Refining the Definition of US Safety-Net Hospitals to Improve Population Health

Safety-net hospitals (SNHs) in the United States provide care for individuals and families regardless of their ability to pay.1 Since 1986, SNHs have received supplemental federal compensation through Medicare Disproportionate Share Hospital (DSH) payments. These payments have historically been calculated based on the proportion of hospital days accounted for by Medicare Supplemental Security Income plus Medicaid, non-Medicare inpatient days. The Affordable Care Act (ACA) modified this definition and reduced DSH payments to offset a growing insured, low-income population.2