Providers Can’t Sue State Medicaid Agencies Over Rates

by User Not Found | Apr 01, 2015
Private healthcare providers can’t sue state Medicaid agencies over low reim-bursement rates, the U.S Supreme Court decided recently, reversing a lower court’s ruling.

Private healthcare providers can’t sue state Medicaid agencies over low reim-bursement rates, the U.S Supreme Court decided recently, reversing a lower court’s ruling.

Justice Antonin Scalia wrote in the majority opinion that the supremacy clause of the U.S. Constitution, which says federal laws reign supreme over state laws, does not allow providers to sue state Medicaid agencies over rates. He also said that the Medicaid Act implicitly does not allow private parties to enforce a part of the law that requires state plans to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguarding against unnecessary utilization of...care and services.” Congress, he summarized, did not mean for the court to be able to get around that part of the law.

Jane Perkins, legal director of the National Health Law Program, said even with the decision, it’s possible some providers might still try to sue state Medicaid agencies. However, they won’t be able to do so by basing their arguments on the Supremacy Clause, which had been one of the foundations of cases such as these. The Supreme Court took up the case after Idaho residential providers for disabled patients sued state officials over the state Medicaid agency’s failure to implement new, higher rates because the Legislature didn’t provide sufficient funding.

Joe Calandra CMO, Midwest Imaging Professionals
Joe Calandra - CMO, Midwest Imaging Professionals
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