SCOTUS: Medicaid Providers Cannot Sue States to Raise Reimbursement Rates

The Supreme Court ruled Tuesday that doctors and health care providers cannot sue to force a state to raise reimbursement rates for Medicaid services. NPR reports that the 5-4 decision comes as a heavy blow to those who provide these services as many doctors and health care companies say stagnant rates are so low that they are losing money on Medicaid patients.

“The majority opinion, written by Justice Antonin Scalia, said that Congress, in creating the Medicaid rate-setting scheme, did not explicitly authorize private suits like the one at issue here. Instead, he said, the law mandates that state reimbursement plans are “consistent with efficiency, economy, and quality of care,” all the while “safeguarding against unnecessary utilization of … care and services.”

 

“It is difficult to imagine a requirement broader and less specific” than that, wrote Scalia. “Explicitly conferring enforcement of this judgment-laden standard upon the Secretary [of Health and Human Services] alone establishes, we think,” that Congress wanted to make the agency cutoff of funds the “exclusive” remedy. With such a big financial club, Scalia said, “we doubt that the Secretary’s notice to a state that its compensation scheme is inadequate will be ignored.” – NPR, March 31, 2015

Read the full report here.