Medicaid and Access to the Courts | Health Policy and Reform

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by Sara Rosenbaum, J.D. in New England Journal of Medicine

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined 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 fundamentally alter states’ accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid’s essential federal requirements.

The Maxwell-Jolly case was precipitated by a series of deep cuts to provider payments that were enacted by the California legislature 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 Appeals 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 providers have the right to seek judicial redress when they allege that state conduct abridges federal law and threatens health and safety.
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When the Family Needs an Umpire - NYTimes.com

Image via CrunchBaseBy JOSHUA TAPPER

The home care aide didn’t expect her new charge to be particularly cantankerous. After all, she had worked for the elderly woman’s sister for four years, and they’d gotten along well.

But the new relationship was rocky from the start. More than once the aide received confusing calls from the 88-year-old woman late at night. She traveled to the woman’s apartment on the Upper West Side, only to be met with a curt “What’s going on? Why are you here?” The older woman, bedridden and recovering from a broken hip, repeatedly told the caregiver to leave because she didn’t need help.

Frustrated and angry, the aide threatened to quit. That’s when the patient’s family called in Joy Rosenthal, an elder mediator.

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