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MACPAC Issues Annual DSH Analysis

Julie Kozminski
March 21, 2022

In its March 2022 report to Congress, the Medicaid and CHIP Payment and Access Commission (MACPAC) examines the relationship between Medicaid disproportionate share hospital (DSH) allotments, uncompensated care costs, and services for low-income, uninsured populations.

MACPAC found 28 million people were uninsured in 2020, increasing 0.9 percent from April to July 2020, then decreasing 1.1 percent from August 2020 to July 2021, while the Medicaid coverage rate increased 1 percent. The commission also found hospitals had $42 billion in charity care and bad debt as reported on the fiscal year 2019 Medicare cost report — a 5.5 percent increase from the previous year.

The report reviews the effects of the COVID-19 pandemic on hospital finances and chronicles provider relief funding. The commission found no association between total hospital relief funding and the number of uninsured in the region. Further, they examined the effect of the enhanced federal medical assistance percentage (FMAP) in the American Rescue Plan Act on DSH allotments and estimate it led to a $1.5 billion increase in federal DSH allotments in FY 2022.

The report also includes chapters on Money Follows the Person residency criteria and vaccine access for adult beneficiaries.

Contact Director of Policy Rob Nelb, MPH, at or 202.585.0127 with questions.

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