While most of the provider aid has been distributed, the Biden administration is expected to begin distributing the remaining funds, which are valued at $ 25 billion of the original $ 178 billion, said McDermott vice president Kristen O’Brien + Consulting in Washington, DC Hospitals are demanding more time to spend the money.

How the help was issued is not fully documented. While the larger hospital networks aggressively sought funding from the start, smaller organizations, children’s hospitals and those in rural areas, or caring for large numbers of low-income patients, had more difficulty obtaining help due to the structure of the funding formula.

In a later round of funding decisions, Department of Health and Human Services officials scrutinized applications more closely and reduced or in some cases denied applications, Ms. O’Brien said.

The grants granted after the first rush were more targeted at hospitals in Covid hotspots or rural areas. Some big chains, including HCA Healthcare and the Mayo Clinic, returned at least some of the money after it was revealed that wealthier hospitals received far more help while reporting healthy profits.

Overall, the aid program prevented hospitals from closing, said Ken Marlow, an attorney at K&L Gates in Nashville who advises hospitals. “We have not launched a real avalanche of these distressed hospitals.”

However, some may no longer be able to withstand takeovers or mergers. “These providers may be more distressed due to the stress of the pandemic and need to think about the future and their survival,” said Torrey McClary, attorney at Ropes & Gray, who also advises hospitals.