Medicaid: Managed Care and Individual Hospital Limits for Disproportionate ShareHospital Payments

摘要

Disproportionate share hospital (DSH) payments are made in addition to otherMedicaid reimbursements to hospitals that serve large numbers of low-income patients. These payments are based on formulas devised by the states, subject to certain federal requirements. Some states, such as Ohio, do not consider the cost and revenues associated with Medicaid recipients enrolled in managed care when calculating hospital DSH payments. This has created some concern that DSH funds are not being distributed equitably and that some state formulas could adversely affect children's hospital, which typically have high Medicaid utilization. Because of these concern, you asked us to determining (1) Whether state formulas vary in their inclusion of managed care costs and revenues when calculating the maximum amount a specific hospital can receive, (2) whether such variation is allowed by the Medicaid program, and, if so, (3) HCFA officials' views on setting a uniform policy in this area.