The Centers for Medicare & Medicaid Services today issued a proposed rule that delineates a methodology for implementing the Affordable Care Act aggregate reductions to state Medicaid Disproportionate Share Hospital allotments beginning in fiscal year 2018. The ACA reduces state Medicaid DSH allotments for FY 2018 through FY 2025. In 2013, CMS issued a final rule to implement the ACA state Medicaid DSH allotment reductions and described the methodology it planned to use. Subsequent legislative actions, led by the AHA, delayed the implementation of the cuts until FY 2018. Today’s proposed rule modifies the methodology outlined in the 2013 rule with some modifications and updated data sources.