This bill modifies limitations on Medicaid Disproportionate Share Hospital (DSH) payment adjustments, which are crucial for hospitals serving a high volume of low-income patients. It amends the Social Security Act to broaden the scope of services and patient populations that qualify for these payments. The legislation expands the definition of uncompensated care by including services provided to Medicaid-eligible individuals who also have coverage through Medicare or private insurance. DSH payments can now account for situations where a hospital's costs exceed the combined payments received from Medicaid, Medicare, and applicable private plans for these patients. This change allows hospitals to count a wider range of services towards their DSH eligibility, potentially increasing their federal funding. A significant provision allows states to utilize unspent DSH allotments from prior federal fiscal years, specifically from October 1, 2021, up to the date of enactment. States can retroactively apply these unspent funds to increase DSH payments to hospitals, provided the adjustments comply with the newly amended DSH rules, thereby maximizing financial support for safety-net hospitals.