Some Supreme Court justices appear skeptical about whether physicians and other health providers have the right to sue states over low Medicaid reimbursement.
During oral arguments Jan. 20 in Armstrong v. Exceptional Child Center Inc., Chief Justice John G. Roberts Jr. questioned whether letting providers challenge state-set payment rates would lead to a wave of litigation and force federal judges to make state budgetary decisions.
“There are dozens of different types of providers under the [Social Security] Act,” Justice Roberts said during oral arguments. “Now, what do you do if each of those providers bring a lawsuit similar to yours? The effect, it seems to me, will be putting the setting of budget priorities in the hands of dozens of different federal judges, and I just don’t know what the practical significance of that’s going to be.”
Courtesy Wikimedia Commons
U.S. Supreme Court Chief Justice John Roberts
In Armstrong v. Exceptional Child Center Inc., the high court justices are weighing whether the U.S. Constitution’s Supremacy Clause – which establishes the Constitution and federal law as the law of the land – gives health care providers under Medicaid a private “right of action” to enforce Medicaid funding conditions against states. The case originates from a 2009 lawsuit by Exceptional Child Center Inc., of Twin Falls, Idaho, and four other residential habilitation centers against Richard Armstrong, director of the Idaho Department of Health and Welfare.
The centers claimed the state was violating Medicaid’s equal access provision by refusing to raise its payment rates. Under the equal access provision, states that accept federal Medicaid funding are required to set reimbursement rates at levels sufficient to retain enough providers and make sure patients have proper access to care. The Idaho Department of Health and Welfare and its Medicaid division conducted yearly cost studies between 2006 and 2009, developed a new rate-setting methodology, and recommended substantial increases in reimbursement rates for supported living services, according to court documents. However, the new methodology and rate increases were not enacted for budgetary reasons.