Implications of ACA Coverage Expansions for Medicaid DSH Policy

This presentation contains preliminary findings on the effects of the Affordable Care Act on uncompensated care, which will help inform MACPAC’s second annual report to Congress on disproportionate share hospital (DSH) payments. MACPAC finds that in 2013 and 2014, uncompensated care fell in states that expanded Medicaid and rose slightly in states that did not expand it. However, safety-net hospital operating margins were still negative in both expansion and non-expansion states, raising the question of whether and how state Medicaid expansion decisions should affect state DSH allotments.