Changing state and federal payment policies for Medicaid disproportionate-share hospitals.

The Medicaid disproportionate-share hospital (DSH) program has been the subject of considerable policy debate throughout the 1990s, prompting Congress to revise the program three times since 1991. Using Medicaid administrative data and information obtained from twelve state case studies, we examined how the study states dealt with the federal reforms. We found a variety of state responses, ranging from not spending their full DSH allotments to seeking new, "DSH-like" federal money to help support safety-net providers.