FY2009 DSH allotments were increased under the American Recovery and Reinvestment Act (ARRA). See Federal DSH Allotments under ARRA for details.

Disproportionate Share Hospital (DSH) adjustment payments provide additional help to those hospitals that serve a significantly disproportionate number of low-income patients; eligible hospitals are referred to as DSH hospitals. States receive an annual DSH allotment to cover the costs of DSH hospitals that provide care to low-income patients that are not paid by other payers, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or other health insurance. This annual allotment is calculated by law and includes requirements to ensure that the DSH payments to individual DSH hospitals are not higher than these actual uncompensated costs. For further details see http://www.hhs.gov/recovery/cms/dsh.html.

FY2008: Federal Register, December 28, 2007 (Vol. 72, No. 248), pp. 73838, available at http://www.gpoaccess.gov/fr/index.html.

FY2009: The United States Department of Health and Human Services, available at http://www.hhs.gov/recovery/cms/dsh.html.

Federal Fiscal Year: Unless otherwise noted, years proceeded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. For example, FY 2009 refers to the period from October 1, 2008 through September 30, 2009.

1. "Low DSH State": The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (P.L. 108-173) included special provisions in Title X, Section 1001 for the 16 states with DSH expenditures between 0% and 3% of total (state and federal) Medicaid spending in FY 2000, defined as low DSH states. The allotment for these states increases by 16% each year from FY 2004 through FY 2008, and by the CPI-U thereafter.
2. Section 404 of the Tax Relief and Health Care Act of 2006 (P.L. 109-432) contained provisions permiting Tennessee and Hawaii to collect federal matching funds for payments to certain hospitals that serve a high proportion of Medicaid beneficiaries and uninsured individuals during fiscal year 2007. Previously, both Hawaii and Tennessee did not have separate DSH allotments because they had incorporated their alotments into their section 1115 Medicaid waiver programs. See http://www.cbo.gov/ftpdocs/77xx/doc7714/hr6111pgo.pdf for more details. After FY2007, their allotments returned to $0.