Confronting the Challenge of Medicaid Cutbacks through Litigation:
The Lessons of Lankford and other cases

Jane Perkins, National Health Law Program
April 4, 2006

Lesson 1: The Deficit Reduction Act of 2005 will provide states with unprecedented flexibility to implement Medicaid cutbacks.

Lesson 2A: Do not count on private enforcement of the Medicaid payment provisions to ensure adequate provider participation.
Ex.: Sanchez v. Johnson, 416 F.3d 1051 (9th Cir. 2005)

Lesson 2B: Consider other claims as the basis for improving provider participation.
Ex.#1: Health Care for All v. Romney, 2005 U.S. Dist. LEXIS 14187 (D. Mass. July 14, 2005) (EPSDT)
Ex.#2: Nelson v. Milwaukee Co. DHFA, 2006 U.S. Dist. LEXIS 7513 (E. D. Wis. Feb. 7, 2006) (ADA)

Lesson 3: Consider a Supremacy Clause preemption challenge to state laws.
Ex.: Lankford v. Sherman, No. 05-4286-C-CV-DW (W.D. Mo. Nov. 22, 2005)

Lesson 4 Strong plaintiffs and clearly defined legal claims can become lost in an increasingly shifting factual and legal landscape.
Ex.: Lankford v. Sherman, No. 05-4286-C-CV-DW (W.D. Mo. Sept. 13, 2005)

Lesson 5: Specific Medicaid provisions may control rather than the general amount, duration and scope principles.
Ex. 1: Edmonds v. Levine, 2006 US Dist. LEXIS 9591 (S.D. Fla. Feb. 14, 2006) (prescription drug provisions, 42 U.S.C. § 1396r-8)
Ex. 2: SD v. Hood, 381 F.3d 581 (5th Cir. 2004) (EPSDT)

Lesson 6: Beware of the Medicaid as payment, not services, argument.
Ex.: Westside Mothers v. Olszewski, 368 F. Supp. 2d 740 (E.D. Mich. 2005)

Lesson 7: There is a growing trend in the courts to defer to agency statements.
Ex.: Harris v. Olszewski, 2006 WL 700887 (6th Cir. Mar. 21, 2006)

Lesson 8: Due process can make cutbacks fairer but will seldom prevent them.
Ex.: Benjamin H v. Ohl, 1999 U.S. Dist. LEXIS 22469 (S.D.W.Va. 1999)

Lesson 9: Seriously consider state courts and administrative forums.
Ex.: Jensen v. Missouri Dep’t of Health & Senior Serv., 2006 Mo. App. LEXIS 369 (Ct. App. Mar. 28, 2006)

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