Sponsors (19)
The bill creates a transparent, multi‑year system to identify and stabilize safety‑net hospitals and guide resource allocation, but its reliance on Medicare DSH/uncompensated metrics and index‑tied support risks leaving some needy community hospitals without help and adds administrative burdens.
Low-income patients and safety-net hospitals: the bill will identify and track hospitals that meet designated criteria annually so policymakers can target Medicaid payments and policies to help preserve local access to care.
State governments and hospitals: the bill creates transparent, comparable index values (CBSA/state/national) and a composite score so resource allocation decisions can be based on objective, comparable metrics.
Designated hospitals: five-year designations with renewal offer multi‑year stability that aids hospital planning and potential eligibility for sustained support.
Rural and other community hospitals: basing designation largely on Medicare DSH/uncompensated-care metrics may miss other dimensions of local access need, leaving some community hospitals without support and risking service reductions.
Low-income patients and marginal hospitals: if policymakers tie funding or support to the index thresholds, hospitals just below those cutoffs could lose or fail to gain assistance, threatening services for vulnerable patients.
State governments and MACPAC: new reporting and monitoring duties for MACPAC create additional administrative workload that could divert attention and resources from other Medicaid priorities if not properly resourced.
Based on analysis of 2 sections of legislative text.
Adds a statutory definition of “essential health system” and requires MACPAC to publish an annual index and list to identify hospitals serving high shares of uncompensated and low‑income care.
Official title: To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.
Introduced January 16, 2026 by Lori Trahan · Last progress January 16, 2026
Creates a statutory definition of “essential health system” within the Medicaid statute and directs the Medicaid and CHIP Payment and Access Commission (MACPAC) to produce and publish an annual index and list of those systems. The designation targets subsection (d) hospitals that serve high shares of low‑income, uninsured, or uncompensated care (based on Medicare DSH/DSH‑like metrics or state‑adjusted top‑percentile values); designations last five years and can be renewed. MACPAC must deliver the first list within six months of enactment and then every year by August 1, report index values at core‑based statistical area, state, and national levels, and review payment policies that use these criteria to direct support and maintain access to essential community services.