Rural hospitals are essential for providing medical care, jobs, and economic stability to 60 million rural residents. Despite their importance, closures have increased over the past two decades. The federal government supports hospitals treating low-income patients through the Disproportionate Share Hospital (DSH) designation, ensuring financial aid for hospitals with high disproportionate-patient percentages.

Recent legal cases, however, have raised questions about how the DSH formula is applied. This study will survey hospital executives to understand how they are navigating DSH-related losses, where they are employing budget cuts, and the impact of judicial decisions on their ability to provide services. Key informant interviews will be conducted to further explore the survey's findings and identify common themes in how hospitals are adapting to fewer DSH dollars.