Hospital Care Assurance Program (HCAP)

Ohio's Hospital Care Assurance Program is a state and federal program administered by the Ohio Department of Medicaid. The program provides funding to hospitals that have a disproportionately high share of uncompensated care costs for services to indigent and uninsured Ohioans. Part of the program offers help with unpaid hospital bills to Ohioans with family incomes at or below 100 percent of the current Federal Poverty Guidelines, and who are ineligible for Medicaid.

2018 HCAP Assessment and Payment Schedule

These dates in 2018 are preliminary and subject to change.
Assessment Due Dec. 11
Payment Made Dec. 24
Assessment Due Jan. 2, 2019
Payment Made Jan. 14, 2019



For more information, please visit our most recent Frequently Asked Questions about HCAP/free care rules, eligibility and audit. If you are a hospital patient and have a question about the status of a pending HCAP application or need to request an application, please contact the hospital where you applied or would like to apply for the program.


CMS Approves HCAP for 2018; OHA, ODM Finalize Schedule

The Centers for Medicaid & Medicare Services today approved the Ohio Department of Medicaid’s state plan amendment, governing the assessment and distribution formulas for HCAP in federal fiscal year 2018. OHA worked with ODM to finalize the schedule of assessments and payments, as follows:

  • HCAP letter sent to hospitals - Nov. 27
  • First assessment due - Dec. 11
  • First payment - Dec. 24
  • Second assessment due - Jan. 2, 2019
  • Second payment - Jan. 14, 2019

Webinar Available on 2016 DSH Audit

Myers & Stauffer has pre-recorded a webinar on the 2016 DSH audit process. The webinar can be found here. The slides can be found here.

There will be a two-week period to submit question not answered in or arising from the webinar. Submit questions to Daniel Vielhaber by Oct. 8.

Myers & Stauffer has informed OHA that its Provider Data Request letter has been sent to providers. For reference, a generic letter can be found here.

Contact Daniel Vielhaber with questions or concerns.

2018 HCAP Delay

OHA has been informed by the Ohio Department of Medicaid that assessments and distributions for 2018 HCAP are expected to be delayed until mid-November. The delay is the result of the rule change for rural designation - a hospital will only be considered rural if it exists in a rural county. ODM does not have new dates for assessments and distributions, but this page will be updated when more is known.

Please contact Daniel Vielhaber with questions.


Update for 2018 HCAP Model

An update for the preliminary 2018 HCAP model can be found here. This update differs from the June model in the following ways:
  • The program size has decreased as the official federal allotment is now known.
  • The close date for Good Samaritan Hospital (Dayton) has been updated as its official close date is now known.

Federal Disproportionate Share Hospital Audit Set for May 14 Release

The results for the 2015 Federal Disproportionate Share Hospital Audit conducted by Myers & Stauffer for the Ohio Department of Medicaid will be released beginning May 14.

Hospitals that Myers & Stauffer has determined to be in a recoupment status will be released first. If your hospital is in a recoupment status, you have 10 days to contact Myers & Stauffer to discuss the results. Contact information will be provided in the audit report. If your hospital is not in a recoupment status, no further action is necessary. 

OHA Submits Comment Letter on Proposed Rule on Medicaid DSH Reductions

OHA submitted comments to CMS Aug. 28 on the proposed rule to implement the Affordable Care Act’s Medicaid DSH reductions. In the comment letter, OHA requested CMS change the proposed methodology to reduce the impact of DSH cuts on Ohio hospitals. As previously reported, based on the proposed methodology, HCAP would be cut in total funds by approximately $150M in the 2018 program. The comment letter can be found here. We will provide additional updates when the rule is finalized.

Second 2017 HCAP Assessment Due Aug. 29

The second and final 2017 HCAP assessment is due Aug. 29, with the final payment to be made to hospitals Sept. 5. It is imperative that assessments are paid on time so that payments can also be made in a timely manner, and there is a $1,000-per-day penalty for late assessments.

If your hospital will have trouble paying the assessment on time, please contact Jody Swisher at ODM as soon as possible.

AHA Issues Bulletin on CMS Proposed Rule for Medicaid DSH Reductions - July 28

The Centers for Medicare & Medicaid services today published a proposed rule in the federal register that describes the methodology the agency plans to use to implement the Medicaid DSH cuts first authorized by the Affordable Care Act. The American Hospital Association Special Bulletin can be found here.

The DSH cuts were originally slated to be implemented in 2014, but have been delayed and amended by various pieces of federal legislation, including MACRA. While the specifics of the 2018 cut for Ohio’s HCAP are not included in the rule, the rule narrative includes an illustration of the impact of this methodology had it been applied to 2017 DSH allotments. Using this analysis as a guide, OHA has preliminarily determined that the cut to HCAP resulting from this proposed rule would be approximately $150 million (24 percent), all funds, in the 2018 program, compared to the size of the program absent any cuts.

The 24 percent reduction to HCAP in 2018 is higher than the national average DSH cut of 16.7 percent largely because of the Medicaid expansion in Ohio and its resulting impact on the number of uninsured Ohioans. The methodology being proposed by CMS would cut DSH by lower percentages in states that did not expand Medicaid. Previous OHA analysis indicated that Ohio could receive a cut as high as 25.1 percent, but while the actual cut appears to be slightly lower, OHA continues to have major concerns with the proposed methodology and will seek to have the proposed cut to HCAP reduced.

OHA plans to submit comments by the Aug. 28 deadline and encourages its member hospitals to join us in doing so. A copy of the OHA comment letter will be shared with members as soon as it’s available.

ODM to Send 2017 HCAP Assessment Letters July 21 - July 17

The Ohio Department of Medicaid will send out assessment letters relation to 2017 HCAP on Friday, July 21. The letter will contain your hospital’s total assessment to be paid in accordance with the 2017 HCAP model. A generic letter can be found here.
The assessment will be paid by hospitals in two equal installments, due Aug. 11 and Aug. 29. Payments in accordance with the 2017 HCAP model will also be made in two equal installments, corresponding with the assessments. For hospitals eligible to receive a payment, the first payment will be made on Aug. 21, and the second on Sept. 5.
The full 2017 HCAP model with total assessments and payments can be found here.

Please contact Daniel Vielhaber with any questions. 

2017 Annual Meeting Presentation Materials - June 27

At the 2017 OHA Annual Meeting, OHA staff gave their annual HCAP update where they presented the first preliminary 2017 HCAP model. A copy of the presentation slides can be found here.


2011 DSH Audit Recoupment and Redistribution - April 24

Ohio Department of Medicaid on April 24 notified hospitals by mail of any amount to be recouped, based on the 2011 DSH Audit prepared by Myers and Stauffer. A sample letter can be found here. The letters were sent only to hospitals affected by this recoupment, so most will not receive a letter.

If your hospital is impacted, the recouped dollars are due to ODM by May 9.

Redistribution of the recouped dollars will take place with the next UPL payment, which takes place June 2. Redistribution amounts by hospital can be found here.

If you have any questions, please contact Daniel Vielhaber.


Additional Assessment and Distribution for 2014 HCAP - March 3

Because CMS under-estimated inflation relating to the 2014 HCAP model, there are additional federal funds available for distribution. Per the standard HCAP process, hospitals will be assessed a small fee in order to collect the federal matching dollars. ODM will be mailing an assessment letter to hospitals on March 10 and the assessments will be due March 31. A generic copy of the assessment letter can be found here. Also, please see this spreadsheet for the assessment and payment amounts your hospital can expect.  

If you have any questions or concerns, please contact Daniel Vielhaber


OHA Releases Final Preliminary Model for 2016 HCAP - Jan. 11

ODM and OHA have agreed on  the final preliminary model for 2016 HCAP. That model can be found here. Assessment letters were mailed by ODM on Jan. 9, and assessments are due in two installments on Jan. 25 and Feb. 8. Upon receiving the assessments from hospitals, ODM will make HCAP payments in two installments on Feb. 3 and Feb. 20. It is imperative that hospitals are timely with the payment of their assessments so that the distribution of HCAP payments can be on time.

OHA was also informed  by ODM that there was an error in assessment letters for a number of hospitals. The total assessments were quoted correctly, but when dividing the total assessment they rounded to the nearest dollar. This means, for instance, that a hospital with an assessment of $150,001 would have two installments of $75,001 and would slightly overpay by one dollar. Corrected assessment letters are being mailed today, Jan. 11, and will have payments specified to the cent so that there are no overpayments. Please note that the total assessment has not changed for any hospital.

If you have any questions, please contact Daniel Vielhaber.


Assessment Letters for 2016 HCAP Mailed - Jan. 6

OHA has been notified by ODM that assessment letters for the 2016 HCAP model are being mailed today, Jan. 6. A generic assessment letter can be found here. Additionally, assessments each hospital can expect to pay can be found here. As the letter points out, the due date for the first installment – equivalent to one-half of the assessment – is Jan. 25, while the due date for the second installment – the other half – is Feb. 8.
OHA is close to matching with ODM on a final preliminary model for the 2016 program; this model will be published here as soon as it is available. Check back for updates in the near future.
If you would like to submit a request for reconsideration to ODM upon receiving your assessment letter, please use the contact information for ODM in the letter. For any other questions or concerns, please contact Daniel Vielhaber.

2016 Preliminary HCAP Update - Sept. 23

OHA presented an updated 2016 Preliminary HCAP Model at the annual Medicare & Medicaid Update in late September. The updated model can be found here.

Please keep in mind that these numbers are subject to change. If you have any questions regarding this model, please contact Daniel Vielhaber (

2016 Preliminary HCAP Update - June 16

 OHA presented the updated 2016 Preliminary HCAP Model at its annual meeting on Tuesday, June 14.
  • A copy of the PowerPoint presentation can be found here.
  • A summary of the model and its distribution pots can be found here.
  • The hospital-specific total distributions and payments for each pot can be found here.
If you have any questions or concerns, please contact Daniel Vielhaber ( or Ryan Biles (

2015 HCAP Delayed by Rulemaking Process - Jan. 28

OHA continues to monitor the state’s rulemaking for the 2015 Hospital Care Assurance Program (HCAP). The program, which was slightly altered from the 2014 version at OHA’s request, received federal approval from CMS, but has yet to be fully authorized in the Ohio Administrative Code (The rules include OAC 5160-2-08 on data policies, 5160-2-08.1 on assessment rates and 5160-2-09 on the distribution formula). The rules await review and approval by the Lieutenant Governor’s Common Sense Initiative office, but are expected to move soon onto the final phase, which includes a public hearing and review by the Joint Committee on Agency Rule Review (JCARR). As of today, OHA anticipates HCAP 2015 assessment notices will be sent in May, with assessments and payments to follow in June/July. Note that even this new timeline is subject to change, so OHA will continue to update the membership as details become available.

Regarding the 2016 and 2017 HCAPs: the OHA Board of Trustees last August recommended the Ohio Department of Medicaid transition from a pre-Medicaid expansion HCAP distribution formula to a post-Medicaid expansion formula. If fully adopted, by 2017 HCAP would no longer have a distribution pool devoted solely to the provision of uncompensated care to Ohioans with incomes at or below the poverty line. ODM states it will soon seek approval from CMS on this two-year recommendation, and OHA hopes the 2016 HCAP will be completed before the close of CY 2016 and the 2017 HCAP before the close of FFY 2017 (9/30/17). Stay tuned for more details as the CMS process unfolds.

One additional item to highlight regards an ODM agreement to amend its data policies to allow for an additional Medicaid Cost Report correction period for all hospitals in the program. Beginning with the 2016 HCAP, hospitals will be granted an additional 30-day period during which cost report data can be corrected. The new 30-day period will apply to all hospitals beginning at the conclusion of the last hospital’s 30-day “free” revision window. As proposed, a hospital wishing to revise its cost report during this new grace period would have to pay an administrative fee equal to 0.03 percent of its adjusted facility costs in order to reopen its cost report. This additional period should allow hospitals to review OHA’s preliminary HCAP model before losing the opportunity to correct major errors and make revisions. 

2015 Preliminary HCAP Update - Nov. 9, 2015

The 2015 Preliminary HCAP Model has been updated. One hospital re-filed their cost report which resulted in a reduced payment for that hospital. Consequently, all other hospitals receiving a payment will see a small increase to their total distribution. The updated model can be found here.

2015 Preliminary HCAP Update - Oct. 23, 2015

The 2015 Preliminary HCAP Model has been updated. There was an error in the cost report data for one hospital, and that error has been corrected. The pots have not been affected, but the assessment lower rate has changed. The updated model can be found here.

 2015 Preliminary HCAP Update - Aug. 26, 2015

The 2015 Preliminary HCAP Model has been updated. The updated model can be viewed here. This update includes changes to the Rural Pot (4B) distribution. No other pots were affected.

At this point, OHA sill anticipates HCAP 2015 will be administered around January 2016.

FFY2013 Medicaid DSH Program Audit Webinar Recording

A recording of the Sept. 10, 2015 webinar on the FFY 2013 Medicaid Disproportionate Share Hospital (DSH) program audits is available here. OHA presented the session with the Ohio Department of Medicaid and Myers and Stauffer. Attendees' questions from the session were also recorded and will posted here once formal answers are completed. 

2015 Preliminary HCAP Update - July 28, 2015

The 2015 Preliminary HCAP Model has been updated. You can view the model here.

Points of interest in regards to this model include:

  • The numbers in the model have been developed in parallel with ODM, so OHA does not expect significant changes to this model before assessments and payments are made. However, the model is still preliminary and numbers still subject to change.

  • ODM has initiated the CMS review process with regard to the 2015 model in the hopes of avoiding delays similar to those that occurred in the 2014 HCAP process.

  • ODM is moving forward with OHA’s recommended changes to the model, which include further reforms to reward hospitals for total uncompensated care costs (including Medicaid shortfall) rather than just free care provided to HCAP-eligible patients.

At this point, OHA anticipates HCAP 2015 will be administered around January 2016.

Annual Updates to Ohio HCAP and Free Care Requirement - June 12, 2015

July 1 marks the start of state fiscal year 2016 and with it comes the annual updates to the Medicaid Cost Report, the HCAP/free care data review Agreed Upon Procedures and to OHA’s Frequently-Asked Questions, designed to help clarify it all.

Details were released at the July 9 HCAP policy session during OHA’s 2015 Annual Meeting. Links to all presentation and supporting materials from the session are provided below.


Ohio Medicaid Issues 2014 HCAP Assessment Letter to Hospitals - May 26, 2015

While the Centers for Medicare and Medicaid Services (CMS) continue to review the proposed state plan amendment that will implement OHA-recommended changes to the distribution of Hospital Care Assurance Program (HCAP) funding for 2014, on Friday, May 22, the Ohio Department of Medicaid (ODM) distributed a letter (click here) to Ohio hospitals regarding the HCAP assessment and payment process for the 2014 Program Year. In order to complete the assessment and payment cycles as quickly as possible, ODM has combined the preliminary and final assessment letter in their distribution. The preliminary assessment becomes the final assessment after fourteen days unless a hospital requests a reconsideration.

The first assessment is due on June 12, with payment to hospitals on or about June 22. The second assessment is scheduled for June 26, with payment to hospitals on or about July 8. However, this timeline is subject to change depending on the timing of CMS approving the state plan amendment. If approval is not granted prior to the first assessment due date, ODM will postpone collection of any assessments and release a new timeline. Though CMS technically has until the end of July to make its decision on approving the amendment, OHA is working to expedite their review process to allow for the distribution of funds according to the schedule released by ODM.

In 2014, Ohio hospitals anticipate receiving $374,022,303 in HCAP funding from the federal government in return for paying assessments totaling $220,030,862. The distribution formula will undergo significant changes in 2014 due to Medicaid expansion and the ability of federal DSH auditors to recoup overpayments from hospitals found to have received payments in excess of their hospital-specific DSH limit.

Ohio Medicaid DSH Program Audits

The Ohio Department of Medicaid and its independent auditor, Myers and Stauffer, have released preliminary results letters to Ohio hospitals on their SFY 2012 Ohio Medicaid Disproportionate Share Hospital (DSH) Audit. OHA will publish a preliminary statewide report as soon as one is available.

A comprehensive report on the FFY 2011 Ohio Medicaid DSH Audit is available here.

HCAP-Related Ohio Hospital Free Care Requirement 

OAC 5160-2-07.17 requires that all hospitals write off bills for basic, medically necessary hospital level services to patients with family incomes at or below federal poverty limits, as defined by the rule. 

OAC 5160-2-07.17 does not cover transplant services, physician charges, ambulance and patient convenience items (telephone, parking, television, personal items). In order for a patient’s care to qualify, (s)he must be an Ohio resident, not be covered by Medicaid recipient, and have a family income at or below the federal poverty line.

Each hospital has a policy for the review and approval of free care eligibility under the state rule. The patient should contact the hospital for an application. In some hospitals the patient will be required to provide proof of income (pay stubs or W-2s).
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