What is the proper handling of Medicaid DSH Expansion funding related to IME/GME on the Medicare Cost Report?

As a part of many states Medicaid Expansion initiatives, providers are receiving an annual distribution to assist in Medical Education funding. 

The state funding not associated with the IME/GME funding is not subject to offset, as this is typically part of the Medicaid DSH funding. As a result, the Medicaid DSH funding related to IME/GME should be classified similar to Medicare funding for IME/GME. The Medicare funding for Medical Education is not subject to offset, and does not have the word "grant" associated with it.

The Medicaid DSH funding is considered reimbursement from another payer for supporting IME/GME costs in the state, similar to grant funds, and would not be subject to offset on the Medicare Cost Report.

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