How the latest ruling affects Medi-Cal and Medicaid

The Medicaid Act requires Medicaid agencies to take provider costs into account when setting rates.  Despite this, some providers often feel hard done by Medicaid because of low rates. Medical providers in Idaho recently challenged Medicaid’s rates in the case of Armstrong vs Exceptional Child Center Inc.It is therefore important to review how that latest ruling affects Medi-Cal and Medicaid.

Medicaid Rates

Medicaid is a state-administered federal health insurance program targeting the low-income and vulnerable populations. The Medicaid statute has specific guidelines regarding rates. It states that rates should be “sufficient to enlist enough providers so that care and services are available.” At the sometime, Medicaid allows states to set their own provider rates.

The Case of Armstrong vs Exceptional Child Center Inc.

The case was brought against Medicaid by medical providers in Idaho who provide in-home care services, or habitation services. The providers wanted the court to compel the Idaho Medicaid agency to increase their rates. The Federal district court sided with the medical providers, but the Supreme Court subsequently ruled that providers cannot sue Medicaid in order to force them to pay higher rates.

Implications for Medi-Cal and Medicaid

The case inhibits the ability of health care providers to bring a suit against Medicaid state agencies, in order to enforce the provisions of the Medicaid Act. It means that in the event of a violation there is no private right to sue, as this is not expressly authorized by Congress. As a result of the ruling, medical providers such as physicians and hospitals will find it difficult to get better funding rates with Medicaid.

Learn more about how this latest ruling affects Medi-Cal and Medicaid, by speaking to an attorney at Nelson Hardiman, Los Angeles, CA. Please call 310-203-2800 to set up an appointment.

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