9th Circuit Says N.J. Violated Medicaid When Changing Payment System

PHILADELPHIA - In partially affirming and partially reversing a lower court, a panel of the Ninth Circuit U.S. Court of Appeals on July 9 held that New Jersey's requirement that Medicaid wraparound payments be contingent on prior managed care organization (MCO) payments violated the federal Medicaid statute's requirements that federally qualified health centers (FQHCs) timely receive full wraparound payment for all Medicaid-eligible claims (New Jersey Primary Care Association Inc. v. State of New Jersey Department of Human Services, et al., No. 12-3220, 3rd. Cir.; 2013 U.S. App. LEXIS 13881).

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