California Medicaid Case Headed To Supreme Court June 3, 2011 Medicare, News, Politics and Medicine Health costs, medicaid, Medicare, News, Supreme Court 0 Memorial, a 278-bed hospital in this city 55 miles north of San Francisco, sued California to try to stop the payment reductions. Now it is part of a case before the U.S. Supreme Court that could redefine states' responsibilities on Medicaid services and ultimately determine whether Democratic Gov. Jerry Brown can go forward with cuts he says are vital to closing the state's budget gap. The court is likely to hear arguments in the fall and render a decision by next spring. Many states are pressing for more flexibility on Medicaid, a joint federal-state health program for the poor and disabled. But Memorial, as well as other hospitals and doctors, counter that the steep cuts violate federal law, which requires that payments be set high enough to ensure providers will see enrollees. They note the state's reimbursement rates rank 46th among the states. Supreme Court Focus In the legal battle over reimbursement cuts, the US 9th Circuit Court of Appeals ruled against the state in several cases. In January, the Supreme Court agreed to hear the case, based on Memorial's suit and two others. The court will focus on whether outside groups, such as hospitals and other providers, as well as Medicaid recipients, have the right to sue when they believe the state is violating federal law. For now the state – barred by the 9th Circuit injunction – is holding off on the disputed cuts at issue in the lawsuit. "This is an extremely important case," said Charles Luband, a partner with the law firm Ropes & Gray LLP in New York City, which has drafted letters in support of hospitals and doctors in the case." The Medicaid statute was created to assure payments were sufficient to enlist enough providers to participate in the program. That’s why it's important providers be able to bring such lawsuits to assure that statute has meaning and relevance." Sara Rosenbaum, chairwoman of the Department of Health Policy at George Washington University, said the case could have broad ramifications for patients. If California wins, Medicaid recipients wouldn’t be able to sue states to compel them to fulfill an array of duties under the law, such as conducting “fair hearings” for enrollees deemed ineligible, she said. The court isn’t expected to rule on whether the proposed provider cuts are legal. If the providers win in the Supreme Court, that issue would likely be sent back to the 9th Circuit. Also, the administration’s proposed Medicaid rule on payment cuts isn’t likely to have much impact; the Supreme Court will be considering the narrow issue of whether private parties have standing to sue states over alleged violations of the Medicaid law. This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Click here to view the full article. Comments are closed.
