Title

Medicaid Payment Rate Lawsuits: Evolving Court Views Mean Uncertain Future for Medi-Cal

Document Type

Report

Publication Date

10-2009

Keywords

Medicaid & SCHIP; Legal

Abstract

"Medicaid Payment Rate Lawsuits: Evolving Court Views Mean Uncertain Future for Medi-Cal" looks at the lengthy history of medical provider rate litigation. In a one year period beginning in April of 2008, five lawsuits were filed against the state of California to stop scheduled reductions in provider payments in the state's Medicaid program, Medi-Cal. A cross-cutting theme of these lawsuits is the theory that Medi-Cal rate cuts violate the "equal access" statute, a federal law which requires payment to Medicaid providers to be "sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area." The theory is that low or reduced Medicaid provider payment rates may act as a disincentive to provider participation in Medicaid programs, hence compromising beneficiary access to health care. Lacking clear federal guidance on such matters, plaintiffs have turned to the courts in attempts to challenge rate-setting methodologies and low reimbursement rates.

Comments

Funder: California HealthCare Foundation.

Open Access

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