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. This program is vitally important to low-income and medically vulnerable Ohioans and the hospitals who care for them. 

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. Congress reduced Medicaid DSH payments in the ACA, reasoning that hospitals would care for fewer uninsured patients as health coverage expanded. However, those coverage increases have not yet been fully realized. Hospitals and their advocates continue to encourage Congress to preserve Medicaid DSH funding.

Find out more about Ohio’s Hospital Care Assurance Program by visiting the Ohio Hospital Association’s HCAP webpage.