Save our Safety-Net Hospitals Act of 2025
- Bill Number
- H.R. 5064
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-08-29: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-06-11T19:26:42Z
AI-Generated Summary
Purpose of the Legislation
The "Save our Safety-Net Hospitals Act of 2025" (H.R. 5064) aims to support hospitals that serve a large number of low-income patients—known as safety-net hospitals—by adjusting rules for extra payments they receive under Medicaid. These payments, called disproportionate share hospital (DSH) adjustments, help cover costs for uninsured or low-income care. The bill modifies limits on these payments to make them more flexible and allow better use of unspent funds.
Key Provisions
- Amendments to DSH Payment Limits: Updates Section 1923(g) of the Social Security Act to change how uncompensated care (costs not covered by payments) is calculated for DSH eligibility. This includes:
- Removing exclusions for certain hospitals from these calculations.
- Adding Medicare (under Title XVIII) payments and payments from certain health plans (defined in Section 1862(b)(8)(F) as employer or union plans) to the mix when figuring out if a hospital's costs exceed payments.
- Including costs for Medicaid-eligible individuals where Medicaid pays after Medicare or another plan, but only if the hospital's total costs for those patients exceed all payments received in a given year.
- Removal and Redesignation: Eliminates one paragraph of restrictions and renumbers others for clarity, while updating related references.
- Effective Date: Changes apply to Medicaid state plan rate years starting on or after the bill's enactment.
- State Option for Unspent Funds: States can use leftover DSH allotments from rate years starting October 1, 2021, up to the enactment date to boost payments to hospitals for those years, as long as total payments stay within the state's annual DSH cap. Key rules include:
- No clawback (recouping) of payments already made if they followed old rules.
- Permission for states to retroactively adjust their Medicaid plans or waivers to allow these increases, with approval from the Secretary of Health and Human Services (HHS), but requests must be filed before the audit deadline for that year.
- States must report any such increases in their next annual DSH report to HHS.
Significant Changes to Existing Law
- Expands the definition of uncompensated care to account for payments from Medicare and other plans, potentially allowing more hospitals to qualify for or receive higher DSH payments.
- Removes prior restrictions (like those in former paragraph (2)) that limited how states could distribute DSH funds, making the system less rigid.
- Introduces flexibility for retroactive use of unspent allotments from recent years, which was not previously allowed without risking recoupment. This prevents states from losing unused funds while enabling targeted support for hospitals.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS, part of HHS) will need to review and approve state requests for retroactive plan changes, potentially increasing administrative workload. Federal Medicaid spending could rise slightly if more DSH funds are used, but it stays within existing state allotments, avoiding new overall costs.
- On Citizens: Low-income and uninsured individuals relying on safety-net hospitals may benefit from improved hospital stability and services, as these facilities treat a high share of Medicaid patients. No direct impact on international relations.
- On Hospitals and States: Safety-net hospitals could receive more funding to offset care costs, reducing financial strain. States gain tools to redistribute unspent funds efficiently, helping manage Medicaid budgets without penalties.
Main Stakeholders Affected
- Safety-Net Hospitals: Primary beneficiaries, as they serve disproportionate numbers of low-income patients and stand to gain from higher or more accessible DSH payments.
- State Medicaid Programs: Gain flexibility in fund use but must comply with reporting and audit rules.
- Medicaid Beneficiaries: Indirectly affected through better-funded hospitals that provide essential care.
- Federal Government (HHS/CMS): Responsible for oversight, approvals, and ensuring compliance with DSH caps.
Notable Legal, Constitutional, or Political Implications
- Legal: The bill aligns with existing Medicaid framework by staying within congressionally set DSH allotments, avoiding new entitlements. Retroactive adjustments could face scrutiny if seen as altering past contracts, but the no-recoupment clause protects hospitals. It requires HHS to approve changes "solely" for this purpose, limiting agency discretion.
- Constitutional: No apparent issues; it operates within Congress's spending power under the Constitution for social welfare programs.
- Political: Supports bipartisan efforts (introduced by members from both parties) to aid vulnerable healthcare providers amid rising costs, potentially reducing hospital closures in underserved areas. It could influence future Medicaid funding debates by demonstrating targeted fixes without broad expansions.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (10)
Rep. Lawler, Michael [R-NY-17], Rep. Mrvan, Frank J. [D-IN-1], Rep. Clarke, Yvette D. [D-NY-9], Rep. Matsui, Doris O. [D-CA-7], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Garbarino, Andrew R. [R-NY-2], Rep. Gillen, Laura [D-NY-4], Rep. Tenney, Claudia [R-NY-24], Rep. Vasquez, Gabe [D-NM-2], Rep. Kim, Young [R-CA-40]
Recent Actions
- 2025-08-29: Referred to the House Committee on Energy and Commerce.
- 2025-08-29: Introduced in House
- 2025-08-29: Introduced in House
Bill Versions
- Save our Safety-Net Hospitals Act of 2025 — issued 2025-08-29 — PDF (7 pages)