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Required Annual Analysis of Disproportionate Share Hospital Allotments

MACPAC is statutorily required to report annually on Medicaid disproportionate share hospital (DSH) allotments in its March report to Congress. MACPAC continues to find that DSH allotments share no meaningful relationship to the different measures of need that the Commission is statutorily required to report.

These include:

  • changes in the number of uninsured individuals;
  • amounts and sources of hospital uncompensated care; and,
  • hospitals with high levels of uncompensated care that also provide access to essential community services.

MACPAC estimates that the American Rescue Plan Act of 2021 increased fiscal year (FY) 2023 federal allotments by 10.9 percent ($1.5 billion). We also estimate that FY 2024 DSH allotments will be reduced by 54 percent ($8 billion) on October 1, 2023 due to scheduled reductions that were implemented as part of the Consolidated Appropriations Act, 2021.