Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Medicaid DSH Expenditure Reports


CMS maintains two public use files related to expenditures under Medicaid DSH programs.

  • The BBA required that each state submit an annual report describing Medicaid DSH payments made to each disproportionate share hospital. Consequently, CMS requests that states submit hospital-specific data (the name of the hospital, the type of hospital--for example, children's, psychiatric, etc., and public or private--and the annual DSH payment amount) by the end of the first quarter after the state's fiscal year. Public use files with FY1998 distributions to individual hospitals were available for our analyses.
  • The HCFA-64 is a quarterly report generated from the Medicaid financial budget and grant system. The report is an accounting statement of actual expenditures made by the states for which they are entitled to receive Federal reimbursement under the Medicaid law for that quarter. The amount claimed on the HCFA-64 is a summary of expenditures derived from source documents such as invoices, cost reports and eligibility records. DSH payments are broken out from other inpatient hospital or mental health facility payments.

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