Explaining Armstrong v. Exceptional Child Center: The Supreme Court Considers Private Enforcement of the Medicaid Act
No. 14-15 (U.S.). For additional background, see Sara Rosenbaum, Medicaid Payments and Access to Care, 371 N. Engl. J. Med. 2345 (Dec. 18, 2014), available at http://www.nejm.org/doi/full/10.1056/NEJMp1412488; National Health Law Program, Update on Private Enforcement of the Medicaid Act: The Supremacy Clause and 42 U.S.C. § 1983 (Oct. 13, 2014), available at http://www.healthlaw.org/publications/browse-all-publications/Issue-brief-medicaid-supremacy-clause#.VK_uHE10yUk. The briefs filed in the Armstrong case are available at http://www.scotusblog.com/case-files/cases/armstrong-v-exceptional-child-center-inc/.
42 U.S.C. § 1396a(a)(30)(A). In 2011, CMS proposed a rule that would, for the first time, provide federal regulatory guidance on what states must do to demonstrate their compliance with the equal access provision. See Kaiser Commission on Medicaid and the Uninsured, Provider Payment and Access to Medicaid Services: A Summary of CMS’ May 6 Proposed Rule (July 2011), available at https://www.kff.org/medicaid/issue-brief/provider-payment-and-access-to-medicaid-services/. To date, that rule has not yet been finalized.
Exceptional Child Center v. Armstrong, No. 12-35382, at 4 (9th Cir., April 4, 2014) (quoting from Stipulated Facts), available at http://www.scotusblog.com/case-files/cases/armstrong-v-exceptional-child-center-inc/.
In Douglas, Medicaid beneficiaries and providers sued the California state Medicaid agency, seeking to enjoin a number of proposed provider payment rate cuts. After the Supreme Court heard oral argument, but before it had issued its decision, CMS approved California’s state plan amendment containing the rate cuts. Consequently, the Douglas majority held that the case should be sent back to the lower courts to consider the effect of CMS’s approval of the state plan amendment, without deciding whether the beneficiaries and providers had a right to sue. Douglas v. Independent Living Center, No. 09-958 (Feb. 22, 2012), available at http://www.supremecourt.gov/opinions/11pdf/09-958.pdf.
A number of amicus briefs were filed, including those by the United States Solicitor General, some Members of Congress, 28 states, and beneficiary and provider advocacy groups. The Solicitor General contends that the Court should not recognize a private right of action to enforce the equal access provision, without deciding whether private parties can sue to enjoin state laws as preempted by federal law more generally.