Can Providers Sue States Over Inadequate Medicaid Rates?

Late last week, the U.S. Supreme Court announced that it will hear a case on whether private sector healthcare providers can sue states to increase Medicaid reimbursements. However, experts say that based on previous rulings, the court will most likely not rule in favor of the providers. In 2009, providers in Idaho sued the state, claiming that the state unlawfully kept Medicaid reimbursements at 2006 levels despite cost of care increases. The federal judge ruled in favor of the providers. The issue at hand is the Supreme Clause in the Constitution; state officials argue that it prohibits private legal action but providers say they have no other options to make sure they receive adequate reimbursements to keep offering services under Medicaid. Medicaid funding must attract enough providers so beneficiaries have the same access to services as the general population.

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