AMA Supports Private Enforcement of Medicaid’s Equal-Access Mandate

Medicaid patient access at stake in U.S. Supreme Court case

WASHINGTON - Jan. 12, 2015 - The American Medical Association (AMA) and a coalition of several health care organizations have filed a friend-of-the-court brief urging the U.S. Supreme Court to allow private actions challenging states that break trust with Medicaid’s promise to provide patients with equal access to medical care.

“The nation’s most vulnerable patients deserve the same access to high-quality medical care as patients with private insurance,” said AMA President Robert M. Wah, M.D.  “The sad fact is that Medicaid’s guarantee of equal access has become an illusion in many states that have cut Medicaid funding and driven physicians and other health professionals from the program.”

The brief in Armstrong v. Exceptional Child Center supports private lawsuits to sensibly enforce the equal-access mandate of the Medicaid Act, which requires states to adopt payment rates that ensure the poorest Americans have access to care on par with the general population. By contrast, the federal government’s primary means of enforcing equal access is revocation of funding – an extreme remedy that the brief notes “would devastate rather than benefit the individuals whom Medicaid was designed to protect.”

Allowed to go unchecked, 32 states reduced and/or froze Medicaid rates in 2012, and 23 did so in 2013. As a result, Medicaid payment rates have often fallen below the average cost to deliver care and make it untenable for physicians to take on Medicaid patients. Surveys consistently show that low payment rates in Medicaid discourage physician participation in the program. According to a report by the Government Accountability Office, 38 states were unable to attract sufficient participation from health care professionals to serve Medicaid patients, with low Medicaid payment rates cited as one of the leading causes.

“Non-compliance with Medicaid’s equal-access mandate will continue unless private enforcement is allowed to challenge states that adopt Medicaid payment rates based on arbitrary or politically expedient budgetary decisions,” said Dr. Wah.

The nation’s high court will hear oral arguments in the case on Jan. 20, just weeks after Medicaid payment rates dropped for many primary care physicians. In addition to its role in this Supreme Court case, the AMA continues to urge the federal government to extend the Medicaid payment increase that had been in effect during 2013 and 2014.

Read more on AMA Wire about this case and related cases in which the Litigation Center of the AMA and State Medical Societies is involved.

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