Save our Safety-Net Hospitals Act of 2025

This bill changes how extra Medicaid payments to safety‑net hospitals are calculated. It updates the hospital cap rules so that, in some cases, patients who have Medicaid plus Medicare or other insurance can be counted if the hospital’s costs are higher than what all those payers covered. It also updates the list of payments that must be considered when figuring the cap and cleans up an older part of the law.

It also gives states more flexibility with past funds. States may use unspent hospital support money from earlier years to raise past payments up to the updated cap, as long as they don’t go over their total limit. States can adjust their Medicaid plans after the fact to do this and must report any increases. They cannot take back payments already made under the old rules if those payments followed the rules at the time. The new rules apply to plan years that start on or after the date this becomes law, and the “use unspent funds” option applies to plan years starting October 1, 2021, through the day before this becomes law.

Key points

• Who is affected: Safety‑net hospitals, state Medicaid programs, and some Medicaid patients who also have Medicare or other coverage.
• What changes: Updates how hospital caps are calculated and which patients/payments count; lets states use unspent past funds to boost payments; bars taking back past payments that followed old rules; requires reporting of any increases.
• When: New rules start with plan years on or after enactment; the past‑funds option applies to plan years starting October 1, 2021, up to enactment.