1. Short title This Act may be cited as the State Accountability, Flexibility, and Equity for Hospitals Act of 2018 , or the SAFE Hospitals Act of 2018 . 2. Determination of State DSH allotments based on State poverty levels Section 1923(f) of the Social Security Act ( 42 U.S.C. 1396r–4(f) ) is amended— (1) in paragraph (3)— (A) in the paragraph heading, by striking year 2003 and thereafter and inserting years 2003 through 2021 ; (B) in subparagraph (A)— (i) by striking , (7), and (8) and inserting and (7) ; and (ii) by inserting through fiscal year 2021 after each succeeding fiscal year ; (C) in subparagraph (C)(ii), by inserting through fiscal year 2021 after each succeeding fiscal year ; and (D) in subparagraph (E)(i)(III), by inserting or paragraph (7), as applicable, after this paragraph ; (2) in paragraph (4)(C), by inserting or paragraph (7), as applicable, after paragraph (3) ; (3) in paragraph (5)(B)— (A) in the subparagraph heading, by striking and subsequent fiscal years and inserting through fiscal year 2021 ; and (B) in clause (iii), by inserting through fiscal year 2021 after any subsequent fiscal year ; (4) in paragraph (6)— (A) in clause (vi) of subparagraph (A)— (i) in the clause heading, by striking 2025 and inserting 2021 ; and (ii) by striking fiscal year 2025 and inserting fiscal year 2021 ; and (B) in clause (iii) of subparagraph (B)— (i) in the clause heading, by inserting through fiscal year 2021 after succeeding fiscal years ; and (ii) in subclause (II)— (I) in the subclause heading, by inserting through fiscal year 2021 after succeeding fiscal years ; and (II) by inserting through fiscal year 2021 after each fiscal year thereafter