DSH in Tennessee Act
- Bill Number
- H.R. 6393
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-03: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-01-09T15:17:38Z
AI-Generated Summary
Purpose
The legislation aims to restore and make permanent federal funding for disproportionate share hospital (DSH) payments to Tennessee under Medicaid (a joint federal-state health insurance program for low-income individuals). DSH payments provide extra support to hospitals that treat a high number of uninsured or low-income patients, ensuring Tennessee's hospitals receive stable funding starting in fiscal year 2026.
Key Provisions
- Permanent DSH Allotment for Tennessee: Beginning in fiscal year 2026 and for all subsequent years, Tennessee will receive a dedicated DSH allotment, regardless of other limitations in current law.
- Initial Funding Amount (FY 2026): The allotment equals Tennessee's DSH amount from fiscal year 2015 under existing Medicaid rules, adjusted upward each year by changes in the Consumer Price Index for All Urban Consumers (a measure of inflation for everyday goods and services).
- Ongoing Adjustments: After 2026, Tennessee will be classified as a "low DSH state" (states with historically lower needs for such payments), allowing its allotment to increase annually in the same way as other low DSH states—based on factors like overall Medicaid spending growth.
- Overrides Existing Limits: The new funding ignores terms from Tennessee's current TennCare Demonstration Project (a special Medicaid waiver program) or other statutory caps.
Significant Changes to Existing Law
- Amends Section 1923(f)(3) of the Social Security Act (the part of U.S. law governing Medicaid DSH payments) by updating references to include a new provision for Tennessee and adding a dedicated subparagraph (G).
- Removes temporary or demonstration-based restrictions on Tennessee's DSH funding, shifting it from potentially expiring or limited support to a permanent, inflation-adjusted entitlement.
- Treats Tennessee as a low DSH state for future years, which was not the case under prior law where such states had predefined allotment tables.
Potential Impacts
- On Government Agencies: Increases federal Medicaid spending through the Centers for Medicare & Medicaid Services (CMS), potentially straining the national budget but providing predictability for state budgeting in Tennessee. No direct impact on international relations.
- On Citizens: Improves access to care for low-income and uninsured Tennesseans by bolstering hospital finances, which could prevent service cuts or closures in underserved areas.
- On Hospitals: Ensures ongoing financial stability for Tennessee hospitals serving vulnerable populations, reducing the risk of reduced charity care or emergency services.
Main Stakeholders Affected
- Tennessee Hospitals: Primary beneficiaries, especially safety-net hospitals treating high volumes of low-income patients.
- Low-Income Residents of Tennessee: Gain indirect benefits through sustained hospital services under Medicaid and related programs.
- Federal and State Governments: CMS and Tennessee's Medicaid agency (TennCare) will manage the new funding stream, with federal taxpayers funding the allotments.
- Other States: Minimal direct effect, but could influence future requests for similar state-specific Medicaid adjustments.
Notable Legal, Constitutional, or Political Implications
- Legal: Creates a targeted exception in federal Medicaid law, potentially setting a precedent for other states seeking permanent DSH restorations amid ongoing reductions from the Affordable Care Act. It does not alter broader DSH reduction schedules but carves out Tennessee specifically.
- Constitutional: No apparent challenges, as it falls within Congress's spending power under the Constitution to allocate federal funds for public welfare programs like Medicaid.
- Political: Reflects bipartisan support in Tennessee's congressional delegation (sponsors from both parties), highlighting regional priorities in national health funding debates. It may fuel discussions on equity in Medicaid allotments across states, especially for non-expansion states like Tennessee.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Harshbarger, Diana [R-TN-1]
Cosponsors (6)
Rep. Fleischmann, Charles J. "Chuck" [R-TN-3], Rep. DesJarlais, Scott [R-TN-4], Rep. Kustoff, David [R-TN-8], Rep. Burchett, Tim [R-TN-2], Rep. Rose, John W. [R-TN-6], Rep. Cohen, Steve [D-TN-9]
Recent Actions
- 2025-12-03: Referred to the House Committee on Energy and Commerce.
- 2025-12-03: Introduced in House
- 2025-12-03: Introduced in House
Bill Versions
- Delivering Support for Hospitals in Tennessee Act — issued 2025-12-03 — PDF (3 pages)