Source: http://www.annalsofhealthlaw.com/annalsofhealthlaw/vol__24_issue_1?pg=104
Timestamp: 2019-04-24 22:44:15+00:00

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Finally, providers and beneficiaries often bring lawsuits together to demand higher reimbursement rates for physicians in order to ensure that beneficiaries have “equal access” to medical care as individuals with private insurance.86 In the absence of federal regulatory guidance or agency enforcement, courts have been the primary actors ensuring that the equal access promise of the Medicaid Act is met.87 As Brietta Clark, a scholar who focuses on the structural inequalities in the healthcare system, has noted, courts have “routinely held that rate cuts motivated exclusively by budgetary concerns violate [the Medicaid Act] because of the failure to consider statutory mandated factors.”88 These cases therefore are particularly important in times of economic downturn, as states often target Medicaid funds as a cost-saving mechanism.89 The wide variety of topics addressed by these cases shows many aspects of the Medicaid program have been directly influenced by private enforcement.
82. PERKINS, PRIVATE ENFORCEMENT, supra note 67, at 6, 8-9 (referencing Table 2 which shows that 23 cases have been brought between 2004 and 2007).
83. 42 U.S. C. A. § 1396a(a)(43)( A); see also 42 U.S. C. A. § 1396d(a)(xvii)(4) (West, WestlawNext through P.L. 113-174.
84. 42 U.S. C. A. § 1396d(r)(5).
85. Smith v. Benson, 703 F. Supp. 2d 1262, 1269 (S. D. Fla. 2010); Ekloff v. Rodgers, 443 F. Supp. 2d 1173, 1179 ( D. Ariz. 2006) (noting that the Seventh, Eighth, and Eleventh Circuits have all adopted this interpretation).
86. Clark, Rate Setting, supra note 59, at 774; see, e.g., Douglas v. Indep. Living Cent. of S. Cal., Inc., 132 U.S. 1204 (2012).
87. Clark, Rate Setting, supra note 59, at 831.
88. Id. at 807 (alteration in original).
89. Donenberg, supra note 13, at 1515; see also Timothy Stoltzfus Jost, The Tenuous Nature of the Medicaid Entitlement: Federal Rights Remain Under Threat and Must be Strengthened, 22 HEALTH AFF. 145, 151 (2003) (“[S]tate responsibility for Medicaid programs has produced program cuts when times are hard, because almost all states are constitutionally prohibited from running deficits, even though Medicaid is a countercyclical program and must thus be funded more rather than less generously during recessions.”).

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