Reforming the Medicaid disproportionate share hospital program

Since 1991, three Federal laws have sought to reform the Medicaid dispropor tionate share hospital (DSH) program, which is designed to help safety net hospitals. This article provides findings from a 40-State survey about Medi caid DSH and supplemental payment programs in 1997. Results indicate that t he overall size of the DSH program did not grow from 1993 to 1997, but the composition of DSH revenues and expenditures changed substantially: A much higher share of the DSH funds were being paid to local hospitals and relati vely less was being retained by the States. The study also revealed that la rge differences in States' use of DSH still persist.