Notes
Under federal law, state Medicaid programs must “take into account the situation of” hospitals that serve a large number of Medicaid and low-income patients in setting payment rates for inpatient services. These hospitals are referred to as DSH or “disproportionate share” hospitals. States generally achieve this requirement by making supplemental payments to hospitals. While states have considerable discretion in determining the amount of DSH payments to each DSH hospital, their discretion is bounded by two caps – one at the state level, and the other at the facility level.
In addition to DSH, states have used a number of different mechanisms to provide support to hospitals or other providers outside of reimbursement rates. Some of these mechanisms include upper payment limit (UPL), supplemental payments, uncompensated care or low-income pools, and more recently Delivery System Reform Incentive Programs (DSRIP). States administer and finance DSRIP programs and Uncompensated Care Pools through broader Section 1115 Waivers which must meet budget neutrality requirements (meaning the federal government cannot spend more than it would have normally without the waiver). A limited number of states have these waivers and they differ significantly in size and purpose.
Expansions of existing initiatives include rollouts of existing initiatives to new areas or groups and significant increases in enrollment or providers.
The 2020 and 2021 survey instruments did not collect data on this indicator.
Sources
DSRIP: KFF Survey of Medicaid Officials in 50 states and DC conducted by Health Management Associates, October 2019. Final Reports of all Medicaid Budget Surveys are available on the following archive page .
UCPs: Uncompensated Care Pools , Eyman Associates, accessed October 2019.
Definitions
Delivery System Reform Incentive Payment (DSRIP) Program: DSRIP programs, which are part of broader Section 1115 demonstration waiver programs, provide states with funding to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. DSRIP initiatives are not grant programs – they are performance-based incentive programs wherein eligible providers undertake reforms and must meet milestones and metrics set by the state and CMS to access funding. These programs vary in terms of the funding available, the providers that can participate, the number and type of projects as well as the metrics that providers must meet. For more information about DSRIP Programs, see the following briefs: An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers and Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States
Uncompensated Care Pool (UCP): Uncompensated care pools (which can be called different names such as a “low-income pool” in Florida), help health care providers—primarily hospitals—defray funding shortfalls from the costs of care that is not paid for. These Medicaid-funded pools are created through Medicaid Section 1115 waivers and are time limited. Funds in these pools go directly to health care providers—they do not provide health coverage.