Texas and Florida have a “balanced budget” while California is “in debt $54 billion and New York is “in debt $6.1 billion.”
The California and New York results illustrate the importance of having information on actual IGTs in examining issues related to the current distribution of Medicaid DSH funds. Across-the-board assumptions such as those made Chapter 4 regarding the proportion of DSH funds that are "new" are not substantiated at the hospital-level. CMS should consider expanding the state DSH reports to obtain information on provider contributions to DSH pools as well as the payments from those pools to individual hospitals. [...] The "snapshot" approach of looking at one year's data may not be sufficient for an adequate understanding of the financial implications of serving low-income patients. In California, the FY1998 payments included payments from the state's fiscal year 1997 and thus overstated the average DSH payments. The New York indigent care pool was in transition during FY1998 and additional changes were enacted in 2000. Wisconsin's uncompensated care costs have increased 60 percent since 1997. Only the first-year impacts of the Balanced Budget Amendment are reflected in the FY1998 data. These considerations suggest that a multi-year study- perhaps with periodic updating- would be appropriate.