A growing number of health systems are continuing to push across state lines through acquisitions, affiliations and new facilities, as they seek greater scale, broader population bases and stronger regional footprints.
Cross-market transactions have become an increasingly prominent growth strategy, offering systems opportunities to diversify risk and strengthen negotiating leverage while financially challenged hospitals and portfolio exits create openings in new markets.
Here are nine health systems that have announced, advanced or completed significant cross-state expansions this year:
1. CaroMont Health plans its first South Carolina hospital
Gastonia, N.C.-based CaroMont Health plans to build its first South Carolina hospital, a neighborhood facility in the Lake Wylie community of York County.
The system bought land and projects a 2031 opening. The hospital would include an emergency department, short-stay inpatient and observation units, surgical and endoscopy services and imaging and laboratory departments. Higher-acuity patients would have access to CaroMont Regional Medical Center in Gastonia and the broader CaroMont network.
The project builds on CaroMont’s existing South Carolina presence. The system has provided care in York County for more than 20 years through physician practices in seven specialties, including cardiology, neurology and OB-GYN. President and CEO Chris Peek said adding emergency and hospital care is “a natural next step.”
2. Prisma Health expands deeper into Tennessee
Greenville, S.C.-based Prisma Health plans to acquire Chattanooga, Tenn.-based Erlanger Health to its system under a nonbinding letter of intent.
The proposed transaction would add Erlanger’s seven hospitals to Prisma’s 20-hospital system and includes $2 billion in planned capital investments across the Chattanooga region. The organizations are working toward a definitive agreement.
The deal would deepen Prisma’s Tennessee footprint rather than mark its entry into the state. Prisma acquired Maryville, Tenn.-based Blount Memorial Hospital in 2024. If the Erlanger transaction closes, Prisma would become a 27-hospital system spanning South Carolina and Tennessee.
Prisma completed its first out-of-state acquisition in December 2024 when it took over Blount Memorial Hospital, a 304-bed, former county-owned facility in Maryville, Tenn.
3. Sutter Health plans Midwest expansion
Sacramento, Calif.-based Sutter Health and Minneapolis-based Allina Health have signed a letter of intent for Allina to join Sutter, which would give Sutter its first operations outside California.
The combined nonprofit system would span California, Minnesota and Wisconsin, with about $26 billion in annual revenue, 39 hospitals, more than 400 care sites and 88,000 employees.
The transaction is expected to close by the end of 2026, pending regulatory approval. Allina would become Sutter’s Upper Midwest division while retaining its brand, board and Minneapolis headquarters.
4. Sanford Health expands in Minnesota
Sioux Falls, S.D.-based Sanford Health finalized its partnership with Robbinsdale, Minn.-based North Memorial Health Sept. 1, creating a 60-hospital nonprofit health system.
North Memorial is now part of Sanford and will anchor a new Twin Cities care delivery region. The transaction expands Sanford from 58 to 60 hospitals and brings its workforce to about 61,000 employees. The combined system serves about 2.5 million patients and includes 310 clinic locations, 145 senior care communities and 4,950 physicians and advanced practice providers.
Sanford plans to invest more than $600 million across Minnesota, including about $100 million at Robbinsdale Hospital for deferred maintenance, facility and equipment upgrades and ongoing operations. Another roughly $500 million is planned for Maple Grove (Minn.) Hospital to expand emergency, inpatient, surgical and specialty care capacity.
The transaction also broadens Sanford’s presence in the Twin Cities market, connecting North Memorial’s trauma, emergency medicine and medical transportation capabilities with Sanford’s broader rural footprint and AirMed program.
5. MultiCare Health System moves toward Oregon affiliation
Tacoma, Wash.-based MultiCare Health System is advancing a proposed affiliation with Corvallis, Ore.-based Samaritan Health Services.
The Oregon Health Authority granted conditional approval in August, though two additional state reviews were still required before the transaction could close. The systems hope to close the transaction in the fourth quarter.
The combination would bring Samaritan’s five hospitals under the MultiCare umbrella. MultiCare, a 13-hospital system, has committed to investing $700 million over 10 years in Samaritan’s region for access expansion, recruitment, technology and facility improvements.
6. UPMC plans Ohio hospital-market entry
Pittsburgh-based UPMC signed a definitive agreement to acquire Steubenville, Ohio-based Trinity Health System — a three-hospital system — from Chicago-based CommonSpirit Health.
The transaction would mark UPMC’s entry into the Ohio hospital market. Trinity Health System includes hospital facilities in Steubenville, St. Clairsville and Dennison, Ohio, along with associated clinics.
The definitive agreement followed a nonbinding letter of intent announced in October. The parties said the deal was expected to close in the fall, pending regulatory review and customary closing conditions.
The proposed sale is part of a broader portfolio shift at CommonSpirit, which is also divesting hospitals in North Dakota.
7. Northwell Health expands Pennsylvania footprint
New Hyde Park, N.Y.-based Northwell Health has expanded into Pennsylvania with two primary and immediate care locations in Pike County, the only county in the state without a hospital.
Northwell opened its first Pennsylvania facility in Dingmans Ferry in December 2025, with clinicians beginning to see patients in January. The system opened a second location in Hawley in June.
Northwell spent years studying northeastern Pennsylvania and entered the market at the invitation of local officials, Executive Vice President and COO Kevin Beiner told Becker’s.
“We’re not there as a carpetbagger to bring people out of Pennsylvania into New York,” Mr. Beiner said. “We bring care into communities slowly but surely as we believe we can safely do it, and that’s our preference rather than moving people out of a community to get care elsewhere.”
The system is evaluating additional diagnostic capacity, particularly mammography and gastroenterology services. Behavioral healthcare, addiction medicine and pediatrics could follow. Northwell is also open to hospital partnerships and acquisitions in Pennsylvania.
8. Freeman Health System enters Arkansas
Joplin, Mo.-based Freeman Health System acquired four Arkansas hospitals from Franklin, Tenn.-based Community Health Systems for $110 million June 1, doubling Freeman’s hospital footprint and expanding the system into Arkansas.
The transaction included 222-bed Northwest Medical Center-Springdale, 128-bed Northwest Medical Center-Bentonville, 73-bed Siloam Springs Regional Hospital and 64-bed Willow Creek Women’s Hospital in Johnson, along with associated outpatient centers and physician practices.
The acquisition doubled Freeman’s hospital count from four to eight and made it a four-state operator.
The transaction also marked CHS’ exit from Arkansas as the for-profit system continues to divest hospitals and reshape its portfolio.
9. Prime Healthcare enters Maine, Illinois
Ontario, Calif.-based Prime Healthcare Foundation acquired Lewiston-based Central Maine Healthcare Feb. 16, marking Prime Healthcare’s entry into its 15th state.
The transaction included three hospitals, a cancer center, a heart institute, long-term care and residential facilities, the Maine College of Health Professions and more than 40 physician practices. Prime committed to invest $150 million in Central Maine Healthcare’s facilities, services and infrastructure over five years.
Last year, Prime acquired eight Illinois hospitals from St. Louis-based Ascension, marking its entry into the state. In January, the health system acquired its ninth Illinois hospital and another Illinois hospital from Mishawaka, Ind.-based Franciscan Alliance.
Prime now operates 55 hospitals across 15 states between its nonprofit and for-profit arms.
