Becker’s has reported on 13 health systems that have received credit rating upgrades from Fitch or Moody’s so far in 2026, and despite differences in size, geography and tax status, the systems share many of the same strengths.
Here is what the upgraded systems share:
Sustained operating improvement. Nearly every upgrade led with a multiyear run of better margins and cash flow. Fitch cited Chattanooga, Tenn.-based Erlanger Health System’s “sustained operating improvement” and Kerrville, Texas-based Peterson Health’s results beating budget through the first nine months of fiscal 2026. Moody’s noted that Greenville, S.C.-based Prisma Health’s EBITDA reached 9.7% in fiscal 2025, while Marietta, Ga.-based Wellstar Health System posted a 10.6% operating cash flow margin through the first half of fiscal 2026.
Resilience to federal Medicaid and supplemental funding cuts. As the effects of HR 1 loom, Moody’s and Fitch noted the systems are well-positioned to handle those pressures. The Cincinnati-based Christ Hospital Health Network and Peterson Health were cited for low Medicaid exposure. Prisma, Kettering (Ohio) Health and Chapel Hill-based University of North Carolina Health carry heavier government pay reliance, but were upgraded on their ability to manage looming reductions. Fitch said Aurora, Colo.-based UCHealth’s margins should stay strong even with HR 1. Moody’s credited Fort Lauderdale, Fla.-based Broward Health’s push to reduce its reliance on government payers.
Diversification and ambulatory expansion. Broward Health was credited for diversifying revenue and access points, Tampa (Fla.) General Hospital for diversification and high-acuity growth and Prisma for its ambulatory strategy, clinically integrated network and health plan. The only for-profit system on the list, Dallas-based Tenet Healthcare, saw double-digit revenue growth in its high-margin ambulatory segment.
Sun Belt and growth-market geography. The list skews toward fast-growing states. Four upgraded systems are in Florida — Broward Health, Fort Myers-based Lee Health, Sarasota Memorial and Tampa General — alongside systems in Georgia, the Carolinas, Texas, Tennessee and Colorado. Several upgrades cited population growth and expanding service areas as tailwinds. Fitch and Moody’s also noted the systems have leading market positions.
Though the systems shared similarities, many had distinct features. Lee Health’s upgrade followed its conversion from a public entity to a private nonprofit. Broward Health and Sarasota Memorial benefit from property tax support as public hospital districts. Christ Hospital’s nursing college was cited as a workforce advantage.
The upgrades, by system:
- UNC Health (Chapel Hill, N.C.): Moody’s, to “Aa2” from “Aa3,” Jan. 23
- Sarasota Memorial Health Care System (Sarasota, Fla.): Moody’s, to “Aa3” from “A1,” Jan. 29
- Lee Health (Fort Myers, Fla.): Moody’s, to “A1” from “A2,” Jan. 30
- Christ Hospital Health Network (Cincinnati): Moody’s, to “A2” from “A3,” Feb. 3
- Erlanger Health System (Chattanooga, Tenn.): Fitch, to “A” from “A-,” Feb. 4
- UCHealth (Aurora, Colo.): Fitch, to “AA+” from “AA,” March 9
- Tampa General Hospital (Tampa, Fla.): Moody’s, to “A3” from “Baa1,” March 16
- Tenet Healthcare (Dallas): Fitch, to “BB” from “BB-,” March 18
- Wellstar Health System (Marietta, Ga.): Moody’s, to “A1” from “A2,” April 2
- Kettering Health (Kettering, Ohio): Moody’s, to “A1” from “A2,” April 7
- Broward Health (Fort Lauderdale, Fla.): Moody’s, to “A2” from “A3,” May 4
- Peterson Health (Kerrville, Texas): Fitch, to “A+” from “A,” May 7
- Prisma Health (Greenville, S.C.): Fitch, to “A+” from “A,” June 18
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