Multiple hospitals and health systems have suffered downgrades to their financial ratings this year amid rising expenses, ongoing operating losses and challenging work environments.
Here are 28 hospitals and health systems that received credit rating downgrades from Fitch Ratings or Moody’s Investors Service in 2025:
Ascension’s rating was downgraded to “AA” from “AA+” by Fitch. The downgrade reflects the St. Louis-based system’s improving but still rebounding operating results, Fitch said. The ratings agency noted that Ascension’s performance materially improved in 2025 and is trending favorably, but not at the level it deems adequate for the higher rating.
Boone Health’s rating was downgraded to “B2” from “B1.” The downgrade reflects the Columbia, Mo.-based system’s continued unrestricted cash losses over multiple years and a protracted pace of operating cash flow recovery. The system has a negative outlook at its new rating.
Cabell Huntington (W.Va.) Hospital’s rating was downgraded to “Ba1” from “Baa3” by Moody’s. The downgrade reflects the system’s very weak liquidity levels, as well as the risk of a potential breach of the days cash on hand covenant if anticipated Direct Payment Program funds are not received by the end of fiscal 2025, Moody’s said. Cabell has a negative outlook at its new rating.
Children’s Hospital Los Angeles’ rating was downgraded to “Ba1” from “Baa3” by Moody’s. The downgrade reflects a “material decline in liquidity and operating performance in excess of expectations from” Moody’s most recent review, the agency said. A key driver of the weak performance is the system’s heavy reliance on state funding due to its significant Medicaid exposure. The rating remains under review for a further downgrade.
Christus Health’s rating was downgraded to “A2” from “A1” by Moody’s. The downgrade reflects a decline in the Irving, Texas-based system’s already modest relative liquidity and higher balance sheet leverage, Moody’s said. The agency added that those will be difficult to improve as the system potentially finances growth strategies.
Community Health System’s rating was downgraded to “A3” from “Baa1,” by Moody’s. The Fresno, Calif.-based system has made operating performance improvements, but will remain subject to significant headwinds that will result in margins that remain modest compared to peers and below historical averages, Moody’s said.
Crouse Health’s rating was downgraded to “B” from “B+” by Fitch. The downgrade reflects the Syracuse, N.Y.-based system’s persistent financial and operating pressures through mid-2025, as well as uncertainty regarding its ability to secure alternate funding to replace reduced New York State Directed Payment Template revenues, Fitch said. The system has a negative outlook at its new rating.
Frederick (Md.) Health’s rating was downgraded to “BBB” from “BBB+” by Fitch. The downgrade reflects a slower-than-expected recovery in its operating performance since fiscal 2022, Fitch said.
Greater Baltimore Medical Center’s rating was downgraded to “A” from “A+” by Fitch. The downgrade reflects continued operating losses at the Towson, Md.-based system, resulting in sustained weakened leverage metrics in fiscal 2024 that have not recovered as expected, Fitch said. The system has a negative outlook at its new rating.
Harris Health’s rating was downgraded to “AA-” from “AA” by Fitch. The downgrade reflects the Houston-based system’s increased leverage associated with current and planned future bond issues and execution risk associated with its “sizable” capital spending plans, which are larger than Fitch’s previous expectations.
Heritage Valley Health System’s rating was downgraded to “A-” from “A” by Fitch. The downgrade reflects the Beaver, Pa.-based system’s wider-than-anticipated losses in fiscal 2024 with financial pressure expected to extend through the end of fiscal 2025, Fitch said.
Holy Redeemer Health System’s rating was downgraded to “B+” from “BB-” by Fitch. The downgrade reflects the Meadowbrook, Pa.-based system’s ongoing operating pressures, with an operating deficit continuing year to date in fiscal 2025 despite ongoing improvement initiatives that are beginning to yield results.
Hunt Regional Healthcare’s rating was downgraded to “Ba3” from “Ba1” by Moody’s. The downgrade reflects the Greenville, Texas-based system’s continued distressed financial position, leading to negative operating margins and extremely narrow liquidity, Moody’s said. The system has a negative outlook at its new rating.
John Fitzgibbon Memorial Hospital’s rating was downgraded to “C” from “CCC-” by Fitch. The downgrade reflects the Marshall, Mo.-based system’s ongoing financial losses, which caused it to miss its debt service coverage covenant in fiscal years 2024 and 2025.
Legacy Health’s rating was downgraded to “A2” from “A1″ by Moody’s. Portland, Ore.-based system’s downgrade reflects “persistently weak operating performance that, while improving, will remain well below industry averages at least through fiscal 2027,” Moody’s said. The downgrade follows the termination of Legacy Health’s proposed merger with Portland-based Oregon Health & Science University in May.
Lompoc (Calif.) Valley Medical Center’s rating was downgraded to “Baa1” from “A3” by Moody’s. The downgrade is driven by the system’s narrowing liquidity that resulted primarily from cash funding of its capital needs, Moody’s said.
Memorial Health System’s rating was downgraded to “B” from “B+” by Fitch. The downgrade reflects the Marietta, Ohio-based system’s weak net leverage profile through Fitch’s forward-looking scenario analysis, due to its stated growth and spending objectives.
Methodist Le Bonheur Healthcare’s rating was downgraded to “Baa1” from “A3” by Moody’s. The downgrade is driven by the Memphis, Tenn.-based system’s new supplemental funding estimates that are materially lower than previous levels, which will exacerbate operating challenges and IT conversion-related accounts receivable issues, Moody’s said.
MetroHealth’s rating was downgraded to “Baa3” from “Baa2” by Moody’s. Moody’s said the downgrade is driven by the Cleveland-based system’s slower-than-expected pace of operating improvement, which has led to a decline in liquidity. The system’s outlook remains negative at its new rating.
Norman (Okla.) Regional Health System’s rating was downgraded to “Caa2” from “B1” by Moody’s. The downgrade reflects the system’s lack of financial flexibility, with weak liquidity equivalent to 15 to 20 days cash on hand, Moody’s said. Cash is entirely reliant on a fully drawn bank line, which increases the likelihood of default and a low recovery value
Northern Regional Hospital’s rating was downgraded to “Caa1” from “B2” by Moody’s. The downgrade reflects the Mount Airy, N.C.-based hospital’s “rapid cash deterioration” and challenges to stem operating cash flow losses amid a prolonged period of severe financial stress, Moody’s said.
Palomar Health’s rating was downgraded to “Caa1” from “B2” by Moody’s. The Escondido, Calif.-based system’s downgrade reflects “further thinning of liquidity resulting in 15 to 20 days cash on hand and limited ability to meaningfully improve given ongoing significant cash flow losses,” Moody’s said.
Providence’s credit rating was downgraded to “A3” from “A2” by Moody’s. The ratings agency said that despite incremental improvement over the past two years, the Renton, Wash.-based system’s margins will remain under pressure in the near term due to unfavorable conditions in many of its markets, including union pressure, continued labor shortages, nurse staffing mandates, increased minimum wages, challenging reimbursement and Oregon’s new presumptive charity law.
Regional West Health Services’ rating was downgraded to “CCC” from “B-” by Fitch. The downgrade reflects the Scottsbluff, Neb.-based hospital’s persistent operating challenges, which led to continued negative cash flow generation in fiscal 2025, Fitch said. Management is aggressively implementing turnaround strategies, but the hospital remains strained as it works to reduce reliance on high-cost agency labor.
ScionHealth’s rating was downgraded to “Caa3” from “Caa2” by Moody’s. The downgrade reflects Moody’s view that the Louisville, Ky.-based system’s weak liquidity elevates the probability of default, and the agency expects that debt recovery rates will be lower. Moody’s anticipates that financial expenses will remain elevated, pressuring cash flow and liquidity.
University Hospitals’ rating was downgraded to “A3” from “A2” by Moody’s. The downgrade reflects the Cleveland-based system’s continued weak financial performance over a protracted period and modest liquidity, despite improvements, Moody’s said. The ratings agency said the health system has a limited cushion to absorb potential federal funding costs or investment market volatility.
UofL Health’s rating was downgraded to “BBB” from “BBB+” by Fitch. The Louisville, Ky.-based system’s downgrade was due to a weaker-than-expected financial performance in fiscal 2024 and a slow anticipated recovery over the coming years, Fitch said.
Westchester County Health Care Corp. and Charity Health System’s rating was downgraded to “Caa1” from “B1” by Moody’s. The Valhalla, N.Y.-based system’s downgrade is due to very weak liquidity that is increasingly reliant on short-term bank lines and loans, Moody’s said. The system has a negative outlook at its new rating.
