Medicaid and access to the courts.

10.1056/nejmp1100991 nejm.org 1 2019 — Medicaid will be reex­ amined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California’s appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court’s ruling could fundamen­ tally alter states’ accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid’s essential fed­ eral requirements. The Maxwell-Jolly case was pre­ cipitated by a series of deep cuts to provider payments that were enacted by the California legisla­ ture and aimed at services used predominantly by the state’s most severely disabled beneficiaries. The payment reductions were halted by the U.S. Court of Ap­ peals for the Ninth Circuit, but this action by no means ended the dispute. Indeed, the question before the Supreme Court is of far greater consequence than that of specific provider payments: it is whether beneficiaries and pro­ viders have the right to seek ju­ dicial redress when they allege that state conduct abridges fed­ eral law and threatens health and safety. The statute regulating Medic­ aid, unlike that underlying Medi­ care, does not expressly address the question of whether private persons deserve access to the courts in order to prevent harm arising from potentially unlaw­ ful state conduct. Virtually since Medicaid’s inception,1 states have disputed the ability of beneficia­ ries and providers to hold Medi­ caid programs judicially account­ able under federal law. Over the years, a series of Supreme Court decisions have offered a partial answer: private individuals can sue when they believe a state’s conduct has violated a right un­ der Medicaid. In such cases, the suit is brought under a law dat­ ing back to the Civil War Amend­ ments and commonly referred to by its U.S. Code number, Sec­ tion 1983, which enables private parties to sue to stop state inter­ ference with a federal legal right. But many of Medicaid’s re­ quirements, including some of the most important ones that give real meaning to the legal right to coverage itself, have never been definitively determined Medicaid and Access to the Courts