Comment on CMS-2026-1916-0001

I write today to express my concerns that the new CMS rule regulating state directed payments represents a significant overreach of federal authority. As a lifelong conservative here in the Texas State House of Representatives, the rule threatens to not only strip power from states, but also could harm rural healthcare access across the state. This new CMS rule is just the latest example of unelected bureaucrats trying to consolidate power at the expense of states. Even though state officials like myself have lived in and served our communities for years, these Washington bureaucrats are determined to dictate how we run our own affairs. Now, they are on the verge of effectively setting new policy that not even President Trump signed on to. The latest rule makes major changes from when he signed the One Big Beautiful Bill Act into law. It enforces mandatory, all-encompassing Medicare caps on state directed payments and service types, while also making it very difficult for states to comply with the new rules. As a result, rather than adhering to what President Trump wanted, the new rule goes well beyond what the law authorizes on a far larger and more aggressive scale. Stripping our ability to properly use state directed payments not only infringes on state rights, but also threatens to jeopardize healthcare access for our rural communities. Texas is just one of many states across the country that relies on state directed payments to help rural healthcare providers stay open. Specifically, they provide the extra funding needed for these facilities to treat seniors, children, and other vulnerable populations living in rural areas. By capping and phasing these programs out, we could see these same rural healthcare providers close their doors, potentially leaving families to drive for hours before they are able to reach the nearest medical facility. I urge you to rewrite this rule in order to preserve state authority and ensure rural families and communities have access to the healthcare they need.