Comment on CMS-2026-2080-0001

RE: Comments on Medicaid Program: Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments (Document ID: CMS-2026-1916-0001) Dear Administrator, I agree with CMS's objective of greater transparency, accountability and fiscal integrity in payments made to states that direct Medicaid. Transparency about payment limits and more robust protections can help ensure that Medicaid dollars are aligned to patient care, access, and evidence-based quality results, instead of being allocated to a small group of providers for which there is no obvious justification. I hope CMS will not cause its Medicaid beneficiaries to suffer from unintended access issues during implementation, however. States must conduct and disclose assessments of the potential for impact on rural hospitals, safety-net providers, nursing facilities, and practitioner participation before cuts. During the transition, CMS must track wait times for appointments, participation in provider networks, service closures, and distance beneficiaries are required to travel. CMS should implement changes in payment gradually and implement corrective action when payment changes result in documented access barriers within the limits Congress sets. Provider classes should be directly linked to specific Medicaid quality and access goals and not so specific as to serve as a payment to a preferred provider. Sincerely, Treshia Ann McDonald Tam361@nyu.edu