Higher spending on chronic diseases, weight-loss drugs and hospital bills helped drive the increase.

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State officials threatened to withhold public money from hospitals, pioneering a strategy that could become a national model.

PEPFAR’s computer systems also are being taken offline, a sign that the program may not return, as Republican critics had hoped.

Pepfar, which is estimated to have delivered lifesaving treatment to as many as 25 million people in 54 countries, faces a funding delay of as long as 180 days.

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US nonprofit hospitals are required by law to have a charity care policy, but hospitals have significant discretion in determining specific eligibility criteria. Using a novel national database, this ...