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MACPAC Issues Annual DSH Analysis

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 27.2 million people were uninsured in 2021, decreasing 0.3 percent from 2020. 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 $41.9 billion in charity care and bad debt as reported on the fiscal year 2020 Medicare cost report — a 3.4 percent increase from the previous year.

The report reviews the effects of PHE policies, such as the Provider Relief Fund and other government appropriations, on hospital finances. Additionally, the commission includes state-specific projections of the Affordable Care Act–mandated Medicaid DSH allotment reductions, scheduled to take effect Oct. 1.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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