Treatment of Third-Party Payment in the Definition of Medicaid Shortfall: Potential Recommendations

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March 2019

As a follow-up to the discussion at MACPAC’s January 2019 public meeting, this presentation reviews the effects of policy options to change the definition of Medicaid shortfall used for Medicaid disproportionate share hospital payments. At issue is how Medicaid shortfall should be counted for Medicaid patients with third-party coverage.

The presentation examines three different policy options:

  • counting all payments and costs for Medicaid patients with third-party coverage;
  • not counting payments or costs for Medicaid patients with third-party coverage; and,
  • establishing different rules for different types of third-party coverage situations.

The Commission is expected to vote on recommendations on this issue at its April 2019 meeting.

Publication Type: Presentations

From: March 2019 MACPAC Public Meeting

Tags: disproportionate share hospital (DSH) payment, hospitals, supplemental payments