Medicaid Financing: The Basics
Urban Institute estimates based on data from CMS (Form 64) and MBES data, FY 2019.
To qualify as a DSH hospital a hospital must meet two minimum qualifying criteria. The first criterion is that the hospital has at least two obstetricians who have staff privileges at the hospital and who have agreed to provide obstetric services to Medicaid patients (except when the hospital predominantly serves children under 18 years or the hospital does not offer obstetric services to the general public). The second criterion is that the hospital has a Medicaid inpatient utilization rate (MIUR) of at least 1 percent. A hospital is deemed as a DSH if the hospital’s MIUR is at least one standard deviation above the mean MIUR in the state, or if the hospital’s low-income utilization rate exceeds 25 percent.
Managed care and health plans includes payments to Managed Care Organizations (MCOs), prepaid health plans (PHPs), and other health plans, as well as primary care case management (PCCM) fees.