Hospital Care Assurance Program
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Medicaid and the Hospital Care Assurance Program

Ohio’s Hospital Care Assurance Program is intended to ensure that hospitals that serve a significant number of low-income patients receive adequate financial support. Northeast Ohio hospital leaders are aware of how vital this program is to low-income and medically vulnerable Ohioans and they know that it impacts their bottom lines. That’s why an understanding of Ohio’s Hospital Care Assurance Program is so important and why The Center for Health Affairs Ohio Medicaid issue site connects you with all the HCAP information you need to know.

What is the Hospital Care Assurance Program?

In 1981, the Medicaid Disproportionate Share Hospital (DSH) program was established by Congress to alleviate the financial pressure on hospitals that serve a disproportionate share of those in poverty. Recognizing that safety net hospitals typically incur higher uncompensated care than other hospitals and rely heavily on Medicaid, which historically has low reimbursement rates, Congress authorized DSH payments to assist states in financing these hospitals. Ohio’s program, called the Hospital Care Assurance Program, began in 1988.

Like the traditional Medicaid program, Medicaid DSH funding is also split by the state and federal governments. Ohio secures its portion of DSH funding by assessing an HCAP fee from all of its hospitals. This money is then paired with a match from the federal government and redistributed to hospitals based on a formula determined by the Ohio Hospital Association under the oversight of the Ohio Department of Medicaid.

Health Reform and the Hospital Care Assurance Program

Passage of the Affordable Care Act (ACA) in 2010 marked the next phase in the evolution of the DSH program. Because the ACA significantly reduced the number of people without health insurance, hospitals have experienced lower uncompensated care costs. In anticipation of this trend, the ACA included provisions that reduce DSH payments each quarter starting in 2014. Under the law, currently being challenged in court, payment to Ohio Hospitals under the State's Hospital Care Assurance Program in 2020 will be reduced 40 percent.

Find out more information about Ohio’s Hospital Care Assurance Program, including details on the latest HCAP model, by visiting the Ohio Hospital Association’s HCAP webpage.




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