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Medicaid

Coverage and Delivery Reform

Medicaid, administered by states and jointly funded by states and the federal government, is the largest health insurance program in the United States, providing coverage to nearly one-in-four Americans – more than 72 million beneficiaries. As part of their missions, AAMC-member teaching hospitals and their physician faculty care for a disproportionate number of these patients, despite low Medicaid reimbursement rates. While representing 5% of the nation’s hospitals, major teaching hospitals account for 25% of all Medicaid hospital care and provide 31% of all charity care. Medicaid disproportionate share hospital (DSH) payments help alleviate some of this burden, but this funding is at risk. Unless Congress acts, Medicaid DSH funding will be cut by $4 billion in FY 2020 and increase to $8 billion per year between FY 2021-2025. Cuts of this magnitude would devastate the health care safety net.

Medicaid also plays a critical role in funding graduate medical education (GME). Though not mandatory, 42 states and Washington, DC, currently contribute to Medicaid GME to help offset the higher costs associated with training residents in teaching hospitals. This funding allows more physicians to be trained in teaching institutions, which improves not only the number of physicians, but also cultural competence, coordination between health care and community organizations, and access for Medicaid beneficiaries. Due to state budget shortfalls and Medicaid managed care organizations, there are serious concerns that less Medicaid funds will be available to train future physicians.


News and Updates


MACPAC Releases March 2019 Report to Congress, Including Recommendation for DSH Allotments to States

March 22, 2019

The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) March 15 released its March 2019 Report to Congress on Medicaid and CHIP. The Commission made recommendations on restructuring disproportionate share hospital (DSH) allotment reductions in current law and upper payment limit (UPL) oversight. Additionally, MACPAC included its annual analysis of DSH allotments to states.


HHS Secretary Testifies Before Congress on President’s Budget Proposal

March 15, 2019

Health and Human Services (HHS) Secretary Alex Azar testified in support of the president’s fiscal year (FY) 2020 budget proposal in front several congressional committees of jurisdiction.


President Trump Releases FY 2020 Budget Proposal

March 15, 2019

The White House March 11 released portions of A Budget for A Better America, the president’s fiscal year (FY) 2020 budget proposal, with additional details expected the week of March 18.


MACPAC Reviews Recommendations on Treatment of Third-Party Payments in Medicaid Shortfall Definition

March 8, 2019

In its March 7-8 meeting, the Medicaid and CHIP Access and Payment Commission (MACPAC) revisited potential policy recommendations for addressing third-party payments in the disproportionate share hospital (DSH) definition of Medicaid shortfall [see Washington Highlights, Jan. 25].


AAMC Endorses Bill to Support States that Expand Medicaid

March 1, 2019

The AAMC Feb. 27 endorsed a bill introduced by Senators Mark Warner (D-Va.) and Doug Jones (D-Ala.) to allow states that expanded Medicaid after 2014 to receive the same full federal matching funds as states that previously expanded Medicaid under the Affordable Care Act.


On Government Affairs



Testimony and Correspondence





External Resources