The United States Supreme Court will hear arguments from the state of Idaho on one side and Medicaid health care providers on the other, about whether those providers can sue the State over low reimbursement rates under the Supremacy Clause of the Constitution.
The underlying dispute stems from how much (or how little) Medicaid providers are paid. In many cases, the providers argue, they are reimbursed less than it costs to provide care. The American Hospital Association and Federation of American Hospitals filed a brief in the case, stating that the cost of providing care to Medicaid beneficiaries exceeded payments by $13.7 billion in 2012.
If payment rates stay low, fewer providers will be willing to accept patients with Medicaid – at the same time the Medicaid market is expanding in many states and more people are covered by Medicaid than ever before. That would have serious implications on access to care.
Idaho argues that Congress has not authorized suits by private parties to enforce the Medicaid law and that lawsuits are not the best way to handle a dispute over rates. Providers argue that lawsuits are a key tool to ensuring adequate rates.
The case Armstrong v. Exceptional Child Center, Inc., will be heard Tuesday, Jan. 20, 2015, and will have major repercussions either way it turns out.
PLDO will be watching this issue closely and provide updated information as it unfolds, as well as information on other important ACA topics. If you have questions about Medicaid, the ACA or other health care-related issues, please call Attorney Jillian Jagling at 401-824-5100 or email [email protected] We welcome your comments, questions and suggestions.