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Providers can’t sue state Medicaid agencies over rates, Supreme Court rules
Modern Healthcare

Private healthcare providers cannot sue state Medicaid agencies over low reimbursement rates, the U.S. Supreme Court decided Tuesday in a 5-4 decision, reversing a lower court’s ruling.

Justice Antonin Scalia wrote in the majority opinion that the supremacy clause of the U.S. Constitution, which says federal laws reign supreme over state ones, does not allow providers to sue state Medicaid agencies over rates. Scalia also wrote that the Medicaid Act implicitly does not allow private parties to enforce a part of the law that requires state plans to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguard(ing) against unnecessary utilization of . . .care and services.” Congress, he concluded, did not mean for the court to be able to get around that part of the law.

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