On March 18, 2019, MACPAC published its recommendations for restructuring the Medicaid disproportionate share hospital (DSH) program. In its March 2019 Report to Congress, MACPAC outlined three recommendations for minimizing the impact of DSH cuts on safety net hospitals: 1) Gradually phase in reductions over a longer period of time; 2) Apply reductions to unspent DSH funds first; and 3) Target reductions to the number of non-elderly, low-income individuals in the state.