Pennsylvania hospitals will lose $17.3 million a year - a hefty amount, though New York will be out three times as much.
Hospitals in seven states will come out ahead, for various reasons. New Jersey's $54.2 million annual gain is the second-biggest, after Massachusetts'.
The news was buried in a Medicare regulation issued Monday and comes at a time when hospitals face more cuts under the newly signed federal debt deal.
Even Medicare says it is concerned about "manipulation" of its inpatient payment rules to create big rewards for one state at the expense of others.
President Obama's health-care overhaul was supposed to lead to reforms in Medicare's byzantine payment system. Critics say this latest twist will encourage the big players to game the system in a scramble for increasingly scarce taxpayer dollars.
The saga of how Massachusetts scored big goes back a few years and twists and turns through Medicare's mind-boggling payment rules that allow for various adjustments. The reclassification of a hospital on the resort island of Nantucket ended up raising reimbursements elsewhere in the state.
Inquirer staff writer Stacey Burling contributed to this article.