On September 23, 2019, CMS issued a final rule implementing its Disproportionate Share Hospital (DSH) reduction methodology. The DSH payment cuts were part of the Affordable Care Act (ACA) and are currently scheduled to begin in 2020 after a series of two-year delays. CMS initially proposed its methodology in 2017, prior to Congress delaying the cuts to 2020. Should the cuts be implemented, CMS’ methodology would require states to target the remaining funding to providers with the highest low-income patient population.