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Using data from a 2002 survey, the authors look at the design and operation of Medicaid disproportionate share hospital (DSH) and upper payment limit (UPL) programs in thirty-four states. The authors find that more available DSH gains were paid to hospitals in 2001 than occurred in the late 1990s. By contrast, survey data suggest that the bulk of available UPL gains in 2001 were kept by states and not by providers. Using simulation analyses, the authors estimate that because of DSH and UPL practices, the effective 2001 federal Medicaid match rate in the survey states was about three percentage points higher on average than it would have been otherwise.