I 
119TH CONGRESS 
1ST SESSION H. R. 5064 
To amend title XIX of the Social Security Act to modify certain limitations 
on disproportionate share hospital payment adjustments under the Med-
icaid program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 29, 2025 
Mr. LALOTA (for himself, Mr. LAWLER, Mr. MRVAN, and Ms. CLARKE of New 
York) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to modify 
certain limitations on disproportionate share hospital 
payment adjustments under the Medicaid program, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Save our Safety-Net 
Hospitals Act of 2025’’. 
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SEC. 2. MODIFYING CERTAIN LIMITATIONS ON DISPROPOR-
TIONATE SHARE HOSPITAL PAYMENT AD-
JUSTMENTS UNDER THE MEDICAID PRO-
GRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Se-
curity Act (42 U.S.C. 1396r–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) in the matter preceding clause (i), 
by striking ‘‘(other than a hospital de-
scribed in paragraph (2)(B))’’; 
(ii) in clause (i), by inserting ‘‘with 
respect to such hospital and year’’ after 
‘‘described in subparagraph (B)’’; and 
(iii) in clause (ii)— 
(I) in subclause (I), by striking 
‘‘and’’ at the end; 
(II) in subclause (II), by striking 
the period and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following new subclause: 
‘‘(III) payments made under title 
XVIII or by an applicable plan (as de-
fined in section 1862(b)(8)(F)) for 
such services.’’; and 
(B) in subparagraph (B)— 
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(i) in the matter preceding clause (i), 
by striking ‘‘in this clause are’’ and insert-
ing ‘‘in this subparagraph are, with respect 
to a hospital and a year,’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) Individuals who are eligible for 
medical assistance under the State plan or 
under a waiver of such plan and for whom 
the State plan or waiver is a payor for 
such services after application of benefits 
under title XVIII or under an applicable 
plan (as defined in section 1862(b)(8)(F)), 
but only if the hospital has in the aggre-
gate incurred costs exceeding payments 
under such State plan, waiver, title XVIII, 
or applicable plan for such services fur-
nished to such individuals during such 
year.’’; 
(2) by striking paragraph (2); 
(3) by redesignating paragraph (3) as para-
graph (2); and 
(4) in paragraph (2), as so redesignated, by 
striking ‘‘Notwithstanding paragraph (2) of this 
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subsection (as in effect on October 1, 2021), para-
graph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to payment adjustments made under sec-
tion 1923 of the Social Security Act (42 U.S.C. 
1396r–4) for Medicaid State plan rate years begin-
ning on or after the date of enactment of this Act. 
(2) STATE OPTION TO DISTRIBUTE UNSPENT 
DSH ALLOTMENTS FROM PRIOR YEARS UP TO MODI-
FIED CAP.— 
(A) IN
GENERAL.—If, for any Medicaid 
State plan rate year that begins on or after Oc-
tober 1, 2021, and before the date of enactment 
of this Act, a State did not spend the full 
amount of its Federal fiscal year allotment 
under section 1923 of the Social Security Act 
(42 U.S.C. 1396r–4) applicable to that State 
plan rate year, the State may use the unspent 
portion of such allotment to increase the 
amount of any payment adjustment made to a 
hospital for such rate year, provided that— 
(i) such payment adjustment (as so 
increased) is consistent with subsection (g) 
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of such section (as amended by this sec-
tion); and 
(ii) the total amount of all payment 
adjustments for the State plan rate year 
(as so increased) does not exceed the dis-
proportionate share hospital allotment for 
the State and applicable Federal fiscal 
year under subsection (f) of such section. 
(B) NO RECOUPMENT OF PAYMENTS AL-
READY MADE TO HOSPITALS.—A State shall not 
recoup any payment adjustment made by the 
State to a hospital for a Medicaid State plan 
rate year described in subparagraph (A) if such 
payment adjustment is consistent with section 
1923(g) of such Act (42 U.S.C. 1396r–4(g)) as 
in effect on October 1, 2021. 
(C) AUTHORITY TO PERMIT RETROACTIVE 
MODIFICATION OF STATE PLAN AMENDMENTS 
TO ALLOW FOR INCREASES.— 
(i) IN
GENERAL.—Subject to para-
graph (2), solely for the purpose of allow-
ing a State to increase the amount of a 
payment adjustment to a hospital for a 
Medicaid State plan rate year described in 
subparagraph (A) pursuant to this para-
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graph, a State may retroactively modify a 
provision of the Medicaid State plan, a 
waiver of such plan, or a State plan 
amendment that relates to such rate year 
and the Secretary may approve such modi-
fication. 
(ii) DEADLINE.—A State may not 
submit a request for approval of a retro-
active modification to a provision of the 
Medicaid State plan, a waiver of such plan, 
or a State plan amendment for a Medicaid 
State plan rate year after the date by 
which the State is required to submit the 
independent certified audit for that State 
plan rate year as required under section 
1923(j)(2) of the Social Security Act (42 
U.S.C. 1396r–4(j)(2)). 
(D) REPORTING.—If a State increases a 
payment adjustment made to a hospital for a 
Medicaid State plan rate year pursuant to this 
paragraph, the State shall include information 
on such increased payment adjustment as part 
of the next annual report submitted by the 
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State under section 1923(j)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–4(j)(1)). 
Æ 
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