Wilder v. Va. Hosp. Ass'n

Wilder v. Va. Hosp. Ass'n

Opinion

 [*501]  [***462]  [**2513]     This case requires us to determine whether a health care provider may bring an action under 42 U.S.C. § 1983 (1982 ed.) ¹ to challenge the method by which a State reimburses health care providers under the Medicaid Act, 79 Stat. 343, as amended, 42 U.S.C. § 1396 et seq. (1982 ed. and Supp. V). More specifically, the question presented is whether the Boren Amendment to the Act, which requires reimbursement according to rates that a "State finds, and makes assurances satisfactory to the Secretary, are reasonable [*502]  and adequate to meet the costs which must be incurred by efficiently and economically operated facilities," 42 U.S.C. § 1396a(a)(13)(A), is enforceable in an action pursuant to § 1983.

 [****7]  I

Medicaid is a cooperative federal-state program through which the Federal Government provides financial assistance to States so that they may furnish medical care to needy individuals. 42 U.S.C. § 1396 (1982 ed., Supp. V). Although participation in the program is voluntary, participating States must comply with certain requirements imposed by the Medicaid Act (Act) and regulations promulgated by the Secretary of Health and Human Services (Secretary). ] To qualify for federal assistance, a State must submit to the Secretary and have approved "a plan for medical assistance," 42 U.S.C. § 1396a(a), that contains a comprehensive statement describing the nature and scope of the State's Medicaid program. 42 CFR § 430.10 (1989). The state plan is required to establish, among other things, a scheme for reimbursing health care providers for the medical services provides to needy individuals.

Section 1902(a)(13) of the Act sets out the requirements for reimbursement of health care providers. As amended in 1980 (Boren Amendment), ² the section provides that

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