CMS has issued a proposed rule establishing a methodology to reduce state Medicaid disproportionate share hospital (DSH) allotments annually beginning with fiscal year (FY) 2018, as mandated by the Affordable Care Act (and modified in subsequent legislation). CMS estimates that the rule would reduce state DSH allotments/payments by $43 billion for the period of FY 2018 through FY 2025, and the agency anticipates that the rule would reduce total federal financial participation claimed by states by similar amounts.  CMS will accept comments on the proposed rule until August 28, 2017.