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Supreme Court of the United States
January 20, 2015, Argued; March 31, 2015, Decided
[*322] [***476] [**1382] Justice Scalia delivered the opinion of the Court, except as to Part IV.
We consider whether Medicaid providers can sue to enforce §30(A) of the Medicaid Act. 81 Stat. 911 (codified as amended at 42 U.S.C. §1396a(a)(30)(A)).
[****4] Medicaid is a federal program that subsidizes the States’ provision of medical services to “families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services.” §1396-1. Like other Spending Clause legislation, Medicaid offers the States a bargain: Congress provides federal funds in exchange for the States’ agreement to spend them in accordance with congressionally imposed conditions.
In order to qualify for Medicaid funding, the State of Idaho adopted, and the Federal Government approved, a Medicaid “plan,” §1396a(a), which Idaho administers through its Department of Health and Welfare. Idaho’s plan includes “habilitation services”—in-home care for individuals who, “but for the provision of such services . . . would require the level of care provided in a hospital or a nursing facility or intermediate care facility for the mentally retarded the cost of which could be reimbursed under the State plan,” §1396n(c) and (c)(1). Providers of these services are reimbursed by the Department of Health and Welfare.
Section 30(A) of the Medicaid Act requires Idaho’s plan to:
“provide such methods and procedures relating to the utilization of, and the payment for, care [****5] and services available under the plan . . . as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments are consistent with efficiency, economy, and quality of care and are 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 . . . .” 42 U.S.C. §1396a(a)(30)(A).
Respondents are providers of habilitation services to persons covered by Idaho’s Medicaid plan. They sued petitioners— [*324] two officials in Idaho’s Department of Health and Welfare—in the United States District Court for the District of Idaho, claiming that Idaho violates §30(A) by reimbursing providers of habilitation services at rates lower than §30(A) permits. They asked the court to enjoin petitioners to increase these rates.
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575 U.S. 320 *; 135 S. Ct. 1378 **; 191 L. Ed. 2d 471 ***; 2015 U.S. LEXIS 2329 ****; 83 U.S.L.W. 4231; 25 Fla. L. Weekly Fed. S 184
RICHARD ARMSTRONG, et al., Petitioners v. EXCEPTIONAL CHILD CENTER, INC., et al.
Notice: The LEXIS pagination of this document is subject to change pending release of the final published version.
Prior History: [****1] ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
Exceptional Child Ctr., Inc. v. Armstrong, 567 Fed. Appx. 496, 2014 U.S. App. LEXIS 6291 (9th Cir. Idaho, 2014)
federal law, providers, state law, rates, federal court, parte, Medicaid Act, preempted, withholding, equitable, courts, private enforcement, foreclose, parties, enjoin, funds, equitable relief, federal statute, reimbursement, violating, invoking, tribe, federal agency, state official, Boren Amendment, ratesetting, plans, general population, intent of congress, injunctive relief
Constitutional Law, Supremacy Clause, General Overview, Supreme Law of the Land, Governments, Courts, Authority to Adjudicate, Civil Procedure, Preliminary Considerations, Equity, Relief, The Judiciary, Jurisdiction, Subject Matter Jurisdiction, Legislation, Statutory Remedies & Rights, Public Health & Welfare Law, Medicaid, Judicial Proceedings, Causes of Action, State Plans, Interpretation