On May 28, 2010, CMS published a final rule with comment period revising its November 25, 2008 final rule that provided state Medicaid agencies with increased flexibility to impose premium and cost sharing requirements on certain Medicaid recipients. The 2010 final rule addresses public comments received during reopened comment periods on the earlier rulemaking and reflects subsequent statutory changes made by the American Recovery and Reinvestment Act of 2009. The revised rule also provides a further opportunity for public comment on revisions made to implement and interpret section 5006(a) of the Recovery Act, which exempts Indians from premiums and cost sharing under certain circumstances. The rule is effective July 1, 2010; comments will be accepted on section 5006(a) provisions until July 27, 2010.