Since 1991, three federal laws have sought to reform the Medicaid disproportionate share hospital (DSH) program, which is designed to provide financial support to safety net hospitals. The article provides findings from a 40-state survey about Medicaid DSH and upper payment limit programs in 1997. Results indicate that the overall size of the DSH program did not increase from 1993 to 1997, but the composition of the DSH revenues and expenditures changed substantially: A much higher share of DSH funds were being paid to local hospitals and relatively less was being retained by states. The study also revealed that large differences in states’ use of DSH still persist. Finally, the survey indicated that a growing number of states established upper payment limits programs in the late 1990s. (Health Care Financing Review 2000 Winter; 22(2):137-158).
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