Disproportionate Share Hospitals

Overview

Federal law requires Medicaid programs to make special payments to hospitals that serve a disproportionately large number of Medicaid and low-income patients. These hospitals are called disproportionate share hospitals (DSH) and receive DSH funding. DSH funds are different from most Medicaid payments because they are not tied to specific services for Medicaid-eligible patients.

Methodology / Rules

The Hospital Services program rules are located at Title 1 of the Texas Administrative Code (TAC), Part 15, Chapter 354, Subchapter A, Division 6, Rules 1071-1073, 1075, and 1077.

Reimbursement rules applicable to Hospitals are located in 1 TAC, Part 15, Chapter 355, Subchapter J, Division 4, Rules 8052, 8054, 8056, 8061, 8065, 8067, 8069, and 8071.

Condition of Participation

Beginning federal fiscal year (FFY) 2024, all hospitals (except for state-owned and rural hospitals) are required to enroll, participate in, and comply with requirements for voluntary supplemental Medicaid or directed Medicaid programs for which the hospital is eligible within the State of Texas to participate in DSH. 1 TAC, Section 355.8065(e)(9) provides further details about this requirement. Please review the list of the required programs (.pdf) to satisfy this condition of participation.

DSH Audit Information

View the DSH Audit information

DSH Qualification

View the Revised FFY 2023 Qualification File (.xlsx) (Updated 5/30/2023)

View the Revised FFY 2024 Qualification File (.xlsx) (Updated 6/18/2024)

DSH Payment Files

Federal Fiscal Year (FFY) 2025

View the FFY 2025 DSH Advanced 1 Payment (.xlsx) (Updated 10/7/2024)

View the FFY 2025 DSH Advanced 2 Payment (.xlsx) (Updated 10/18/2024)

Federal Fiscal Year (FFY) 2024

View the FFY 2023 Qualification File with Adopted Rule used for the Advances (.xlsx) (Updated 9/29/2023) 

View the FFY 2024 DSH Advanced Payment 1 (.xlsx) (Updated 9/29/2023)

View the FFY 2024 DSH Advanced Payment 2 (.xlsx) (Updated 2/9/2024)

View the FFY 2024 DSH Off Cycle Advanced Payment 3 (.xlsx) (Updated 3/15/2024)

View the Revised FFY 2024 DSH Final Payment (.xlsx) (Updated 10/14/2024)

Federal Fiscal Year (FFY) 2023

View the FFY 2023 DSH Advanced Payment 1 (.xlsx) (Updated 9/20/2022)

View the FFY 2023 DSH Advanced Payment 2 (.xlsx) (Updated 10/14/2022)

View the FFY 2023 DSH Advanced Payment 3 (.xlsx) (Updated 2/14/2023)

View the Revised FFY 2023 DSH Final Payment (.xlsx) (Updated 5/31/2023)

View the FFY 2023 DSH Pass 3 Payment (.xlsx) (Updated 6/12/2023)

DSH Payment Redistribution & IGT Call

View the 2018 Post Audit DSH Redistribution File (.xlsx) (Updated 2/28/2025)

View the 2019 Post Audit DSH Redistribution File (.xlsx) (Updated 2/28/2025)  

View the 2020 DSH Redistribution File (.xlsx) (Updated 7/14/2022)

View the 2020 Post Audit DSH Redistribution File (.xlsx) (Updated 10/25/2024)

View the 2021 DSH Redistribution File (.xlsx) (Updated 7/21/2023)

View the 2022 DSH Redistribution File (.xlsx) (Updated 7/11/2024)

View the 2023 DSH Redistribution File  (.xlsx) (Updated 2/20/2025)

DSH Payment Information

View the Proposed DSH Timeline for Payments (.pdf)

View the DSH 2024 Payments (.pdf)

View the DSH 2023 Payments (.pdf)

View the DSH 2022 Payments (.pdf) 

View the DSH 2021 Payments (.pdf)

View the DSH 2020 Payments (.pdf)

View the DSH 2019 Payments (.pdf)

View the DSH 2018 Payments (.pdf)

View the DSH 2017 Payments (.pdf)

View the DSH 2016 Payments (.pdf)

View the DSH 2015 Payments (.pdf)

View the DSH 2014 Payments (.pdf)

View the DSH 2013 Payments (.pdf)

View the DSH 2012 Payments (.pdf)