| Hospital Name |
State Estimated Hospital-Specific DSH Limit |
Medicaid I/P Utilization Rate |
Low-Income Utilization Rate |
State-Defined Eligibility Statistic |
Regular IP/OP Medicaid FFS Rate Payments |
IP/OP Medicaid MCO Payments |
Supplemental / Enhanced IP/OP Medicaid Payments |
Total Medicaid IP/OP Medicaid Payments |
Total Cost of Care - Medicaid IP/OP Services |
Total Medicaid Uncompensated Care Costs |
Total IP/OP Indigent Care/Self-Pay Revenues |
Total Applicable Section 1011 Payments |
Total IP/OP Uninsured Cost of Care |
Total Uninsured Uncompensated Care Costs |
Total Eligible Uncompensated Care Costs |
Medicaid Provider Number |
Medicare Provider Number |
Total Hosptial Cost |
|