Title page
Contents
Summary 2
Introduction 5
Background: Medicaid DSH 6
States Slow to Implement DSH Programs 7
Sharp Increase in DSH Expenditures 7
Limits on DSH Payments 8
DSH Allotments 8
DSH Allotment Methodology 8
Limits on DSH Expenditures 10
States' DSH Allotments 10
Exceptions for Certain States 13
DSH Allotment Reductions 14
DSH Payments 14
Defining DSH Hospitals 14
Calculating DSH Payments 15
Hospital-Specific DSH Limits 16
Definition of Uninsured 16
Definition of Medicaid Shortfall 17
Institutions for Mental Disease DSH Limits 19
DSH Expenditures 19
State Variation 22
DSH as a Percentage of Total Medical Assistance Expenditures 23
Hospital Versus IMD 24
State Reporting and Auditing Requirements 26
Conclusion 27
Appendix A. A Chronology of State DSH Allotments Calculations 28
Appendix B. IMD DSH Limits 34
Appendix C. State-by-State DSH Expenditures 36
Author Information 38
Acknowledgments 38
Disclaimer 38
Table 1. Total DSH Expenditures and Total DSH Expenditures as a Percentage of Total Medicaid Medical Assistance Expenditures 7
Table 2. DSH Allotments for FY2020 Through FY2023 11
Figure 1. Total Medicaid DSH Expenditures, FY1990-FY2022 20
Figure 2. Total DSH Expenditures as a Percentage of Total Medicaid Medical Assistance Expenditures 21
Figure 3. States' Share of Total Medicaid DSH Expenditures 22
Figure 4. Total State DSH Expenditures as a Percentage of Total Medicaid Medical Assistance Expenditures 23
Figure 5. Proportion of State DSH Expenditures Allocated to Hospitals and IMDs 25
Table B-1. States' IMD DSH Limits 34
Table C-1. DSH Expenditures by Type and DSH Expenditures as a Percentage of Medical Assistance Expenditures, FY2022 36