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S 474119th CongressIn Committee

Fair Funding for Rural Hospitals Act

Introduced: Feb 6, 2025
Standard Summary
Comprehensive overview in 1-2 paragraphs

The Fair Funding for Rural Hospitals Act would modify federal Medicaid rules to guarantee a minimum Disproportionate Share Hospital (DSH) payment allotment to every state. DSH payments are federal funds intended to help hospitals that treat large numbers of low-income, uninsured, or Medicaid patients. The bill creates an annual floor for each state's DSH allotment starting in fiscal year 2025. Specifically, from 2025 through 2029, no state’s DSH allotment may be less than $20 million. Beginning in 2030, the floor would continue for each state but would rise with inflation, following an inflation-adjustment mechanism referenced in the bill. The floor applies notwithstanding existing DSH tables or any reductions that are otherwise required, meaning it acts as a baseline minimum that states must receive each year. In short, the bill aims to stabilize and increase funding for rural and other safety-net hospitals by ensuring a predictable minimum level of DSH support across all states, with inflation-based increases starting in 2030.

Key Points

  • 1Establishes a floor for annual state DSH allotments starting in fiscal year 2025.
  • 2Fixed minimums: $20,000,000 per state from 2025 through 2029.
  • 3Inflation-adjusted floor from fiscal year 2030 onward (the adjustment is specified to be per a provision on inflation in the bill).
  • 4The minimum is a floor “notwithstanding” the existing DSH table or reductions under other sections, ensuring it cannot be overridden by those provisions.
  • 5The measure is codified by adding a new subparagraph to Section 1923(f)(6) of the Social Security Act, creating a nationwide minimum baseline for DSH funding.

Impact Areas

Primary group/area affected: States administering Medicaid and their hospitals, especially rural and safety-net facilities that rely on DSH funding.Secondary group/area affected: Uninsured and low-income populations served by rural and safety-net hospitals; healthcare providers and hospital systems that participate in DSH programs.Additional impacts: Potential increase in federal Medicaid spending due to the nationwide minimum floor; reduced variation in DSH funding across states; the inflation mechanism starting in 2030 will tie future funding to price changes, affecting long-term budget planning for both states and the federal government. The bill’s fiscal impact would depend on the number of states and the inflation rate used for the annual adjustment.
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