R
Robert Bradner
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Aug 21, 2026
HIMSSCast: CMS proposes sweeping changes to State Directed Payments
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Susan MorseHOST
And I'm wondering if we can just jump right in, and you can tell me what are these programs, please, and what do they do?

Robert BradnerGUEST
Now, I have to go sort of back a couple of steps to explain really how they fit into the world.

Robert BradnerGUEST
Um, as I'm sure a lot of your listeners know, Medicaid is a large and growing state federal program that dates back to the 1960s, where the feds come up with a portion of the money, the states come up with the rest of it, and the state then administers their program under a plan.

Robert BradnerGUEST
The, um, um, H.R.1, the budget reconciliation bill, the president likes to call it the big, the one big beautiful bill, uh, that passed through Congress last year.

Robert BradnerGUEST
This was, this was legislation that, that made the tax Trump cuts permanent, had new tax cuts, gave money to the Department of Defense, and one of the major, uh, savings items was significant changes to Medicaid.

Robert BradnerGUEST
And, and so there, the sort of, the big three were imposing community, uh, engagement requirements on beneficiaries.
7 MINS LATER

Susan MorseHOST
Is there anything you're recommending to them to prepare or do, uh, about this? Because they're going to have to eat a lot of uncompensated care costs.