Chapter 2 updates MACPAC’s analysis on Medicaid disproportionate share hospital (DSH) payments, including allotments to states and payments to hospitals. Congress requires MACPAC to report annually on the relationship between DSH allotments to states and three indicators of the need for DSH funds: (1) changes in the number of uninsured individuals; (2) the amount and sources of hospitals’ uncompensated care costs; and (3) the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income, uninsured, and vulnerable populations.
MACPAC’s new analysis shows that hospital uncompensated care is falling nationally, and much more in states that expanded Medicaid to low-income adults under the ACA than in states that did not expand their programs. But despite these declines in uncompensated care, MACPAC finds that the hospitals serving the highest share of low-income patients (known as deemed DSH hospitals) continued to report negative operating margins before DSH payments in both expansion and non-expansion states in 2014.
To complement its quantitative analyses and better understand the different types of hospitals that receive DSH payments, MACPAC contracted with Urban Institute to profile seven DSH hospitals during the summer and fall of 2016.The profiles illustrate the different circumstances under which these hospitals operate but also show the importance of DSH funds to all of these institutions. The DSH profiles are available here.
From: March 2017 Report to Congress on Medicaid and CHIP