Project 2025 Tracker / What’s done, what’s next

14. Department of Health and Human Services · Minor

Reform Medicaid payments to hospitals for uncompensated care

Not started

467 14. Department of Health and Human Services

“Reform payments to hospitals for uncompensated care.”

What has happened

  1. Not started

    Medicaid Disproportionate Share Hospital allotments and the uncompensated-care pools that States run under Section 1115 are unchanged. Public Law 119-21 contains no DSH or uncompensated-care provision (the enrolled text has no occurrence of "disproportionate share" or "uncompensated care"), the three DSH bills of the 119th Congress are protective and in committee, and no CMS rulemaking addresses uncompensated care. The nearest in-window action is the CRUSH request for information, which asks how CMS can help States address fraud in supplemental payments "for example, disproportionate share hospital (DSH) payments" — a question, not a reform. Negative search recorded in `docs/research/ch-14.md` under the round-2 (ticket 16) cluster searches.

    No action found yet. This entry is the starting point, not a finding.

Research log

What was searched, and what didn’t count as evidence

Research notes

  • Searched: the enrolled text of Public Law 119-21 for “disproportionate share” and “uncompensated care” → 0 each; the titles of the bills we keep and search, for “Disproportionate Share” or “DSH” → 3 (Protect DSH Act, and two DSH in Tennessee Act companions), all referred; Federal Register “uncompensated care” in-window returns Medicare DSH/uncompensated-care payment paragraphs in the IPPS rules, a different program.
  • #1276 is the version of the DSH half of this ask that needs an act of Congress, and it reaches the same result.
  • Unified Agenda, checked 2026-09-01. Checked against the full HHS agenda on reginfo.gov (183 active RINs in the 2026 Unified Agenda, published 2026-08-14), not the abbreviated version the Federal Register prints. The nearest entries are recorded here; neither names this ask’s object, so the Status is unchanged: an agenda entry, like a strategic plan, counts only when it names what the ask asks for.
    • The two Medicaid payment entries are 0938-AV69 (Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments, CMS-2449, NPRM 07/2026) and 0938-AV70 (Strengthening the Integrity of Medicaid and CHIP Managed Care, Financing, and Access to Care, CMS-2450, NPRM 07/2026). Both cap or condition payments to providers under OBBBA § 71116 and the June 2025 waste-and-fraud memorandum; neither touches DSH allotments or the § 1115 uncompensated-care pools. “Uncompensated” appears in none of the agenda’s entries.
Action
other
Object
Medicaid uncompensated care payments
ID
1274