On March 2, 2018, DC District Judge Emmet Sullivan ruled in favor of hospital plaintiffs and vacated a final rule promulgated by CMS requiring the inclusion of Medicare and commercial payments in the calculation of the Medicaid disproportionate share hospital (DSH) limit. The decision arrives on the heels of a similar ruling in Missouri district court in early February. This is the second ruling in the midst of a wave of litigations across the country led by various hospitals seeking to challenge this CMS policy.