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'Medicaid shortfall' definition should change when tallying DSH payments, MACPAC says

April 12, 2019 / Tina Reed

To avoid Medicaid making disproportionate share hospital (DSH) payments to cover costs already paid by other payers, Congress should change the definition of "Medicaid shortfall," the Medicaid and CHIP Payment and Access Commission said Thursday. That definition should exclude payments for Medicaid-eligible patients for whom Medicaid is not the primary payer, according to a majority of commissioners in the nonpartisan legislative branch agency that makes recommendations to Congress, the Department of Health and Human Services and the states regarding Medicaid and the Children's Health Insurance Program (MACPAC). At issue is the 2018 court ruling that found third-party payments could not be counted in the shortfall calculation and allows hospitals to claim higher Medicaid shortfall even if they receive third-party payments.