The Center for Reproductive Rights submitted a comment opposing the Medicaid State Directed Payments (SDPs) proposed rule from the Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS). The comment highlights how the rule would significantly limit states’ ability to use SDPs to address maternal mortality and severe maternal morbidity and how it would harm hospitals that serve a high number of Medicaid beneficiaries, particularly teaching hospitals and hospitals in rural and underserved communities. The comment also argues that the rule violates the Administrative Procedure Act (APA) by going beyond what Congress authorized in the One Big Beautiful Bill Act (H.R. 1) without a reasoned explanation and without adequately considering the impact on Medicaid beneficiaries, providers, and states’ maternal health improvement initiatives. The comment urges CMS to withdraw the proposed rule.

Submitted: 7/21/2026