The Supreme Court dealt a serious blow to Medicaid residential care providers on Tuesday in a ruling that prohibits them from suing for higher reimbursement to recoup escalating costs.

The case stemmed from a lawsuit filed by providers against the state of Idaho in 2009, claiming reimbursements were inadequate to keep pace with rising medical costs. There were several ill-fated attempts to raise Medicaid rates before and since, but they were defeated every time in the state Legislature. The Supreme Court’s 5-4 vote on the case indicates just how divisive the issue has been.

The 9th U.S. Circuit Court of Appeals ruled in 2013 that the providers could sue. Various trade groups and the U.S. Chamber of Commerce vigorously attempted to help providers get more Medicaid funding from the state.