Disproportionate Share Hospitals (DSH) are facilities that treat large numbers of Medicaid and uninsured patients. Congress created DSH payments in 1981 under the Medicaid statute to compensate these safety-net hospitals for uncompensated care costs that private-pay hospitals don't bear. DSH payments allow safety-net hospitals to remain financially viable while serving patients who pay below cost or nothing at all. When Medicaid cuts reduce enrollment or constrain DSH payments directly, these hospitals face the greatest closure risk.