Supreme Court hears Medicaid reimbursement case

Photo of a gavel and stethoscope
SCOTUS Hears Medicaid Case

The Supreme Court heard oral arguments January 20 in a closely watched case that could redefine the contours of who can file lawsuits to challenge violations of federal Medicaid law.

In 2009, a group of Idaho health care providers filed a lawsuit challenging the state’s reimbursement rates to providers of Medicaid services, which are jointly funded by the federal and state governments. Specifically, they argued that the reimbursement rates, which hadn’t been raised since 2006, ran afoul of the Medicaid Act’s Equal Access provision, which requires states to “provide adequate funding to ensure that Medicaid beneficiaries have equal access to medical services and care as available to the general population in their geographic area.”

The state of Idaho argues that the providers did not have standing to bring the lawsuit, on the basis that the Medicaid Act allows only the federal government to bring lawsuits against states to challenge reimbursement rates.

The Medicaid Act does not expressly allow such lawsuits, but it does not expressly prohibit them either. Numerous lawsuits have been brought challenging states’ compliance with the Equal Access provision, as well as other provisions of the Medicaid Act.

Both the U.S. District Court for the District of Idaho and U.S. Circuit Court of Appeals for the 9th Circuit ruled that the plaintiffs had standing to bring the lawsuit, prompting the Supreme Court to grant certiorari to hear the case in October.

As is often the case at the Supreme Court, the decision likely hinges on Justice Anthony Kennedy, the primary swing justice on the nine-member body. Justice Kennedy did not ask any questions during the plaintiff’s argument, but sharply questioned Carl Withroe, the attorney representing the state of Idaho.

“Did I miss something? … I thought you were going to give us a principled way to say why this case is different from our other preemption cases,” Justice Kennedy asked Withrow, according to Scotusblog.

The Supreme Court heard oral arguments in a similar case in 2011, challenging California’s Medicaid reimbursement rates.

While the case was pending, a five-member majority of the Supreme Court remanded the case back to the 9th Circuit for new proceedings. The Court’s four more conservative justices, however, dissented from the decision, writing that they did not believe the health care providers challenging the California rates had standing to bring the lawsuit.

Nearly every major disability rights group has weighed in on the case. In December, 13 disability rights groups signed onto an amicus brief, written by famed civil rights attorney Samuel Bagenstos, in support of the plaintiffs.

“Amici submit this brief because private suits…are critical to assure that people with disabilities, particularly those who live in poverty or are elderly, get the health care they need and deserve, and that they have recourse to the federal courts and do not need to depend on an overburdened federal agency to revoke funding when they do not receive such care,” they wrote in the brief, which was signed by the American Association of People with Disabilities, the ARC and the Autistic Self Advocacy Network, among other groups.

The National Disability Rights Network, Disability Rights Idaho and 17 other other disability and civil rights groups signed onto another amicus brief submitted in December, urging the Supreme Court to grant the plaintiffs standing in the case.

“Millions of Americans depend on their states’ Medicaid programs operating pursuant to the Constitution and as Congress intended,” the brief states. “Over the 50-year history of the Medicaid Act, private enforcement has consistently been the primary means of halting ongoing state violations of federal law and realizing Medicaid’s promises and protections.”

Disability Rights Idaho and Disability Rights Washington, the publisher of this Galaxy website, are part of the federally funded protection and advocacy system and members of the National Disability Rights Network.