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MACPAC Issues Annual DSH Analysis, Medicaid Managed Care Denials

March 18, 2024
Julie Kozminski

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

MACPAC found 25.9 million people were uninsured in 2022, decreasing 0.4 percent from 2021. This decrease likely is attributable to the continuous coverage requirements implemented during the COVID-19 public health emergency (PHE). The commission also found hospitals had $39.3 billion in charity care and bad debt as reported on the fiscal year 2021 Medicare cost report — a 0.4 percentage point decrease from the previous year.

MACPAC discusses widening its scope of hospital payment analysis to review DSH policy in the context of other Medicaid payments, particularly supplemental and directed payments. This is the last year MACPAC is statutorily required to analyze specific factors (number of uninsured; amount and sources of hospitals’ uncompensated care costs; and essential community services) as they pertain to DSH payments.

Denials and Appeals in Medicaid Managed Care

In a chapter on denials and appeals in Medicaid managed care, MACPAC makes seven recommendations, with a focus on improving the appeals process for beneficiaries. The commission recommended that states collect, monitor, and publish data on denials and appeals.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.

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