Forum Session

Medicaid Disproportionate Share Hospital Payments and Health Care Reform
June 19, 2009

Manager

Christie Provost Peters

Summary

Medicaid disproportionate share hospital (DSH) payments provide financial assistance to hospitals that serve a large number of low-income patients, such as people with Medicaid and the uninsured. It is expected that $11.3 billion of the projected $216 billion that the federal government will spend on Medicaid in fiscal year 2009 will be for DSH payments. Over the years policymakers have grappled with a variety of issues regarding Medicaid DSH, including rapid growth in state programs and federal expenditures, questionable methods of raising state matching funds, and inappropriate targeting and use of DSH funds. As state and federal policymakers consider health care reform options, the Medicaid DSH program and use of DSH payments face renewed scrutiny. Some advocate redirecting DSH funds to cover the costs of expanded insurance coverage; others call for changing how DSH payments are made. An option under consideration by the Senate Committee on Finance involves federalizing Medicaid DSH payments with payments to hospitals being determined and paid directly by the federal government instead of the states. This Forum session examined the current Medicaid DSH program, the role DSH funding plays for states and safety net hospitals, and the potential implications for the program under health care reform.

Speakers

A presentation by:
Jim Frizzera, Principal, Health Management Associates

With discussion featuring:
John Curless, Director, Bureau of Coverage and Reimbursement Policy for Medicaid, State of Utah; Peg Burnette, Chief Financial Officer, Denver Health and Hospital Authority; Thomas P. Traylor, Vice President, Federal, State and Local Programs, Boston Medical Center

Slides from the presentations by Mr. Frizzera, Mr. Curless, Ms. Burnette, and Mr. Traylor are available for download. Speakers' biographies are also available.

Related Materials

For more in-depth information, see "Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments" (Background Paper, September 14, 2004).

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