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The Medicaid and CHIP Payment and Access Commission today released its March 2019 , which recommends Congress phase in the Affordable Care Act’s Medicaid Disproportionate Share Hospital reductions over a longer period and restructure the DSH allotment methodology based on the number of low-income individuals in a state. The commission also recommends that Congress require the Department of Health and Human Services to apply the reductions to unspent DSH allotments first. The commission approved the recommendations in January. 

“Although increased coverage under the ACA has reduced unpaid costs of care for uninsured individuals, there has been a net increase in hospital uncompensated care costs for DSH hospitals because of an increase in Medicaid shortfall, which is the difference between a hospital’s Medicaid payments and its costs of providing services to Medicaid-enrolled patients,” the report notes.

AHA continues to urge Congress to delay the ACA’s Medicaid DSH reductions until more substantial coverage gains are realized, as it noted in comments to the commission in January. 

The report also includes the commission’s January recommendations that HHS establish process controls to ensure that annual hospital upper payment limit demonstration data are accurate and complete, and use these data in the review of claimed expenditures; and that the Centers for Medicare & Medicaid Services make hospital UPL demonstration data and methods publicly available in a standard format that enables analysis.