The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) released its March 2021 Report to Congress on Medicaid and CHIP on March 15. The report includes the commission’s annual analysis of disproportionate share hospital (DSH) allotments to states.
MACPAC reported that the number of uninsured individuals in 2019 (29.6 million people) rose nationally for a second consecutive year. Additionally, the report found that the unpaid costs of care for uninsured individuals — including reported charity care and bad debt — rose to $40.7 billion for fiscal year (FY) 2018, which is a 7.1% increase from FY 2017.
Moreover, as part of the report’s DSH analysis, MACPAC noted that Medicaid shortfall was $19.7 billion in 2018 — a $3.2 billion reduction from 2017. MACPAC also asserted that deemed DSH hospitals reported negative aggregate operating margins both before and after counting DSH payments (-6.1% and -2.3%, respectively) — considerably lower than aggregate margins across all hospitals (+0.6%). The analysis also noted that DSH allotment reductions were again delayed and are scheduled for FYs 2024 through 2027 ($8 billion reduction per year).
Finally, the report addressed the impact of the COVID-19 public health emergency on safety-net providers’ finances.