Some of Oklahoma's rural hospitals and nursing homes with a large number of Medicaid operate on a shoestring. Any changes in regulations could have drastic impact on their bottom lines.

Those hospitals and nursing homes could see further reductions in federal Medicaid funds under a plan proposed to save nearly $4 billion over the next five years.

The issue, according to the Associated Press, is the financing arrangements between states and the federal government. Some poor states receive a greater federal share.

In some states, the AP reports, the financing arrangements between health care providers and the state result in the provider being paid more than the law allows.

The new plan would limit such instances and hospitals and nursing homes would then look to the state to make up the lost revenues. The trouble is, most states are already tapped when it comes to health care funding.

The proposed rule, announced last week, will be the subject of comments for the next 60 days. In announcing the proposed change, the government acknowledged a significant economic impact on a number of health care providers that are part of governments.

Nearly 1,200 hospitals are operated by local governments or hospital districts. Another 1,000 nursing homes or intermediate care facilities also would be impacted.

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