States Refusing Medicaid Expansion Grapple with Uncompensated Care

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By design, the ACA reduces funding that previously covered the costs of emergency care for the uninsured, known as Disproportionate Share Hospital payments, under the assumption that every state would adopt Medicaid expansion to reduce its uninsured population. Hospitals in states that chose not to expand Medicaid continue to provide uncompensated care for the expansion-eligible uninsured, but nonetheless

face steep cuts in DSH funding — straining the budgets of hospitals that serve poorer populations. Congressional Republicans want to address this by boosting DSH payments in non-expansion states while keeping DSH cuts largely in place for states that expanded Medicaid.



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