and outpatient figures are inferred. A hospital reporting in only one setting has no row for the other. The missing side is recorded as zero only where the reported side already accounts for the whole of that hospital's regulated revenue, and is left unknown otherwise.
  9. Nine rate center codes are inferred rather than defined. Beyond the four undefined codes above, nine are read from a documented naming convention rather than from a definition. The source of every code is recorded per code in the rate center reference table.
  10. Negative values appear in the source and are retained. Some monthly rows carry negative revenue or volume, normally a correction to an earlier month. They are flagged, not removed.
  11. Coordinates are not all equally sourced. Most come from the US Census geocoder against a licensed facility address. Eight were placed by hand where the address postdates the geocoder's road file, and one facility's site is inferred from its first reporting year rather than from a published address.
  12. An earlier financial series is provisional. The per hospital operating margin shown for FY2007 to FY2018 in the hospital record comes from PDF extraction of the older Disclosure Reports. Its column labels are the reports' own, flattened, and most have not been reconciled line by line against the source. Values are as printed.

About

Purpose and scope

Maryland's hospital payment system is documented in detail by the Health Services Cost Review Commission, but the underlying figures are distributed across spreadsheets and scanned reports that are difficult to use without substantial preparation. This tracker compiles those filings into a single documented dataset and presents the resulting series.

The tracker is descriptive. It reports what the Commission has published and does not evaluate the performance of the global budget system, assess individual hospitals, or advance a policy position. Analyses that do so are published separately and cite this dataset as a source.

Update schedule

The HSCRC and CMS source pages are reviewed on a monthly cycle. The dataset is rebuilt when a new file is posted, and each rebuild is versioned. Approximate publication times for the underlying sources:

Revenue and volume, final full yearSeptember to October
Revenue and volume, partial year updatesQuarterly
Hospital Financial Condition ReportAround May, covering a year ended 23 months earlier
Casemix weights and ECMADAnnually, by rate year

Current holdings: revenue and volume through FY2026, a complete fiscal year; financial condition through FY2025. Sources last checked against HSCRC on 18 September 2026. Page last rebuilt 25 September 2026.

Compiled by

Farzin Ahmadi, Assistant Professor of Healthcare Management, Towson University.

This project is not affiliated with, endorsed by, or speaking for the Health Services Cost Review Commission. All figures are derived from files published by HSCRC and CMS; HSCRC is the system of record. Corrections are welcome and are recorded in the release history.