Idaho Medicaid Case Makes it to U.S. Supreme Court & Why it Matters

Supreme Court

Last week the United States Supreme Court began hearing arguments in an Idaho case that could set a new precedent. The case centers on Idaho’s reimbursement rates for Medicaid providers. The case began in 2009 when 5 Idaho facilities sued the state in an effort to get an increase in the rates providers receive for treating Medicaid enrollees. The state lost the 2009 case and in 2011 a U.S. District Court ordered Idaho to increase reimbursement rates. Now the state has appealed the case all the way to the U.S. Supreme Court. The court’s ruling on this case could potentially affect Medicaid throughout all 50 states.

At the heart of the case is whether or not providers and other parties (such as patient advocacy groups) should be able to petition the courts in order to get states to increase reimbursement rates. Idaho officials have taken the position that reimbursement rates for Medicaid should only be set by states and federal government agencies. On the other hand, providers and others feel that they have no other option but to turn to the courts for assistance. With states “freezing” reimbursement rates for year or decades, Medicaid enrollees now face decreased access to care, and providers are faced with the decision as to whether or not they can afford to treat Medicaid patients.

Many are optimistic that the 5 agencies stand a chance to win this case due to compelling evidence that supports their argument. If Idaho losses this cases it will set a precedent and potentially open the doors for similar lawsuits in the future. The issue of “frozen” reimbursement is not a problem that is unique to only Idaho. There are other states like Florida and Pennsylvania that also have serious issues as well. Florida ranks as one of the lowest-paying states as it relates to reimbursing Medicaid providers. As a result of the low reimbursement, on December 31, 2014 a federal judge found that Florida violated federal Medicaid laws, because the state failed to ensure that Medicaid patients received care that they are guaranteed and entitled to as a Medicaid enrollee. In Pennsylvania, Medicaid reimbursement rates have been “frozen” at 1991 rate levels. As a result, it is estimated that Medicaid providers are only reimbursed for approximately 30% of the actual cost of each treatment for their Medicaid patient population.

Those who feel that a reimbursement rate increase is necessary, also believe the increase will help change the current way that many people have their healthcare needs met. It is believed that there will be an increase in patients who establish a “medical home” or primary care physician that they can see for routine types of visits. Which in turn will decrease the number of non-emergent visits to local emergency rooms, which are some of the most costly visits.

For now, we wait to see what the Supreme Court decides.

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