Reforming The Medicaid Disproportionate-Share Hospital Program

Congress and the Obama administration are considering redirecting federal spending on the Medicaid disproportionate-share hospital (DSH) program to help pay for health reform. In this paper, we propose linking federal Medicaid DSH funding to state-level Medicaid enrollment or uninsured populations,...

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Bibliographic Details
Published in:Health Affairs 2009-09, Vol.28 (5), p.w926
Main Authors: McKethan, Aaron, Nguyen, Nadia, Sasse, Benjamin E, Kocot, S. Lawrence
Format: Article
Language:English
Subjects:
At risk populations
Budget deficits
Cost control
Enrollments
Federal budget
Federal funding
Government programs
Health care expenditures
Health care policy
Indigent care
Insurance coverage
Medicaid
Medicare
Studies
Uninsured people
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Summary:Congress and the Obama administration are considering redirecting federal spending on the Medicaid disproportionate-share hospital (DSH) program to help pay for health reform. In this paper, we propose linking federal Medicaid DSH funding to state-level Medicaid enrollment or uninsured populations, or both. This approach could produce as much as $44 billion in federal savings overtime without exposing hospitals to uncertain or across-the-board spending cuts. It could also gradually address state variations in Medicaid DSH funding. We also offer ideas to ensure that DSH spending is more directly connected than it is now to improvements in care for vulnerable populations. [PUBLICATION ABSTRACT]
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.28.5.w926