Hospitals are bracing for the impact from the Medicaid cuts in President Trump’s sweeping spending and tax cut law.

While most of the cuts won’t happen immediately, rural facilities in particular say they likely will have to make difficult financial decisions about which services they can afford to keep and which may need to be cut.

Hospitals loudly raised alarms about the legislation, but their warnings went unheeded, and now they say they will bear the brunt of the changes.

The new law cuts about $1 trillion from Medicaid, primarily through stringent work requirements as well as reductions to how states can fund their Medicaid programs through provider taxes and state directed payments.

Rural hospitals rely heavily on Medicaid funding because many of the patients they care for are low income.

“Restrictions on state directed payments and provider taxes cut off critical financial lifelines for hospitals,” Bruce Siegel, president and CEO of America’s Essential Hospitals said in a statement.

“State directed payments are a critical source of support for hospitals, particularly in rural areas, and provider taxes help reduce the gap between Medicaid and other payers, ensuring that physicians can take Medicaid patients and hospitals can be adequately staffed. Cutting these lifelines is not sustainable, and it will harm patients.”

© The Hill