COVID Relief Funding for Medicaid Providers — Advising Congress on Medicaid and CHIP Policy (February 2021)
Summary
Issue brief dated February 2021, titled COVID Relief Funding for Medicaid Providers under the heading Advising Congress on Medicaid and CHIP Policy. It reviews the distribution of provider relief funds to Medicaid and CHIP providers based on applications submitted as of November 26, 2020. It states that Congress increased the provider relief fund to a combined total of $175 billion and that approximately $58 billion remained unspent as of the week of January 11, 2021, and that HHS had allocated $150.4 billion through general and targeted distributions. It states that many Medicaid and CHIP providers who are not enrolled in Medicare have not received any provider relief funds. It describes the Phase 1 general distribution, beginning with $30 billion on April 10, 2020 and increased to $50 billion total on April 24.
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“COVID Relief Funding for Medicaid Providers — Advising Congress on Medicaid and CHIP Policy (February 2021).”
Original at www.macpac.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/the-health-202-pandemic-relief-funds-boosted-surpluses-for-some-large-hospitals/
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February 2021 Advising Congress on Medicaid and CHIP Policy
COVID Relief Funding for Medicaid Providers
The COVID-19 pandemic has created financial strains for many health care providers due to the increased
costs of treating patients with virus-related illnesses and decreased revenue from disruptions to the health
care delivery system, such as delays in elective procedures and other routine services. Safety-net providers
that serve a high share of Medicaid and uninsured patients are particularly vulnerable because prior to the
pandemic they often had low operating margins and because Medicaid patients have been
disproportionately affected by COVID-19.1
In March 2020, Congress created a provider relief fund intended to help cover expenses and lost revenue
attributable to COVID-19 through the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L.
116-136). In April 2020, Congress enacted the Paycheck Protection Program and Health Care
Enhancement Act (P.L. 116-139), which increased the size of the provider relief fund to a combined total of
$175 billion. Both Medicare- and Medicaid-enrolled providers are eligible to receive funds, but they have
received relief funding at different times and through different processes. The U.S. Department of Health
and Human Services (HHS) began distributing relief funds to Medicare-enrolled providers automatically in
April 2020. It did not begin distributing funding to Medicaid and State Children’s Health Insurance Program
(CHIP) providers who were not enrolled in Medicare until June 2020.2
This issue brief reviews the distribution of provider relief funds to Medicaid and CHIP providers based on a
review of applications submitted as of November 26, 2020 (after the deadline for the most recent general
distribution of relief funds). Overall, we find that many Medicaid and CHIP providers who are not enrolled in
Medicare have not received any provider relief funds, which has particularly affected provider types that
serve a high share of Medicaid patients, such as pediatric practices, home- and community-based services
(HCBS) providers, and behavioral health providers.3
In December 2020, Congress enacted the Consolidated Appropriations Act (P.L. 116-260), which added an
additional $3 billion to the provider relief fund and directed HHS to distribute at least 85 percent of the
unspent funds appropriated under the CARES Act to providers based on their financial performance in the
second half of calendar year 2020 and the first quarter of 2021. As of the week of January 11, 2021,
approximately $58 billion in provider relief funds remained unspent (HHS 2021a).
Allocation of Provider Relief Funds
The statute provides the Secretary of HHS with broad authority to determine which providers are eligible
for provider relief funding and how much funding individual providers may receive. To date, HHS has
allocated $150.4 billion in funding through a variety of general distributions available to most provider
types and targeted distributions available to specific types of providers (HHS 2021b). Additionally, HHS
has allocated approximately $3 billion in funding to reimburse providers for COVID -19 testing and
2
treatment of uninsured individuals (HHS 2021a). More information about each provider relief fund
allocation to date is provided in Appendix A.
Initial distributions from the provider relief fund prioritized making payments quickly over providing funds
in a targeted manner. On April 10, 2020, two weeks after the CARES Act was passed, HHS made an initial
distribution of $30 billion to all Medicare-enrolled providers based on their Medicare fee-for-service (FFS)
revenue. On April 24, HHS increased this general distribution to $50 billion total and developed a new
formula for targeting payments to providers based on their patient care revenue across all payers. HHS
has referred to these initial disbursements as the Phase 1 general distribution. Approximately 62 percent
of Medicaid and CHIP providers are also enrolled in Medicare and thus received funds in Phase 1 (HHS
2020).
In response to concerns that the initial distributions did not adequately target funding to providers with the
greatest need, HHS subsequently made additional distributions to particular provider types, such as
safety-net hospitals, nursing facilities, and rural providers. For each provider type, HHS developed methods
to determine which providers were eligible and how much funding they would receive. For example, safety-
net hospitals received payments based on their Medicare disproportionate share hospital (DSH) patient
percentage and nursing facilities received payments based on their number of certified beds.4
In addition to the targeted distributions, HHS also made another general distribution (Phase 2) in June
2020 for Medicaid and CHIP providers who were not eligible for Phase 1, as well as dentists and assisted
living facilities.5 Funds were distributed using the same method as in Phase 1 (i.e., 2 percent of providers’
patient care revenue). Unlike the initial distributions based on Medicare revenue, eligible providers had to
formally apply and submit detailed financial information to receive funds in the Phase 2 general
distribution. The application deadline for the Phase 2 general distribution was extended several times and
ended on September 13, 2020.
In October 2020, HHS created a Phase 3 general distribution that was open to all previously eligible
providers as well as additional behavioral health providers who were not previously eligible. Most of the
funding in this distribution was based on a share of providers’ losses during the first half of 2020
compared to providers’ revenue and expenses during the first half of 2019.6
In December 2020, the Consolidated Appropriations Act required HHS to distribute 85 percent of unspent
provider relief funding appropriated under the CARES Act through a new general distribution that accounts
for providers’ losses during the second half of 2020 and the first quarter of 2021. However, as of this
writing, HHS has not announced the details of this funding distribution.
Share of Eligible Providers Receiving Provider Relief Funding
As of the week of January 11, 2021, approximately $120 billion in provider relief funds had been distributed
to a total of 403,235 provider tax identification numbers (TINs) (HHS 2021a). A single provider organization
may have multiple TINs for different components of its business (e.g., an inpatient hospital and its
ambulatory surgery center may have separate TINs), so it is possible that fewer than 403,235 entities
3
received funds and estimates of potentially eligible TINs likely overstate the number of provider
organizations that could apply.
To understand the characteristics of providers that have received provider relief funding to date, we
compared the TINs of provider organizations that received funds through the general distribution to TINs
listed in the National Plan and Provider Enumeration System (NPPES). In this analysis, we excluded
individual professionals registered in NPPES with a social security number (SSN) because most of these
applied for funding using the TIN of their employer (e.g. employed physicians who applied for funding
through their medical group).7 We compared the list of organizations receiving funding to the HHS list of
potentially eligible TINs, which was curated based on provider enrollment files from Medicare, state
Medicaid and CHIP agencies, the Transformed Medicaid Statistical Information System (T-MSIS), and
other sources.8 This list of potentially eligible providers was intended to be broadly inclusive and thus
includes some providers that did not directly bill Medicaid for services in 2018 or 2019 or meet other
eligibility criteria.
Overall, while 53.7 percent of potentially eligible provider organization TINs received relief payments
through the general distribution, only 18.4 percent of potentially eligible Medicaid and CHIP-enrolled
providers not enrolled in Medicare received funding (Table 1). A total of about $50.2 billion in relief
payments were made through the general distribution based on providers’ patient care revenue, but only
$2.6 billion of these payments went to Medicaid and CHIP-enrolled providers not enrolled in Medicare.
Overall, less than 15 percent of the $18 billion initially allocated for the Phase 2 distribution was spent on
Medicaid and CHIP providers (HHS 2021b).
TABLE 1. Share of Potentially Eligible Provider Organization TINs Receiving Provider Relief Fund General
Distribution Payments, 2020
Share of Total payments from the
Total eligible Number of potentially eligible provider relief fund
provider TINs receiving TINs receiving general distribution
Provider enrollment organization TINs1 funding funding (billions)2
Total 600,019 322,182 53.7% $50.2
Medicare-enrolled
providers 258,554 258,103 99.8% $47.0
Medicaid or CHIP-
enrolled providers not
enrolled in Medicare 239,579 44,170 18.4% $2.6
Other eligible
providers 101,886 19,909 19.5% $0.6
Notes: TIN is tax identification number. Analysis limited to TINs that could be matched to organizational national provider
identifiers (NPIs) in the National Plan and Provider Enumeration System (NPPES). Analysis is based on applications
submitted as of November 26, 2020.
1
Number of provider organizations potentially eligible for provider relief funding is based on a curated list of providers
developed by the Health Resources and Services Administration (HRSA) using provider enrollment files from Medicare, state
Medicaid and CHIP agencies, the Transformed Medicaid Statistical Enrollment System (T-MSIS), and other sources.
Providers with potentially eligible TINs must meet other eligibility criteria to receive funding.
4
2
Total payments include payments from the Phases 1, 2, and 3 general distribution based on patient care revenue. Analysis
excludes Phase 3 general distribution payments based on provider losses and targeted distribution payments, and it does
not account for general distribution payments that have been returned by providers.
Source: Acumen, 2021, analysis for MACPAC of NPPES and the HRSA curated list of providers potentially eligible for the
provider relief fund general distribution.
The subset of provider types that often serve Medicaid, but not Medicare beneficiaries also appear to have
been less likely to receive provider relief funding (Figure 1). For example, Medicaid is the primary source of
insurance coverage for more than one-third of children and Medicaid is the single largest payer for long-
term care and behavioral health (MACPAC 2020). However, less than half of potentially eligible TINs for
pediatric providers, HCBS-, and mental health providers received funding. In contrast, Medicare is the
single largest payer for hospital care and virtually all hospitals are enrolled in Medicare and received
provider relief funding.9
In the fall of 2020, MACPAC interviewed Medicaid officials in five states and representatives from national
provider organizations for pediatricians, HCBS, and behavioral health providers to learn more about the
barriers experienced by Medicaid providers applying for provider relief funding. Stakeholders noted that
some providers did not apply because they were not aware they were eligible and were confused about
how the provider relief fund related to other forms of COVID-19 relief funding, such as the paycheck
protection program and Medicaid retainer payments for HCBS providers. Also, stakeholders noted that the
application process was burdensome, especially for small providers with few administrative staff and for
Medicaid providers who were not included in HHS’s list of potentially eligible providers curated by state
Medicaid and CHIP agencies and had to follow a special exceptions process to prove that they were
eligible.
5
FIGURE 1. Share of Eligible Provider Organization TINs Receiving Provider Relief Funds in General
Distribution by Provider Type, 2020
Medicare providers Medicaid or CHIP providers not enrolled in Medicare Other providers
Hospice 85%
Hospitals 73%
Optometrists and opticians 69%
Chiropractors 67%
Pathology 66%
Laboratories 66%
Surgeons 66%
Dietitians and nutritionists 65%
Transportation 65%
Institutional long-term care providers 63%
Adult medicine providers 62%
Durable medical equipment suppliers 61%
Midlevel practitioners 59%
Clinics 59%
Rehabilitation and therapy 59%
Radiology and imaging 57%
Physical, occupational, and speech therapists 56%
Dental providers 54%
Pharmacies 50%
Pediatric providers 48%
Home and community-based services organizations 44%
Nurses 44%
Other 43%
Managed care organizations 42%
Case management 40%
Residential treatment facilities 38%
Mental health and substance use disorder providers 36%
Notes: TIN is tax identification number. Other providers include technicians, therapists, and other provider types not listed.
Provider types are based on provider classifications in the National Plan and Provider Enumeration System (NPPES). TINs
for health systems that contain multiple provider types are counted in each provider type that is part of the health system.
Some providers may have multiple TINs for different components of their business but only apply with one TIN. Analysis
limited to TINs that could be matched to organizational national provider identifiers (NPIs) in NPPES. Provider organization
TINs potentially eligible for provider relief funding is based on a curated list of providers developed by the Health Resources
and Services Administration (HRSA) using provider enrollment files from Medicare, state Medicaid and CHIP agencies, the
Transformed Medicaid Statistical Enrollment System (T-MSIS), and other sources. Providers with potentially eligible TINs
must meet other eligibility criteria to receive funding. Analysis is based on applications submitted as of November 26, 2020.
Source: Acumen, 2021, analysis for MACPAC of NPPES and the HRSA curated list of providers potentially eligible for the
provider relief fund general distribution.
6
Payment Amounts
Payment amounts from the initial general distribution varied widely. For example, multi-specialty provider
systems affiliated with hospitals received an average payment of $6.8 million while mental health and
substance use disorder providers, which often employ fewer staff and have less revenue, received an
average payment of $8,362 from the general distribution (Acumen 2021).
In the initial general distribution, payments equaled 2 percent of providers’ net patient revenue from patient
care. There was no consideration of unpaid costs of care to uninsured individuals or the fact that Medicaid
typically pays less than commercial insurers, both of which would affect net revenue. However,
subsequent targeted distributions aimed to account for some of these factors for some provider types.
To look at payments received by safety-net hospitals, we estimated provider relief funding to hospitals
under each allocation relative to their annual operating costs before the pandemic (Table 2). Specifically,
we examined funding to deemed DSH) hospitals, which serve a high share of Medicaid-enrolled and low-
income patients. We found that although deemed DSH hospitals received relatively less funding in the
initial distribution, they received relatively more funding than non-deemed DSH hospitals after accounting
for the targeted distribution payments. This analysis does not include additional funding that hospitals
may have received in the Phase 3 general distribution based on financial losses in the first half of 2020,
which was targeted to providers experiencing the greatest financial hardship during the pandemic.
Overall, critical access hospitals and other rural hospitals appear to have received more provider relief
funds as a share of their operating expenses than other types of hospitals.10 Rural hospitals generally have
lower operating margins than urban hospitals and are often the sole source of inpatient care for residents
in their communities (MACPAC 2018).
7
TABLE 2. Estimated Distribution of Provider Relief Funding to Hospitals (millions)
General, safety-net,
General, safety-net, rural, tribal, and
rural, and tribal high-impact
General distribution distribution distribution
Funding Funding Funding
as a as a as a
share of share of share of
Number Number of FY 2018 FY 2018 FY 2018
Hospital of beds Total operating Total operating Total operating
characteristics hospitals (thousands) funding expenses funding expenses funding expenses
Total 6021 670.3 $21,077 2.0% $44,566 4.2% $64,241 6.1%
Hospital type
Short-term
acute care
hospitals 3292 529.8 18,943 2.0% 36,205 3.9% 55,655 5.9%
Critical access
hospitals 1355 28.4 742 1.9% 5,714 14.4% 5,829 14.7%
Children's
hospitals 95 10.2 782 2.0% 2,037 5.2% 2,037 5.2%
Other 1279 101.9 610 1.7% 610 1.6% 719 1.9%
Urban or rural status
Urban 3567 567.8 18,643 2.0% 30,305 3.3% 49,273 5.3%
Rural 2454 102.5 2,433 1.9% 14,261 11.0% 14,967 11.5%
Deemed DSH status
Deemed 767 128.9 4,264 1.8% 11,251 4.8% 15,905 6.8%
Not deemed 5254 541.4 16,813 2.1% 33,315 4.1% 48,336 5.9%
Notes: FY is fiscal year. DSH is disproportionate share hospital. Deemed DSH hospitals are statutorily required to receive
DSH payments because they serve a high share of Medicaid-enrolled and low-income patients. Other hospital types include
psychiatric, rehabilitation, and long-term care hospitals. Analysis excludes $1.7 billion in high-impact distributions that could
not be matched to hospital-level data, Phase 3 general distribution payments based on provider losses, and provider relief
payments that have been returned by providers. Numbers do not add due to rounding.
Source: MACPAC, 2021, analysis of HHS 2020b, CDC 2020a, CDC 2020b, and Medicare cost report data.
Nursing facilities also received targeted relief funding that was primarily based on the number of certified
nursing facility beds at a facility. Because the per diem rates for Medicaid-covered nursing facility stays
are typically much lower than the rates for Medicare-covered stays, the targeted payment based on the
number of certified beds resulted in relatively higher payments to facilities that serve a high share of
Medicaid-covered patients (Table 3). For example, after accounting for the targeted relief funding, facilities
that serve the highest quartile of Medicaid patients received relief payments equal to 7.7 percent of their
fiscal year (FY) 2018 operating expenses, compared to the 5.3 percent for the lowest quartile (facilities
with less than half their patient population covered by Medicaid).
8
TABLE 3. Estimated Distribution of Provider Relief Funding to Nursing Facilities as a Share of FY 2018
Operating Expenses, by Payer Mix of Facility
Share of residents whose primary support was Medicaid
Lowest Second Third Highest
All quartile quartile quartile quartile
Provider relief distribution facilities (<47%) (47–61%) (61–72%) (>72%)
Total provider relief funding 6.8% 5.3% 7.0% 7.4% 7.7%
General distribution
(2 percent of patient care revenue) 2.0% 2.0% 2.0% 2.0% 2.0%
Targeted distribution (based on
number of certified beds) 4.8% 3.3% 5.0% 5.4% 5.7%
Note: FY is fiscal year. Total funding for each distribution is estimated based on available data and excludes $2.0 billion in quality
incentive payments to nursing facilities from the provider relief fund and does not account for provider relief payments that have
been returned by providers.
Source: MACPAC, 2021, analysis of Medicare cost report data and the Minimum Data Set.
Data are not yet available on whether relief funding has been adequate to cover providers’ lost revenues
and increased expenses due to COVID-19. Preliminary analyses by the Medicare Payment Advisory
Commission suggest that, in the aggregate, initial relief funding offset several months of losses for
hospitals, nursing facilities, and physicians at the start of the pandemic (MedPAC 2020). However, these
analyses do not examine how particular types of providers have been affected; these may vary at the
system or individual level. In addition, as the COVID-19 pandemic continues, it is unclear how provider
finances will be affected in the future.
Reporting Requirements
All recipients of provider relief funding must attest to certain terms and conditions, including reporting
requirements and prohibitions on surprise billing. Some providers have returned funding rather than meet
these requirements.
HHS has posted a public list of the names of providers that have attested to the terms and conditions and
the amount of funding that they have received, but this list does not include the national provider identifier
(NPI) or other information that could be used to link to other data sources. It is also not possible to identify
individual providers who are part of the multi-provider systems that received approximately two-thirds of
provider relief payments (Acumen 2021). State Medicaid programs were not given any additional
information beyond what is publicly available, making it difficult for states to consider who has received
federal relief payments when targeting other state funding.
Providers who receive more than $10,000 in provider relief funding will be required to submit reports to
HHS describing how these funds were used (HHS 2021a). Specifically, they must document that the
funding received was less than their lost patient care revenues and COVID-19 related expenses that were
9
not reimbursed by other sources. If funding exceeds this amount, it must be returned to HHS after these
audits are complete.
The HHS Office of Inspector General (OIG) is required to report on provider relief funding within three years
after payments were made, but OIG and the U.S. Government Accountability Office (GAO) can conduct
interim audits of provider relief fund payments before that date. For example, GAO has been releasing bi-
monthly reports on the implementation of the CARES Act, which have included preliminary analyses of
provider relief spending (GAO 2021).
Notes
1
Black, Hispanic, and American Indians and Alaskan Native people have been experiencing a disproportionate burden of
COVID-19 cases and deaths, and the majority of Medicaid patients identify as a non-white race or ethnicity (Artiga et al, 2020,
MACPAC 2019). In addition, Medicaid is the primary payer for most residents of long-term care facilities, which have
accounted for 36 percent of COVID-19 deaths as of January 28, 2021 (COVID Tracking Project 2021).
2
Medicare-enrolled providers who did not bill Medicare in calendar year 2019 were not eligible to receive initial provider relief
fund distributions but were eligible to receive funding in the Phase 2 distribution announced in June 2020.
3
In this memo, provider relief funds refer to the federal provider relief fund created by the CARES Act and Paycheck
Protection Program and Health Care Enhancement Act. Providers may have received other forms of state and federal
assistance during the COVID-19 pandemic from other sources.
4
Medicare DSH patient percentage is the sum of a hospital’s share of patients enrolled in Medicaid and the share receiving
Supplemental Security Income.
5
Providers who were eligible for the Phase 1 general distribution but did not apply and Medicare providers who had a change
of ownership in 2020 were also eligible to apply in Phase 2.
6
Eligible providers who had not previously applied for funding in Phase 1 or 2 could also apply during phase 3 for the funding
that they would have received during those earlier phases.
7
Of the 369,439 TINs that received provider relief funding and could be matched to NPPES in our analysis, 47,257 TINs (13
percent) were registered with a SSN and were thus excluded from our analysis. These providers accounted for approximately
1 percent of provider relief general distribution funding based on patient care revenue.
8
HHS asked state Medicaid and CHIP agencies to provide identifying information on all Medicaid-enrolled providers and
then used this list to help verify provider eligibility for the Phase 2 general distribution.
9
The less than 100 percent uptake rate for hospitals is likely due to the fact that some providers have multiple TINs for
different components of their business but only applied using one TIN and because of changes in hospital ownership.
10
Critical access hospitals receive a special payment designation from Medicare because they are small (fewer than 25
beds) and are often the only hospital provider in the community.
10
References
Artiga, S., B. Corallo, and O. Pham. 2020. Racial disparities in COVID-19: Key findings from available data and analysis.
August 17. Washington, DC. Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/racial-disparities-
covid-19-key-findings-available-data-analysis/.
Acumen, 2021, analysis for MACPAC of the National Plan and Provider Enumeration System and the Health Resource and
Service Administration’s curated list of providers potentially eligible for the provider relief fund general distribution.
Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services. 2020a. HHS provider
relief fund data. August 25, 2020. Atlanta, GA: CDC. https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-
3es6.
Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services. 2020b. Provider relief
fund COVID-19 high-impact payments. August 11, 2020. Atlanta, GA: CDC. https://data.cdc.gov/Administrative/Provider-
Relief-Fund-COVID-19-High-Impact-Payments/b58h-s9zx.
COVID Tracking Project. 2021. The long-term care COVID tracker. February 3, 2021. https://covidtracking.com/nursing-
homes-long-term-care-facilities.
Medicare Payment Advisory Commission (MedPAC). 2020. The coronavirus pandemic and Medicare. September 2020.
Washington, DC: MedPAC. http://www.medpac.gov/docs/default-source/meeting-
materials/medpac_covid_sept_2020_rev.pdf?sfvrsn=0.
Medicaid and CHIP Payments and Access Commission (MACPAC). 2020. Exhibit 2: Characteristics of non-institutionalized
individuals by age and source of health coverage. In MACStats. December 2020. Washington, DC: MACPAC.
https://www.macpac.gov/publication/characteristics-of-non-institutionalized-individuals-by-source-of-health-insurance/.
U.S. Department of Health and Human Services (HHS). 2021a. HHS announces provider relief fund reporting update. January
15. Washington, DC: HHS. https://www.hhs.gov/about/news/2021/01/15/hhs-announces-provider-relief-fund-reporting-
update.html.
U.S. Department of Health and Human Services (HHS). 2021b. CARES Act provider relief fund: General information. January
21. Washington, DC: HHS. https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html.
U.S. Department of Health and Human Services (HHS). 2020. HHS announces enhanced provider portal, relief fund payments
for safety net hospitals, Medicaid & CHIP providers. June 9. Washington, DC: HHS.
https://www.hhs.gov/about/news/2020/06/09/hhs-announces-enhanced-provider-portal-relief-fund-payments-for-safety-
net-hospitals-medicaid-chip-providers.html.
U.S. Government Accountability Office (GAO). 2021. Coronavirus oversight. Washington, DC: GAO.
https://www.gao.gov/coronavirus.
11
Appendix A. Provider Relief Fund Distributions Timeline
TABLE A-1. Summary of Provider Relief Fund Allocations Announced as of December 31, 2020
Provider relief Date Amount of funding Eligible providers Payment
category announced methodology
(2020)
Phase 1 general April 10 (initial $50 billion All providers who bill 2 percent of patient
distribution $30 billion); Medicare FFS revenue (First $30
April 24 billion based on
(additional $20 Medicare FFS
billion) revenue)
Rural distribution May 6 $11.3 billion Rural health care Fixed payment per
providers provider plus
additional payment
as a share of
operating expenses
COVID-19 high- May 7 $22 billion Hospitals with a Fixed amount per
impact distribution (admissions as high number of COVID-19
of April 10); COVID-19 admission; higher
June 15 admissions rate for Medicare
(admissions as DSH hospitals
of June 10)
Skilled nursing May 22; $9.4 billion Certified nursing $60,000 plus $3,950
facilities and August 7 facilities with six or per bed and $2
nursing homes (additional more beds billion based on
distribution allocation); performance
September 3 incentives
(performance
payment)
Tribal hospitals, May 29 $500 million Indian Health Fixed amount plus a
clinics, and urban Service and tribal share of operating
health centers hospitals, clinics, expenses
distribution and programs
12
Provider relief Date Amount of funding Eligible providers Payment
category announced methodology
(2020)
Safety-net June 9 $14.7 billion Short-term acute $13.3 billion
hospitals hospitals with a distributed relative
August 14 Medicare DSH to a hospitals’
(additional percentage above Medicare DSH
allocation to 20.2 percent, total percentage and
children’s margins below 3 number of beds;
hospitals) percent, and
uncompensated Additional $1.4
care costs greater billion payment to
than $25,000 per children’s hospitals
bed; children’s based on 2.5
hospitals with a high percent of net
Medicaid patient patient revenue
percentage
Phase 2 general June 9 $18 billion Medicaid or CHIP- 2 percent of patient
distribution enrolled providers, revenue;
dentists, and Eligible providers
assisted living must apply by
facilities, and certain September 13, 2020
Medicare providers
that did not receive
funding in Phase 1
Phase 3 general October 1 $24.5 billion Providers eligible for 2 percent of patient
distribution previous general revenue for newly
distribution eligible providers;
payments, additional Approximately 88
behavioral health percent of reported
providers, and losses for the first
providers who began half of 2020
practicing in 2020
Notes: FFS is fee for service. Medicare DSH patient percentage is the sum of a hospital’s share of patients enrolled in Medicaid and
the share receiving Supplemental Security Income.
Source: MACPAC, 2021, analysis of HHS 2020b.
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