On April 20, The U.S. Court of Appeals for the Fifth Circuit became the third appeals to court to reinstate CMS’ 2017 final rule requiring states to include Medicare and commercial payments in their Medicaid DSH limit calculations. The rule was recently reinstated on a nationwide basis by an April 2019 ruling in the D.C. Circuit. Plaintiff hospitals in the D.C. Circuit filed petition for writ of certiorari, which is currently pending before the Supreme Court.