Medicaid Disproportionate Share Payments (CRS Report for Congress)
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| Release Date |
Revised July 30, 2007 |
| Report Number |
97-483 |
| Authors |
Jean Hearne, Domestic Social Policy Division |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Summary:
Today, a state's DSH payments cannot exceed an allotment amount, calculatedbased on a statutory formula, for that state. States must define, in their stateMedicaid plan, hospitals qualifying as DSH hospitals and DSH payment formulas.DSH hospitals must include at least all hospitals meeting minimum criteria and maynot include hospitals that have a Medicaid utilization rate below 1%. The DSHpayment formula also must meet minimum criteria, and DSH payments for anyspecific hospital cannot exceed a hospital-specific cap based on the unreimbursedcosts of providing hospital services to Medicaid and uninsured patients. DSHpayments for mental hospitals cannot exceed an aggregate cap based on a percentageof such payments in 1995. However, within these broad guidelines, states also havea great deal of discretion in designating DSH hospitals and calculating adjustmentsfor them. For this reason, Congress has required states to report the methods usedto identify and pay DSH hospitals and the payments made to each of the identifiedhospitals. Annual state reporting, however, is not yet being routinely collected by theCenters on Medicare and Medicaid Services (CMS).Congress has intervened a number of times to change various features of theDSH allotments, sometimes to reduce payments below the levels provided for in the1991 legislation and other times to provide additional allotment funds. Statutorychanges are described in this report.
