In a 5-4 ruling yesterday, the Supreme Court decided that health care providers cannot sue state Medicaid programs to enforce federal Medicaid law. In Armstrong v. Exceptional Child, Medicaid providers for individuals with developmental disabilities had sued Idaho over payment rates that, they argued, violated requirements in the Medicaid statute that require states to pay participating providers rates that ensure patients’ access to services.
By deciding that health care providers do not have a private right of action — the ability to bring suit against the state to enforce Medicaid requirements — the Court leaves women’s health providers who rely on Medicaid payments with limited recourse. Medicaid, which accounts for 75 percent of all public spending on birth control services, and is one of the largest payors for maternity services, is particularly important for women’s health care. The Armstrong decision does not change the federal government’s responsibility for ensuring that state Medicaid programs comply with all aspects of the law, nor does it change Medicaid enrollees’ right of action when they are not able to access covered services. But providers must now take their complaints on inadequate payment rates to the Centers for Medicare and Medicaid Services — a strategy that rarely results in success. In this case, for example, federal officials had not required Idaho to improve provider payments.
For more information on this case and its potential impact on Medicaid, please see this reaction from NHeLP.