The Supreme Court Ruling That Blocked Providers From Seeking Higher Medicaid Payments Also Undercut The Entire Program

Abstract

In Armstrong v. Exceptional Child Center, Inc., the US Supreme Court revisited the question of whether Medicaid providers may seek relief in federal courts when states fail to pay "sufficient" Medicaid rates. A divided Supreme Court held that the Supremacy Clause of the US Constitution does not support such actions, even when states violate the Medicaid Act of 1965. Payment sufficiency is vital to Medicaid's success in expanding health insurance coverage under the Affordable Care Act. By terminating providers' ability to seek relief in federal courts, Armstrong makes it easier for states to cut Medicaid payment rates at the same time that millions of new enrollees will enter the program, undercutting operation of the Medicaid program and its role in health care reform.

Does Medicaid Insurance Confer Adequate Access to Adult Orthopaedic Care in the Era of the Patient Protection and Affordable Care Act?

“…This requires physician reimbursement rates to be ''sufficient to enlist enough providers so that services under the plan are available to recipients at least to the extent that those services are available to the general population'' [18]. Despite this provision, the reimbursement rate disparity between private insurance and Medicaid continues to be substantial, as does the disparity between Medicaid and Medicare rates [10]. Additionally, for a given reimbursement rate, private practices were less likely to take an adult patient with Medicaid insurance relative to an academic practice.…”

“…The reimbursement rates for CPT 1 codes 99213 (established followup outpatient visit -level 3 of 5), 99243 (new outpatient consultation -level 3 of 5), and 27786 (closed treatment of distal fibular fracturelateral malleolus -without manipulation -surgical care only) were determined at the time of the telephone survey via state Medicaid agency fee schedules for comparison to the responses attained via the telephone survey (Table 1). If the state Medicaid fee schedule did not provide the required information, the Kaiser Foundation Medicare-toMedicaid Fee Index was used to determine the associated CPT 1 code Medicaid reimbursement rates from known Medicare reimbursement rates [6,10,17,20].…”