(Oct. 2012) This analysis describes the potential impact of hospitals incurring $53.3 billion more in uncompensated care costs than originally estimated when lawmakers approved the Affordable Care Act

(Oct. 2012)This brief provides an overview of disproportionate share hospital (DSH) payments and their essential role in supporting the nation’s safety net hospitals and health systems.

(June 2012) This summary offers a brief overview of America’s Safety Net Hospitals and Health Systems, 2010: Results of the Annual NAPH Hospital Characteristics Survey.

(June 2012) This monograph examines the utilization and financial characteristics of NAPH members in 2010. Key findings for member hospitals include comparatively high levels of uncompensated care delivered, an increasing volume of care provided in both inpatient and outpatient settings, and the continued delivery of critical services to underserved populations.

(May 2012) This policy brief outlines NAPH's recommendations for implementing the reductions to Medicaid DSH funding specified in the Affordable Care Act (ACA).

(October 2011) This brief highlights economic impact and employment findings for NAPH member states in FY 2009. This brief also outlines substantial cuts to state Medicaid programs and the impact of those cuts on providers and patients.

(May 2011) This brief summarizes the findings from 10 years of data collected as part of the NAPH Annual Characteristics Survey. The study reveals past challenges for NAPH members including growing service demands, limited capacity, changing payer mix, and uncertain financing. NAPH members have increasingly become providers of choice attracting patients of all insurance types. Find out how these trends may influence safety net hospitals as they navigate health reform.

(March 2011) In December 2008, the federal Centers for Medicare & Medicaid Services (CMS) issued a final DSH audit and reporting rule. Unfortunately, the rule goes beyond congressional intent by making substantive DSH policy changes that go beyond the scope of the rule-making process and congressional intent. NAPH urges the Administration to limit the scope of the rule to increasing transparency through greater auditing and reporting.

(February 2011) This brief summarizes the results of the 2009 NAPH Characteristics Survey. Key findings for member hospitals include increased volumes of care delivered in both inpatient and outpatient settings (particularity to low-income populations), continued demand for specialized services (like trauma and burn care) from public hospitals, and the critical importance of Medicaid in funding NAPH members.

(December 2010) This monograph examines the utilization and financial characteristics of NAPH members in 2009. Key findings for member hospitals include comparatively high levels of uncompensated care being administered, an increasing volume of care being provided in both inpatient and outpatient settings, and the continued delivery of critical services to underserved populations.

(August 2010) NAPH recently conducted a survey of its members to measure the impact of the economic recession of safety net hospitals. This document highlights the survey findings for the third and fourth quarters of calendar year 2009. Survey findings will be updated on a quarterly basis throughout the duration of the economic recession.

(July 2010) In December 2008, the Centers for Medicare & Medicaid Services (CMS) issued a final DSH auditing and reporting rule. Unfortunately, the rule goes beyond congressional intent by making substantive DSH policy changes that go beyond the scope of the rule-making process and congressional intent. NAPH urges the Administration and Congress limit the scope of the rule to increasing transparency through greater auditing and reporting.

(February 2010) Since the start of the current economic recession, safety net health systems have treated more patients overall and provided even more uncompensated care to low-income populations. This research brief explores how safety net organizations remain critical to the nation's health care system.

(February 2010) Results of the Annual NAPH Characteristics Survey: This Monograph examines the utilization and financial characteristics of NAPH members in 2008. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(December 2009) Results from the NAPH 2008 annual Characteristics Survey indicate safety net hospitals continued to fulfill critical roles in their communities amid the initial effects of a national economic downturn. Read more about the what the survey findings mean for the future of the safety net.

(June 2009) Results from the National Association of Public Hospitals and Health Systems (NAPH) annual membership characteristics survey indicate that safety net hospitals continue to fulfill critical roles in their communities.

(May 2009) Results of the Annual NAPH Characteristics Survey: This Monograph examines the utilization and financial characteristics of NAPH members in 2007. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(October 2006) Results of the Annual NAPH Characteristics Survey: This Monograph examines the utilization and financial characteristics of NAPH members in 2004. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(March 2006) Section 1115 of the Medicaid statute enables the Centers for Medicare and Medicaid Services (CMS) to waive compliance with certain Medicaid requirements. This paper focuses on an emerging trend among states to use Section 1115 demonstrations to restructure Medicaid payments supporting safety net providers (i.e. “safety net financing”).

(March 2006) In 2005, four states – Massachusetts, California, Iowa, and Florida – received approval for Section 1115 demonstration projects that restructure Medicaid safety net hospital financing. In part, this trend is an outgrowth of the Centers for Medicare and Medicaid Services' (CMS) enhanced scrutiny of Medicaid reimbursement and financing mechanisms. Section 1115 may present opportunities for states and public hospitals to preserve funding for the safety net in the face of CMS efforts to restrict or eliminate intergovermental transfers and supplemental upper payment limit (UPL) payments.

(October 2005) Results of the Annual NAPH Characteristics Survey: This Monograph examines the utilization and financial characteristics of NAPH members in 2003. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(September 2004) Results of the Annual NAPH Characteristics Survey: This report examines the utilization and financial characteristics of NAPH members in 2002. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(September 2003) Results of the Annual NAPH Characteristics Survey: This Monograph examines the utilization and financial characteristics of NAPH members in 2001. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(October 2001) Results of the Annual NAPH Characteristics Survey: This report examines the utilization and financial characteristics of NAPH members in 1999. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals.

(October 2000) Results of the Annual NAPH Characteristics Survey: This report examines the utilization and financial characteristics of NAPH members in 1998. Key findings include: financial challenges faced, clinical and community services provided, and profiles of patients served by member hospitals. This report also outlines NAPH member trends, including the increasing burden of treating the uninsured, the shift from inpatient to outpatient care, increased competition for Medicaid and commercially insured patients, and reduced federal/state funding.

This chart outlines key features of select demonstration projects approved by CMS between January 2001 and December 2005.