MRF Monitor — The Compliance Gap Has Left Texas
Issue 001 • Week of April 20, 2026 • Data as of Apr 20, 2026
Five weeks ago, 11% of Texas hospitals were verifiably publishing machine-readable price files. Today 519 of 573 active TX hospitals (90.6%) are publishing. Every major system — HCA, CHRISTUS, Memorial Hermann, Parkland, CommonSpirit, Ascension, MD Anderson, UT Southwestern, UTMB — is at 90–100%. The compliance story inside Texas is effectively over. The gap has moved to Florida (32.3% compliant) and New York (49.5%), concentrated in independent hospitals and two specific regional systems.
State-by-state, where MRF compliance actually lives in April 2026
| State | Active hospitals tracked | Verified publishers | % compliant | Comment |
|---|
| Texas | 573 | 519 | 90.6% | Compliance story is largely resolved. |
| Florida | 740 | 239 | 32.3% | Independent hospitals + Steward Health + Jackson Health are the gap. |
| New York | 198 | 98 | 49.5% | Independent + some SUNY campuses lag; academic majors comply. |
"Verified publisher" = at least one current mrf_file record with a SHA-256-hashed download from the hospital's own MRF endpoint. Not self-reported; not CMS-attested; actual fetched files on our disks.
Texas — the work is done
| Health system | TX hospitals | Verified publishers | % verified |
|---|
| CHRISTUS Health | 29 | 29 | 100% |
| HCA Healthcare | 25 | 25 | 100% |
| CommonSpirit / CHI | 19 | 19 | 100% |
| Memorial Hermann | 9 | 9 | 100% |
| UT Health / Academic | 11 | 11 | 100% |
| Parkland Health | 3 | 3 | 100% |
| AdventHealth (TX) | 2 | 2 | 100% |
| Tenet Healthcare | 1 | 1 | 100% |
| Baylor Scott & White | 31 | 30 | 96.8% |
| Texas Health Resources | 27 | 26 | 96.3% |
| Ascension Texas | 22 | 20 | 90.9% |
| Houston Methodist | 9 | 8 | 88.9% |
| Independent / Other | 378 | 331 | 87.6% |
| Children's Hospitals (TX) | 6 | 4 | 66.7% |
Florida — the gap that actually exists
| Health system | FL hospitals | Verified publishers | % verified |
|---|
| Baptist Health System (FL) | 24 | 20 | 83.3% |
| AdventHealth | 30 | 24 | 80.0% |
| HCA Healthcare | 55 | 44 | 80.0% |
| Ascension (FL) | 13 | 9 | 69.2% |
| Orlando Health | 13 | 8 | 61.5% |
| Mayo Clinic | 2 | 1 | 50.0% |
| Cleveland Clinic | 8 | 3 | 37.5% |
| Mount Sinai Health System (FL) | 4 | 1 | 25.0% |
| Tampa General | 6 | 1 | 16.7% |
| Baptist Health (FL multistate) | 9 | 1 | 11.1% |
| Jackson Health (FL) | 3 | 0 | 0% |
| Steward Health (FL) | 7 | 0 | 0% |
| Community Health Systems | 2 | 0 | 0% |
| Independent / Other | 563 | 127 | 22.6% |
Three findings that matter
- Texas independents compliance caught up. A month ago "Independent / Other" in TX was at 20.8% verified. Today it is 87.6% — 331 of 378 independent and regional TX hospitals now publish verifiable files. Most are in rural and exurban Texas. This reverses the narrative we published in March.
- Florida independents are the new gap. 563 independent FL hospitals, only 127 publishing — 77.4% dark. Plus Steward Health (7 facilities, zero publishing), Jackson Health (3 / 0), Community Health Systems (2 / 0), and Tampa General (1 of 6). Florida's overall compliance rate (32.3%) is where Texas was at the end of last summer.
- Academic medical centers are now compliant everywhere we tracked. MD Anderson, UT Southwestern, UTMB Galveston, the seven UT Health East Texas facilities, UT Health San Antonio, Stony Brook, SUNY Downstate, Duke, NYU Langone, NY Presbyterian — all publishing. Last month we flagged this as the biggest outlier gap. That reversed fast.
Freshness
Every hospital on the state-by-state tables above was re-checked by the MRF Monitor crawler within the last 7 days. Files were re-downloaded where hashes differ. No self-reported data; every row is a live pull from the hospital's own MRF endpoint.
Why this matters — by role
For self-funded employer benefits teams.
If you have members in Florida, your carrier is negotiating rates in a state where 68% of hospitals still don't publish verifiable files. The same data lever that disciplined Texas rates for the last five months has not yet arrived in Florida. Your in-network spend there is effectively negotiated in the dark.
For employee-benefits brokers.
For your Texas-headquartered clients, rate-transparency leverage is now fully available: 519 hospitals publish, covering every metro. For Florida clients the story is the opposite — 239 of 740 hospitals publish; the cheapest-in-market hospital may or may not be one of them. Broker-level intelligence reports for Florida books require more aggressive data coverage than Texas did, and we deliver that.
For plaintiff's attorneys.
Provably-non-compliant targets have shifted: 501 FL hospitals + 100 NY hospitals now represent documented federal-mandate gaps with SHA-256 audit chains and timestamped crawler logs. Texas still has ~54 non-publishers, but the Florida and New York non-publishing pools are much larger and have not received enforcement attention yet.
For healthcare journalism and policy.
"Texas hospitals went from 11% to 91% compliant in eight months" is the finished-on-Tuesday story. "Florida is still at 32% and one large regional system (Steward) publishes nothing" is the publishable-this-week story. We can supply the named-facility breakdown for either on request.
What we offer
Broker Client Report (single-employer) — from $25,000: For a named self-funded employer's client book, deliver the per-facility verified-publisher status, rate benchmarking for shoppable procedures in their metros, and projected annual savings from steering. Included: a broker-ready PDF plus a raw-data CSV. 7–14 day turnaround.
Multi-Client Broker Engagement — from $100,000: For a broker book of 5–25 self-funded employer clients, deliver the same analysis at scale, plus carrier-specific rate benchmarking (BCBS, UHC, Aetna, Cigna), plus quarterly refresh cadence. Designed for benefit-renewal cycle support. Engagement-based, not subscription.
Compliance Snapshot (one-off) — $7,500: Verified publishing status for up to 25 named hospitals, with tier classification, file-size-weighted substantive-publishing scoring, and SHA-256 audit chain. Board-ready PDF. 48-hour turnaround.
Reply to discuss a broker or employer engagement, or to subscribe to next week's brief.
Next issue
Week of April 27: Florida — the 501 non-publishing hospitals, broken down by metro, system, and commercial-insurance mix. The shape of the data gap in a state where most of it is still missing.