Georgia Medicaid SFY 2021 DSH Limit Calculation Cost In‐State Uninsured Out‐of‐State Total Total Cost MCD Provider O/P FFS X‐ Uninsured Medicaid and Hospital Name I/P Medicaid O/P Medicaid Tax I/P MCO O/P MCO I/P FFS X‐Over Over I/P OME O/P OME I/P O/P Provider Tax I/P O/P Uninsured 23 4 5 6 7 8 9 10 11 12 13 14 15 16 17 APPLING HOSPITAL 1,225,498 429,453 ‐ 77,821 1,117,584 3,014,125 1,037,641 303,881 525,606 272,154 1,231,238 ‐ ‐ ‐ 9,235,001 AU MEDICAL CENTER 44,635,810 19,433,407 ‐ 36,159,992 24,189,104 34,672,223 20,107,546 5,729,685 2,958,814 36,181,697 22,021,951 ‐ 36,083,315 17,193,972 299,367,516 BACON COUNTY HOSPITAL 919,550 619,906 ‐ 724,901 763,062 1,481,300 1,813,704 6,526 998 517,763 965,078 ‐ ‐ ‐ 7,812,788 BLECKLEY MEMORIAL HOSPITAL 21,352 327,973 ‐ 15,949 557,264 24,495 484,754 2,330 324,720 3,772 861,330 ‐ ‐ ‐ 2,623,939 BROOKS COUNTY HOSPITAL 95,281 439,715 ‐ 16,803 689,827 147,011 481,326 46,586 177,382 63,671 1,007,838 ‐ ‐ 17,346 3,182,786 BURKE MEDICAL CENTER 145,022 358,377 ‐ 30,083 628,264 257,327 424,754 195,055 652,704 165,324 967,325 ‐ ‐ 3,741 3,827,976 CANDLER COUNTY HOSPITAL 359,077 518,789 ‐ 10,562 785,701 342,742 1,174,635 13,535 536,965 198,758 1,024,076 ‐ ‐ ‐ 4,964,840 CANDLER HOSPITAL 5,597,033 4,761,262 ‐ 9,321,814 8,547,941 6,535,284 4,802,788 7,895,000 6,780,238 6,387,992 9,836,675 ‐ 167,733 511,430 71,145,190 CARTERSVILLE MEDICAL CENTER 6,582,987 1,930,174 731,169 4,665,769 4,297,828 5,571,194 2,007,564 3,358,172 1,816,972 5,051,616 6,371,989 376,947 138,997 62,090 42,963,468 CHATUGE REGIONAL HOSPITAL 64,996 85,510 ‐ 12,096 207,829 280,271 569,800 49,029 205,000 105,367 515,432 ‐ 121,585 368,826 2,585,741 CHI MEMORIAL HOSPITAL ‐ GEORGIA 94,051 744,607 ‐ 55,435 1,572,186 221,346 1,591,155 87,607 433,933 239,220 2,939,511 ‐ 7,809 147,287 8,134,147 CHILDREN'S HEALTHCARE‐SCOTTISH RITE 63,495,979 21,095,686 ‐ 82,191,024 51,394,633 124,761 28,231 24,101,292 13,767,502 2,899,639 3,914,238 ‐ ‐ ‐ 263,012,985 CHILDREN'S HLTHCRE‐HUGHES SPALDING 1,366,278 4,408,527 ‐ 1,832,857 19,801,258 ‐ ‐ 40,110 219,276 90,635 1,283,288 ‐ ‐ ‐ 29,042,229 CHILDREN'S HOSPITAL ATL AT EGLESTON 98,184,940 23,409,531 ‐ 131,411,838 45,362,301 936,842 1,139,570 25,871,805 8,890,372 7,791,039 3,428,714 ‐ ‐ ‐ 346,426,952 CLINCH MEMORIAL HOSPITAL 138,815 349,741 ‐ 19,579 445,306 353,006 935,331 47,484 386,928 52,607 742,605 ‐ ‐ ‐ 3,471,402 COFFEE REGIONAL MEDICAL CENTER 3,701,228 2,642,741 402,978 3,171,119 3,853,598 3,800,921 1,845,217 3,454,771 4,423,467 2,749,240 4,455,352 126,033 2,884 11,433 34,640,982 COLISEUM MEDICAL CENTER 10,352,184 1,641,864 1,093,125 8,421,923 3,033,818 9,358,682 1,771,353 9,539,987 2,725,866 5,820,220 3,153,834 274,983 108,122 27,504 57,323,465 COLISEUM NORTHSIDE 1,275,632 674,904 279,091 367,645 2,235,211 1,808,705 684,903 1,983,625 1,454,762 1,595,836 2,987,665 165,037 92,224 27,191 15,632,431 COLQUITT REGIONAL MEDICAL CENTER 6,466,355 2,354,174 ‐ 3,000,015 4,325,828 6,073,626 5,072,511 5,378,003 2,786,835 1,875,095 5,287,539 ‐ 31,413 39,715 42,691,109 COOK MEDICAL CENTER 107,910 92,650 ‐ 15,233 104,580 718,169 339,582 423,110 156,759 105,505 171,972 ‐ ‐ ‐ 2,235,470 CRISP REGIONAL HOSPITAL 2,243,304 1,574,094 ‐ 1,643,664 2,492,317 3,135,754 1,906,561 2,056,011 1,987,744 2,139,863 3,104,717 ‐ ‐ ‐ 22,284,029 DOCTORS HOSPITAL‐AUGUSTA 15,362,772 1,711,251 2,019,199 10,953,921 7,775,015 11,818,929 1,562,395 9,977,686 2,583,050 16,219,481 7,315,441 670,074 14,678,058 3,332,526 105,979,798 DODGE COUNTY HOSPITAL 1,441,654 692,275 ‐ 580,416 1,026,142 2,023,104 823,598 296,599 601,581 440,036 778,003 ‐ ‐ 1,891 8,705,299 DONALSONVILLE HOSPITAL 2,118,352 255,079 ‐ 2,318,599 744,178 1,061,914 371,246 291,500 217,907 1,028,581 1,414,695 ‐ 83,291 11,888 9,917,230 DORMINY MEDICAL CENTER 1,158,812 718,121 ‐ 790,720 1,248,287 1,535,888 570,644 1,219,359 532,754 654,650 921,667 ‐ ‐ ‐ 9,350,902 EAST GEORGIA MEDICAL CENTER 7,221,817 2,917,753 ‐ 8,986,294 5,807,896 8,574,513 5,649,207 6,775,688 3,343,548 4,385,919 4,275,915 ‐ 2,319,629 1,213,871 61,472,050 EFFINGHAM HOSPITAL 149,602 996,180 ‐ 116,104 1,954,091 372,174 2,084,842 231,545 581,069 400,684 2,956,776 ‐ 12,221 45,175 9,900,463 ELBERT MEMORIAL HOSPITAL 105,086 413,400 ‐ 31,648 681,960 428,890 432,485 256,564 456,723 177,654 806,026 ‐ ‐ 1,859 3,792,295 EMANUEL MEDICAL CENTER 1,292,451 606,774 ‐ 127,332 1,298,893 1,645,620 522,069 283,494 710,705 570,310 1,326,152 ‐ ‐ ‐ 8,383,800 EMORY DECATUR 17,171,658 4,967,836 2,204,650 26,948,234 6,708,305 14,217,372 4,699,700 18,680,695 7,906,964 14,244,513 8,267,742 620,572 489,051 233,248 127,360,540 EMORY EASTSIDE MEDICAL CENTER 9,717,296 1,609,380 924,996 10,646,135 5,158,192 10,746,277 1,695,947 4,618,773 1,301,783 8,278,317 7,267,754 476,520 885,404 285,232 63,612,006 EMORY HILLANDALE HOSPITAL 4,743,305 2,391,030 289,833 859,755 4,154,515 3,261,962 1,743,643 2,838,841 2,908,378 4,087,833 6,589,199 161,137 273,459 254,505 34,557,395 EMORY JOHNS CREEK 3,554,064 372,979 177,895 3,102,466 986,777 3,052,621 905,693 2,222,161 943,344 4,012,363 2,889,680 98,514 ‐ 7,635 22,326,192 EMORY UNIVERSITY HOSPITAL 60,189,240 5,166,876 2,202,104 10,273,531 4,703,932 39,426,698 8,548,146 34,300,882 4,740,021 37,005,922 10,459,314 674,653 248,251 96,401 218,035,971 EMORY UNIVERSITY HOSPITAL MIDTOWN 35,828,862 7,358,484 1,957,600 39,563,405 7,368,898 26,495,457 18,253,738 26,717,004 5,144,057 17,844,986 14,384,156 462,337 123,965 8,059 201,511,008 EVANS MEMORIAL HOSPITAL 395,235 363,568 ‐ 29,531 776,859 1,179,714 444,579 138,200 389,164 224,617 771,711 ‐ ‐ ‐ 4,713,178 FAIRVIEW PARK HOSPITAL 4,962,933 1,706,062 698,779 5,849,079 4,880,512 6,044,307 2,371,127 5,179,071 2,892,078 3,011,580 3,220,015 171,335 186,426 36,466 41,209,770 FANNIN REGIONAL HOSPITAL 448,002 564,823 ‐ 46,747 1,009,021 391,263 824,391 342,612 414,448 371,609 1,159,445 ‐ 532,736 746,228 6,851,325 FLINT RIVER HOSPITAL 5,112,985 21,345 ‐ 146,778 31,485 822,473 67,154 368,243 40,143 84,848 2,988 ‐ ‐ ‐ 6,698,442 FLOYD MEDICAL CENTER 20,683,237 9,089,396 ‐ 17,071,957 12,795,688 17,215,741 6,572,289 12,052,165 5,840,487 11,236,471 16,278,468 ‐ 2,130,528 917,758 131,884,185 GORDON HOSPITAL 3,149,836 2,360,552 534,266 2,921,857 4,860,272 4,365,477 4,444,771 3,286,342 2,455,762 3,501,203 4,661,807 170,202 ‐ ‐ 36,712,347 GRADY GENERAL HOSPITAL 1,057,936 622,399 95,262 1,304,873 1,449,789 914,630 905,112 82,439 381,873 746,837 1,413,950 35,481 28,796 29,168 9,068,545 GRADY MEMORIAL HOSPITAL 132,314,640 27,415,711 3,291,736 42,755,977 19,248,616 23,107,342 10,936,595 108,274,779 35,343,898 120,836,597 105,987,509 2,402,357 3,339,186 732,275 635,987,218 HABERSHAM COUNTY MEDICAL CENTER 1,067,432 775,941 ‐ 2,552,696 1,821,330 1,488,626 1,690,229 416,239 212,943 822,366 2,227,143 ‐ ‐ ‐ 13,074,945 HAMILTON MEDICAL CENTER 8,677,363 4,977,375 774,828 11,524,303 6,008,941 9,339,972 8,556,008 1,474,478 1,118,173 7,132,318 10,151,322 306,152 220,013 209,167 70,470,413 HIGGINS GENERAL HOSPITAL 193,054 984,797 ‐ 51,609 1,589,595 334,454 838,393 247,770 601,022 234,612 2,786,470 ‐ 3,855 121,001 7,986,632 HOUSTON MEDICAL CENTER 10,370,864 4,086,035 595,779 9,475,672 6,498,223 10,206,688 6,044,001 8,037,806 2,484,176 9,626,906 10,702,147 248,117 294,165 179,950 78,850,529 IRWIN COUNTY HOSPITAL 575,006 462,421 ‐ 2,000,929 1,561,946 221,143 680,974 340,015 541,158 385,617 1,001,102 ‐ ‐ ‐ 7,770,311 JASPER MEMORIAL HOSPITAL 8,396 168,579 ‐ ‐ 457,821 ‐ 284,008 ‐ 110,391 3,110 638,353 ‐ ‐ ‐ 1,670,658 JEFF DAVIS HOSPITAL 485,913 429,174 ‐ 92,746 705,559 1,166,262 1,342,024 640,658 610,840 338,576 1,076,757 ‐ ‐ ‐ 6,888,509 JEFFERSON HOSPITAL 178,107 310,087 ‐ 29,190 491,913 464,261 599,635 285,720 376,548 7,002 669,569 ‐ ‐ ‐ 3,412,032 JENKINS COUNTY HOSPITAL 11,225 126,784 ‐ 9,318 261,845 23,881 206,458 69,375 302,859 ‐ 322,769 ‐ ‐ ‐ 1,334,514 JOHN D.