The tenuous nature of the Medicaid entitlement

Health Affairs

Volumn 22, Issue 1, 2003, Pages 145-153

  Jost, Timothy Stoltzfus ^a  

^a WASHINGTON AND LEE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CIVIL RIGHTS; DISABLED PERSON; ECONOMICS; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; JURISPRUDENCE; LEGAL ASPECT; MANDATORY PROGRAM; MEDICAID; POVERTY; SOCIOECONOMICS; UNITED STATES;

CIVIL RIGHTS; CONTRACT SERVICES; DISABLED PERSONS; FEDERAL GOVERNMENT; HEALTH POLICY; HUMANS; MANDATORY PROGRAMS; MEDICAID; POVERTY; SOCIOECONOMIC FACTORS; STATE GOVERNMENT; STATE HEALTH PLANS; SUPREME COURT DECISIONS; UNITED STATES;

EID: 0037270692     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.1.145     Document Type: Review

References (48)

1. 42 U.S. Code, sec. 1395ff (b)(1)(A).
2. Public Law 89-97, sec. 121.
3. See Note, "Federal Judicial Review of State Welfare Practices," Columbia Law Review 67, no. 1 (1967): 84-129.
4. 392 U.S. 309, 333, note 34 (1968).
5. 392 U.S. at 312, note 3.
6. 448 U.S. 1, 4 (1980).
7. 496 U.S. 498 (1990).
8. Suter v. Artist M, 503 U.S. 347 (1992).
9. Congress has at least five other times rejected legislation that would have deprived Medicaid recipients of a federal right of action. See E. Chemerinsky, "Ensuring the Supremacy of Federal Law: Why the District Court Was Wrong in Westside Mothers v. Haveman," Health Matrix 12, no. 1 (2002): 139-156, 152.
10. Edelman v. Jordan, 415 U.S. 651 (1974).
11. Exparte Young, 209 U.S. 123 (1908).
12. 42 U.S. Code Amended, sec. 1396a(a)(8). See Doe v. Chiles, 136 F.3d 709 (11th Cir. 1998) (finding that disabled people placed on a waiting list for intermediate care facility services were not provided services with "reasonable promptness").
13. 42 U.S. Code, secs. 1396a(a)(10)(A) and 1396d(a).
14. 42 CFR, sec. 440.230(b).
15. 42 CFR, sec. 440.230(c).
16. Centers for Medicare and Medicaid Services, "Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative," 17 September 2002, www.cms.hhs.gov/hifa/default.asp (23 October 2002).
17. See, commenting on HIFA, E. Park and L. Ku, Administration Medicaid and SCHIP Waiver Policy Encourages States to Scale Back Benefits Significantly and Increase Cost-Sharing for Low-Income Beneficiaries (Washington: Center on Budget and Policy Priorities, 15 August 2001).
18. 496 U.S. 498 (1990).
19. Former 42 U.S. Code Amended, sec. 1396a(a)(13)(E).
20. 42 U.S. Code Amended, sec. 1396a(a)(30)(A).
21. Reported cases were identified using a Westlaw search of the ALLFEDS database for 1999 and 2000 cases including a citation to a provision of 42 U.S. Code 1396ff and the word Medicaid. Only cases in which a Medicaid agency was the defendant were included. Fraud and abuse and qui tam cases were excluded, as were cases challenging or seeking a share of tobacco tort litigation settlements. Cases involving purely procedural issues such as class certification or attorneys' fees awards were also excluded Cases were coded as either wins for the plaintiff or for the Medicaid agency. Cases in which both parties won on some issues were coded for computing win/loss statistics as favoring each party half and half.
22. Both recipients and providers were much less successful, however, in the courts of appeals, where state Medicaid agencies won 83 percent of the reported cases in 1999 and 81 percent in 2000.
23. 133 F. Supp. 2d 549 (ED. Mich. 2001).
24. 42 U.S. Code, secs. 1396d(a)(4)(B) and 1396d(r).
25. See, for example, OKAAP v. Fogarty, 2002 WL 1271782 (May 21, 2002); Rancourt v. Concannon, 175 F. Supp. 2d 60 (D. Me. 2001); Bryson v. Shumway, 177 F. Supp. 2d 78 (D. N. H. 2001); Memisovski v. Patla, 2001 WL 1249614 (N.D. Ill, Oct. 17, 2001); Markva v. Haveman, 168 F. Supp. 2d 695 (E.D. Mich. 2001); and Boudreau v. Ryan, 2001 WL 840583 (N.D. Ill. May 2, 2001).
26. Antrican v. Odom, 290 F.3d 178 (4th Cir. May 9, 2002).
27. Ibid. at 188.
28. Westside Mothers v. Hoveman, 289 F.3d 852 (6th Cir. 2002).
29. Barnes v. Gorman, 122 S.Ct. 2097 (2002).
30. 122 S.Ct. at 2100.
31. 122 S.Ct. at 2104, n.3.
32. Gonzaga University v. Doc, 122 S.Ct. 2268 (2002).
33. 122 S.Ct. at 2279.
34. S. Sugarman, "Welfare Reform and the Cooperative Federalism of America's Public Income Transfer Programs," Yale Law and Policy Review 14, no. 1 (1996): 125-147.
35. See R. Lieberman, Shifting the Color Line: Race and the American Welfare State (Cambridge: Harvard University Press, 1998), 118-176;
36. and J. Quadagno, "From Old-Age Assistance to Supplemental Security Income: The Political Economy of Relief in the South, 1935-1972," in The Politics of Social Policy in the United States, ed. M. Wier et al. (Princeton: Princeton University Press, 1988), 235-263.
37. 42 U.S. Code, sec. 1397bb(b)(4).
38. S. Rosenbaum et al., "Devolution of Authority and Public Health Insurance Design: National SCHIP Study Reveals an Impact on Low-Income Children," Houston Journal of Health Law and Policy 1, no. 1 (2001): 33-61.
39. Families USA, Disparities in Eligibility for Public Health Insurance: Children and Adults in 2001 (Washington: Families USA, February 2002).
40. See J.E. Wennberg, E.S. Fisher, and J.S. Skinner, "Geography and the Debate over Medicare Reform," 13 February 2002, www.healthaffairs.org/ WebExclusives/Wennberg_Web_Excl_021302.htm (24 July 2002).
41. See T. Coughlin and D. Liska, The Medicaid Disproportionate Share Hospital Payment Program: Background and Issues (Washington: Henry J. Kaiser Family Foundation, October 1997);
42. and L. Ku, Limiting Abuses of Medicaid Financing: HCFA's Plan to Regulate the Medicaid Upper Payment Level (Washington: Center for Budget and Policy Priorities, September 2000).
43. F. Piven, "Comment on Interstate Competition and Welfare Policy," in Welfare Reform: A Race to the Bottom? ed. S. Schram and S. Beer (Washington: Woodrow Wilson Center Press, 1998), 43-48;
44. and D. Kenyon, "Health Care Reform and Competition among the States," in Health Policy, Federalism, and the American States, ed. R. Rich and W. White (Washington: Urban Institute, 1999), 253-276, 264-268.
45. See V. Smith and E. Ellis, Medicaid Budgets under Stress: Survey Findings for State Fiscal Year 2000, 2001, and 2002 (Washington: Kaiser Commission on Medicaid and the Uninsured, October 2001);
46. and Kaiser Commission, The Role of Medicaid in State Budgets (Washington: Kaiser Commission, November 2001).
47. T. Conlan, New Federalism: Intergovernmental Reform from Nixon to Reagan (Washington: Brookings Institution, 1988), 151.
48. Budget of the United States Government, Fiscal Year 2003, Table S-2, w3.access.gpo.gov/usbudget/fy2003/pdf/bud34.pdf (24 July 2002).