Ruling Restricts Medi-Cal Lawsuits
A three-judge panel for the 9th U.S. Circuit Court of Appeals on Tuesday ruled that Medicaid providers and beneficiaries, including people with disabilities and seniors, are prohibited from suing the state to enforce the equal-access and quality-of-care provisions in the federal law that governs Medi-Cal, the Sacramento Bee reports. A group of Medi-Cal beneficiaries with developmental disabilities, patient advocacy groups and health care providers filed the lawsuit seeking to require California to increase Medi-Cal funding for community-based services to help prevent unnecessary institutionalization.
Citing a 2002 U.S. Supreme Court decision, the judges said a private entity can seek to enforce a federal statute against a state only if that right has been "unambiguously" written into the statute by Congress. The panel ruled that the language and structure of the Medicaid statute "simply do not focus on an individual recipient's or provider's right to benefits, nor is the broad and diffuse language of the statute amenable to judicial remedy."
The opinion -- written by Judge Diarmuid O'Scannlain, with concurrence from Judge Carlos Bea and Judge Robert Cowen -- concluded that "Congress has not spoken with an unambiguous, clear voice that would put a state on notice that Medicaid recipients or providers are able to compel state action."
Michael Churchill, an attorney for the plaintiffs, said that he and his clients are determining their next course of action. The plaintiffs might ask for a hearing before an enlarged circuit panel or before the U.S. Supreme Court.
According to the Bee, the ruling reversed a 2003 district court ruling in a lawsuit filed by the California Medical Association and other groups seeking to block a reduction in Medi-Cal reimbursement rates (Walsh, Sacramento Bee, 8/4).