Hospitalizations of Low-Income Children and Children With Severe Health Conditions: Implications of the Patient Protection and Affordable Care Act.

Hospitalizations of Low-Income Children and ChildrenWith SevereHealth Conditions: Implications of the Patient Protection andAffordable Care Act Medicaid reimbursement often falls below health care costs (Medicaid shortfall). Therefore, hospitals face financial losses from caring for both uninsured and Medicaid-insured patients. The US government provides disproportionate share hospital (DSH) payments to institutionswith large uninsured andMedicaidpopulations.Anticipatingdecreasednumbersof uninsuredpatients, thePatientProtectionandAffordableCare Act (ACA) reducesDSHpayments.1TheACAalsopenalizeshospitals for readmissions.2 There will not be large decreases in the number of uninsured children since only a small percentage of children are uninsured. In contrast, a high percentage of childrenhaveMedicaid insurance, and institutionswill continue to face Medicaid shortfalls. The loss of DSH payments maynot bematchedby reductions in financial losses fromdecreases in the number of uninsured patients. In addition, the readmission penalties of the ACAmay not adequately adjust for low-income patients or patientswith severe health condi-