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Under the Social Security Act , Medicaid Disproportionate Share Hospital (DSH) payments to hospitals cannot exceed the uncompensated cost of providing inpatient and outpatient hospital services to Medicaid-eligible and uninsured individuals. The 2008 DSH final rule required state reports and audits to ensure the appropriate use of DSH payments and compliance with the DSH limit imposed at Section 1923(g) of the Social Security Act .