On June 30, CMS issued an Informational Bulletin announcing that it will use “targeted” enforcement discretion to work with states that are unable to meet the Medicaid managed care rule’s original deadlines for compliance, particularly those rules that take effect for managed care contract rating periods beginning on or after July 1, 2017. CMS will not, however, grant flexibility in enforcing specified rules related to directed and pass-through payments, medical loss ratios, and actuarial soundness. States seeking enforcement discretion must identify for CMS the deadlines with which they are unable to comply.