On January 16, United States District Court for the District of Columbia denied a request from several hospitals (“Hospitals”) to enjoin CMS from approving California’s State Plan Amendment relating to the state’s Quality Assurance Fee (“QAF”) program, a Medicaid supplemental payment program. The Hospitals reside outside of California and, as a result, would not receive QAF payments under the plan amendment as written. The Court held that Plaintiffs’ failed to state a claim under the Administrative Procedures Act for lack of final agency action because CMS has yet to approve the plan amendment. Furthermore, the court found that Plaintiffs’ claims were not ripe because approval of the state’s amendment would not force the Hospitals to make immediate or significant changes to their business practices.