Moody's Investors Service has placed Harvey, Ill.-based Ingalls Health System's "Baa1" rating on review for downgrade.
The action affects $62 million of debt issued through the Illinois Finance Authority.
It is based on Ingalls Health System's multi-year decline in operating revenue as a result of increased competition, decreasing volumes and a challenging service area with a high reliance on Medicaid reimbursement.
The review for downgrade will focus on Ingalls Health System's proposed affiliation with the University of Chicago Medical Center.