Supreme Court's Medicaid decision heartens providers
Nursing home can't escape billing charges for "worthless care," federal judge rules.
The country's highest court did not rule against the idea of providers suing the state over its efforts to cut Medicaid reimbursements by 10%. Instead, the high court sent the case back to the 9th Circuit Court for further consideration.
Long-term care lobbyists were among the provider groups pleased with the non-decision. Another was the California Medical Association, which called the action a “win” since it believes providers now have an avenue through which to file complaints about Medicaid policies.
The Supreme Court apparently has “recognized the ability of beneficiaries and providers to challenge Medicaid rate reductions” under the Administrative Procedures Act, wrote Lloyd Bookman, an attorney for several provider groups.
California sought and received permission from the federal government to cut Medicaid reimbursements by 10%. Long-term care, acute-care and other providers filed five lawsuits, stating that state amendments failed the federal law calling for adequate payments to ensure quality care for beneficiaries.
The 9th U.S. Court of Appeals agreed with the complainants and blocked the state from making any changes. The Centers for Medicare & Medicaid Services, however, pushed ahead and approved some amendments. The state pulled back some of the others it had wanted.
The Supreme Court voted 5-4 to remand the case to the lower court, with Justice Stephen Breyer writing the majority opinion. He wrote that providers are now free to challenge CMS's decisions instead of trying to challenge the propriety of federal law over state law.