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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

House Energy and Commerce Committee Advances Numerous Bipartisan Health Care Bills

July 19, 2019

The House Energy and Commerce Committee held a July 17 markup to advance legislation regarding several key health care issues, including Medicaid Disproportionate Share Hospital (DSH) payments, the Patient-Centered Outcomes Research Institute (PCORI), and the Title VII health professions workforce development programs. Additionally, the committee passed an amended version of its proposal to address surprise medical bills.

CMS Releases Proposed Rule to Remove Requirements for Documenting and Assuring Beneficiary Access to Medicaid

July 12, 2019

The Centers for Medicare and Medicaid Services (CMS) July 11 issued a proposed rule to remove requirements for states to document whether Medicaid fee-for-service payments sufficiently assure beneficiary access to covered Medicaid services.

House Health Subcommittee Holds Markup on Key Health Care-Related Bills

July 12, 2019

The House Energy and Commerce Subcommittee on Health July 11 held a markup on key priorities for AAMC, including Medicaid Disproportionate Share Hospital (DSH) payments, the Patient-Centered Outcomes Research Institute (PCORI), and diversity programs in the health care workforce.

Energy and Commerce Health Subcommittee Holds Hearing on Funding of Critical Health Care Programs

June 7, 2019

The House Energy and Commerce Health Subcommittee June 4 held a hearing, “Investing in America’s Health Care,” to address a variety of health care programs, including Medicaid Disproportionate Share Hospital (DSH) payments, Patient-Centered Outcomes Research Institute (PCORI), the National Quality Forum (NQF), National Health Service Corps (NHSC), and Teaching Health Centers (THC).

Supreme Court Issues Decision on Medicare DSH Case

June 7, 2019

The U.S. Supreme Court June 3 issued a decision in Azar v. Allina Health Services, ruling that the Medicare Act — Title VII of the Social Security Act — required the Department of Health and Human Services (HHS) to use notice and comment rulemaking when it included Medicare Part C enrollees in the determination of the “Disproportionate Share Hospitals (DSH) Medicare fraction” for fiscal year (FY) 2012.

On Government Affairs

Testimony and Correspondence

External Resources