Obama Justice Department sides with states in Medicaid case

Federal law says that Medicaid, the federal/state system that covers millions of low- and moderate-income individuals and families as well as a huge portion of the nursing home population, must pay provider rates that are "sufficient to enlist enough providers" to ensure equal access to care for Medicaid recipients as the general population.

How that is enforced, and more importantly who has a right to sue to ensure that it is enforced, is the subject of a case before the Supreme Court, and the Obama administration's Department of Justice has weighed in on the side of the states.

Here's the background on the case:

The California Legislature in 2008 initially adopted a 10 percent reduction in reimbursements by Medi-Cal, which is California's Medicaid program. The cuts were blocked in court.

In his proposed spending plan, Brown adopted some of the same reimbursement proposals in a bid to close a $25 billion budget gap. Cutting reimbursements would save $709 million in the fiscal year that begins July 1, according to Brown's budget.

The cases brought by the Independent Living Center of Southern California, the California Pharmacists Association and Santa Rosa Memorial Hospital raise substantially the same legal question. This question to be solved by the Supreme Court doesn't involve California's authority to impose cuts, or the wisdom of the budget cuts.

Rather, the court will rule on whether Medicaid beneficiaries and physicians have the right to sue over the proposed reimbursement reductions.

Though it sounds acutely technical, this argument over legal standing is crucial because it determines who can challenge government decisions and who's shut out of court. Chief Justice John Roberts Jr. and other Supreme Court conservatives have repeatedly adopted a narrow view of legal standing in other cases.

In a friend of the court brief, the Justice Department argues that federal law does not allow individuals, Medicaid recipients and providers, to sue.

Such lawsuits ?would not be compatible? with the means of enforcement envisioned by Congress, which relies on the secretary of health and human services to make sure states comply, the administration said in the brief, by the acting solicitor general, Neal K. Katyal.

In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them.

But, the Justice Department said, the Medicaid law?s promise of equal access to care is ?broad and nonspecific,? and federal health officials are better equipped than judges to balance that goal with other policy objectives, like holding down costs....

Consumer advocates were dismayed by the administration?s position, which they said undermined Medicaid recipients? rights and access to the courts.

?I find it appalling that the solicitor general in a Democratic administration would assert in a Supreme Court brief that businesses can challenge state regulation under the supremacy clause, but that poor recipients of Medicaid cannot challenge state violations of federal law,? said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, who is usually sympathetic to the administration.

Representative Henry A. Waxman of California, the senior Democrat on the Energy and Commerce Committee and an architect of Medicaid, said the administration?s brief was ?wrong on the law and bad policy.?

?I am bitterly disappointed that President Obama would accept the position of the acting solicitor general to file a brief that is contrary to the decades-long practice of giving Medicaid beneficiaries and providers the ability to turn to the courts to enforce their rights under federal law,? Mr. Waxman said. He said that he and other Democratic lawmakers planned to file a brief opposing the administration?s view.

How much weight the court will give this amicus brief is unknown. The timing and the politics of this decision by Justice to file the amicus brief are also a little murky?massive cuts to Medicaid are in the Republican sights now in budget negotiations, and the administration has come down hard against those cuts. Medicaid expansion is also a cornerstone of expansion of care under the Affordable Care Act.

The National Governors Association and the National Conference of State Legislatures have also filed an amicus brief supporting California, as have 30 states in a separate filing, arguing that "[a]llowing 'supremacy clause lawsuits' to enforce federal Medicaid laws will be a financial catastrophe for states."

Source: http://feeds.dailykos.com/~r/dailykos/index/~3/Ta5J7iNQ0Po/-Obama-Justice-Department-sides-with-states-in-Medicaid-case

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