Safety-net hospitals could receive higher Medicaid payments under HR 5064

What does this do?

HR 5064 changes how Disproportionate Share Hospital payment limits are calculated under Medicaid by requiring that Medicare and certain other insurance payments be counted alongside Medicaid and uninsured patient losses. The bill also allows states to retroactively distribute unused DSH funds from years going back to October 2021, subject to new rules and an audit-linked deadline.

Who does it affect?

Safety-net hospitals — especially those serving high mixes of Medicaid and Medicare patients — and state Medicaid officials who must recalculate payment limits are most directly affected. Patients at these hospitals are not billed or paid differently under this bill.

Why does it matter?

Whether individual hospitals receive higher payments depends on their specific patient mix and whether their state chooses to act under the new options. The financial stability of hospitals serving low-income communities could shift depending on state-level decisions about retroactive distributions and recalculated limits.

What does it cost, and who pays?

• Affects existing Medicaid DSH funds
• Covers unused funds back to Oct 2021
• No new spending totals specified