On the Uneasy Relationship Between Medicaid and Charity Care

Abstract

Medicaid and charity care have a lengthy relationship fraught with complications. These complications will remain and in some respects become even more acute following the implementation of the Patient Protection and Affordable Care Act.

This article focuses on the uneasy relationship between Medicaid and charity care, one that becomes particularly acute in the context of Medicaid reimbursement. It traces the lineage of Medicaid in charity, and uses Medicaid reimbursement and supplemental payments as lenses through which to examine the relationship between Medicaid and charity care. The tension that we uncover will need to be resolved if Medicaid is to come closer to achieving its arguable aim of placing the poor on the same footing in our health care system as enjoyed by wealthier, privately-insured Americans.

Keywords: Medicaid, charity care, supplemental payments, DSH, UPL