Enforcing A Critical Entitlement: Preemption Claims as an Alternative Way to Protect Medicaid Recipients' Access to Healthcare

Abstract

When faced with shrinking budgets and swelling Medicaid rolls, states frequently try to reduce Medicaid spending by slashing provider reimbursement rates. Reimbursement rates, however, significantly impact provider participation and consumer access to healthcare services. Therefore, such cutbacks to Medicaid’s already low rates often undermine the program’s promise of “mainstream” medical access for the poor and disabled. Medicaid beneficiaries and providers long used the court system to combat these rate cuts by suing under 42 U.S.C. § 1983 and arguing that inadequate reimbursement rates violate the “equal access provision” of the federal Medicaid Act. But in 2002, the U.S. Supreme Court foreclosed this avenue of relief and seemed to leave doctors and patients without standing to challenge even the most draconian rate cuts. A recent series of decisions by the U.S. Court of Appeals for the Ninth Circuit, however, suggests that the Supremacy Clause presents an alternative means of enforcing the equal access provision. This Note explores both the promise and pitfalls of an equal access preemption claim and argues that Medicaid providers and beneficiaries should be able to enjoin significant rate cutbacks and protect healthcare access by challenging state changes to reimbursement rates as preempted by the Medicaid Act.