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Page 27 – CMCS Informational Bulletin Section Provision Key Date(s) Subchapter C – Stopping Abusive Financing Practices Section 71114 Sunsetting Increased FMAP Incentive Applies to states adopting the Medicaid adult group under section 1902(a)(10)(A)(i)(VIII) of the Act on or after January 1, 2026. Section 71115 Provider Taxes October 1, 2026: Restriction on new or increased provider taxes. October 1, 2027: Expansion state hold harmless reduction begins. Section 71116 State Directed Payments Applies to rating periods beginning on or after July 4, 2025. For grandfathered SDPs, applies to rating periods beginning on or after January 1, 2028. Section 71117 Requirements Regarding Waiver of Uniform Tax Requirement for Medicaid Provider Tax Effective July 4, 2025, subject to any transition period determined by the Secretary (not to exceed 3 fiscal years). Section 71118 Requiring Budget Neutrality for Medicaid Demonstration Projects under Section 1115 Applies beginning January 1, 2027 Subchapter D – Increasing Personal Accountability Section 71119 Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals Applies beginning January 1, 2027, or earlier at state option; outreach requirements will apply several months before implementation; state good-faith temporary exemption expires no later than December 31, 2028 Section 71120 Modifying Cost Sharing Requirements for Certain Expansion Individuals under The Medicaid Program Applies beginning October 1, 2028 Subchapter E – Expanding Access to Care Section 71121 Making Certain Adjustments to Coverage of Home or Community-Based Services under Medicaid (new section 1915(c) option) New waiver option available beginning July 1, 2028 Chapter 4 – Protecting Rural Hospitals and Providers Section 71401 Rural Health Transformation Program Effective July 4, 2025 Administrator must approve or deny applications by December 31, 2025