Duke Health Doubles Operating Margin, Boosted by Medicaid State Payments
Duke University Health System's fiscal 2026 financial report shows operating income of $453.1 million, a 5.4% margin, up from 2.5% a year earlier, on total operating revenue of $8.4 billion. Revenue from North Carolina's Healthcare Access and Stabilization Program, a Medicaid state-directed payment program, rose to $603.4 million from $417.2 million, while Medicaid managed care grew to 15.3% of patient service revenue from 13.3%. Expenses also rose sharply, including a 23.2% increase in state provider assessments to $411.6 million, and charity care and self-pay revenue both climbed substantially. Duke flagged that provisions of the One Big Beautiful Bill Act could reduce future Medicaid supplemental payments, including funds from the state-directed payment program, posing a risk to the margin gains reported this year.