About Prof. Fentiman:
- She has taught health care law for more than two decades
- Worked as a practicing health care lawyer in New York
- Has published extensively on issues relating to health care access and bioethics, including articles on physician advocacy and managed care and Internet pharmacies.
- She is a fellow of the New York Academy of Medicine, and a member of the American Society of Law, Medicine and Ethics
Professor Fentiman on Douglas v. Santa Rosa Memorial Hospital:
“The case has important implications for states as they try to control spiraling health care costs under the federal-state partnership that is Medicaid. The case is also likely to have political ramifications for the Department of Health and Human Services as it is ramping up to implement the Affordable Care Act, which raises issues about whether the internal administrative remedies for resolving disputes about Medicaid payment should be exclusive, taking place outside of federal courts.
This case turns on who can challenge the adequacy of payments to healthcare providers under Medicaid. It began when a coalition of healthcare providers and patients who receive healthcare through Medicaid sued California to prevent it from implementing major budget cuts to Medicaid (called Medi-Cal in California) due to its financial crisis. The U.S. Court of Appeals for the Ninth Circuit has said these suits can go forward, and has enjoined California from making the budget cuts. The Supreme Court has granted certiorari.
The healthcare providers and Medi-Cal patients base their case on the supremacy clause of the Constitution, which makes federal law primary over state law. They claim that California’s budget cuts violate a key provision (section 30A) of the federal Medicaid law. In opposition, the California Attorney General claims that the Medicaid law does not authorize providers and patients to sue to enforce the law. Instead, California claims that only the federal government, through the Centers for Medicare and Medicaid Services at the Department of Health and Human Services (HHS), has the authority to force California to change its Medicaid program to meet federal requirements. The Department of Justice has filed an amicus brief supporting California’s position, and claims that allowing private parties to sue to enforce Medicaid would interfere with HHS’ ability to supervise state Medicaid programs.
It is always dangerous to speculate about how the Supreme Court will rule. However, the fact that the Court granted certiorari in this case suggests that it is concerned about the use of the Constitution’s supremacy clause to permit private citizens to sue to enforce their interpretation of a federal statute even in cases, such as this one, when Congress has not specifically endorsed a private right of action to those who benefit under from a particular federal program. Thus, the odds favor the Court reversing the Ninth Circuit.”
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Pace Law School
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Professor Linda Fentiman