Law Commons^™

Who Pays First?: Medicaid Third-Party Liability In Florida And Virginia’S Birth-Related Neurological Injury Compensation Programs, Alexandra M. Robbins

Saint Louis University Journal of Health Law & Policy

In response to an impending obstetrician shortage and medical malpractice crisis, the states of Florida and Virginia adopted no-fault birth-related neurological injury compensation programs in the 1980s. Both of these programs provide lifetime coverage for eligible children with serious birth-related neurological injuries; however, both programs treated themselves as the payer of last resort and required families to submit claims to Medicaid first based on an inaccurate interpretation of Medicaid third party-liability (“TPL”) laws and the program-enabling statutes. Both programs’ policies treating themselves as the payer of last resort not only violated Federal and State Medicaid laws, they caused harm to …

Retaining Medicaid Covid-19 Changes To Support Community Living, Elizabeth Edwards, David Machledt, Jennifer Lav

Saint Louis University Journal of Health Law & Policy

The impact of COVID-19 on people with disabilities in institutional settings, like nursing facilities, has garnered significant attention. But people receiving comparable services in the community have also been affected significantly. States used several emergency authorities in efforts to facilitate access to and stabilize these Medicaid home and community-based services (HCBS), including behavioral health services. Although states made different policy choices within those authorities, many states expanded the provider pool, increased HCBS provider rates, decreased onerous utilization controls and other barriers to care, expanded telehealth, and added new community-based services. These state policy responses have resulted in new services or …

Skirting The Law: Medicaid Block Grants And Per-Capita Caps In A Pandemic, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

To what extent can an administration abridge Medicaid’s entitlement status by administrative fiat? In the final year of the Trump administration, just before the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) sought to push the outer bounds of this question by announcing the Healthy Adult Opportunity (HAO) initiative. It invited states to submit § 1115 demonstration applications to cover individuals not eligible for Medicaid benefits under the state’s Medicaid plan—meaning, in many cases, the Affordable Care Act’s (ACA’s) Medicaid expansion population. Spending on those populations would be capped, not by purporting to waive federal law regarding matching …

Justice And The Struggle For The Soul Of Medicaid, Dayna Bowen Matthew

Saint Louis University Journal of Health Law & Policy

The soul of Medicaid is and always has been to achieve justice in health care. Medicaid at its inception was designed to ensure that the most vulnerable members of society are not excluded from access to good health that all others enjoy. Yet, as the title of this symposium aptly reflects, “The Struggle for the Soul of Medicaid” remains vulnerable to repeated and relentless political attacks. Why is this so, given that the program finances care for nearly sixty-four million Americans?

This article posits that Medicaid is vulnerable because our nation’s commitment to justice in health care remains uncertain. Historically, …

Medicaid’S Role For Seniors And People With Disabilities: Current State Trends, Marybeth Musumeci

Saint Louis University Journal of Health Law & Policy

Medicaid fills a gap in the U.S. health care system as the primary payor for long-term services and supports (LTSS). These services enable seniors, people with disabilities, and those with chronic illnesses to live independently in the community, outside of nursing homes and other institutions. Most Medicaid home and community-based services (HCBS) are covered at state option, unlike nursing home care, which all state Medicaid programs must cover. States have substantial flexibility in designing their Medicaid HCBS programs under federal law, and Medicaid provides an important source of federal funding to states to help meet the LTSS needs of seniors …

The Administration’S Medicaid Waivers: Exploding In The Guise Of Experimenting, Jane Perkins

Saint Louis University Journal of Health Law & Policy

Congress enacted the Medicaid Act with the stated purpose of furnishing medical assistance to low-income people. Medicaid participation is not required of a state, but if a state does choose to participate—which they all do—the federal government will contribute the lion’s share of the cost of providing care. In return, the state agrees to pay the remaining costs of care. The state must also adhere to the detailed regulatory scheme Congress placed in the Medicaid Act, including requirements for determining eligibility for the program and the scope and affordability of coverage. Section 1115 of the Social Security Act authorizes the …

Threats To Medicaid And Health Equity Intersection, Mary Crossley

Saint Louis University Journal of Health Law & Policy

The year 2017 proved politically tumultuous in the U.S. on many fronts, but perhaps none more so than health care. For enrollees in the Medicaid program, it was a “year of living precariously.” Long-promised Republican efforts to repeal the Affordable Care Act also took aim at Medicaid, with proposals to fundamentally restructure the program and drastically cut its federal funding. These proposals provoked pushback from multiple fronts, including formal opposition from groups representing people with disabilities and people of color and individual protesters. Opposition by these groups should not have surprised the proponents of “reforming” Medicaid. Both people of color …

Health Justice In The Age Of Alternative Facts And Tax Cuts: Value-Based Care, Medicaid Reform, And The Social Determinants Of Health, Elizabeth Tobin-Tyler

Saint Louis University Journal of Health Law & Policy

Some provisions of the Patient Protection and Affordable Care Act of 2010 (ACA) as well as regulatory policies under the Obama administration reflected the overwhelming evidence that to reduce health care costs, and to improve quality of care and population health, the social determinants of health (SDOH) must be addressed. These policies included funding for partnerships between public health agencies, community organizations, and health care institutions, promotion of value-based payment models that incentivize integrated health and social care delivery, and support for Medicaid program innovations that directly address social needs as part of health care. The Trump administration, through a …

Putting The Brakes On Consumer Driven Medicaid: The Failures And Harms Of Healthy Indiana Plan (Hip) 2.0, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

In January 2015, the U.S. Department of Health and Human Services (HHS) granted Indiana a Section 1115 Demonstration Waiver to experiment with consumer driven Medicaid. The Healthy Indiana Plan (HIP) 2.0 combines a $2,500 high deductible with a Personal Responsibility and Wellness (POWER) Account, premiums, and copays. Described as “the most significant departure from traditional Medicaid ever approved,” Indiana claims that the POWER Account, the signature feature of HIP 2.0, is “similar to a health savings account (HSA)” and encourages members to be more cost-conscious consumers, helps familiarize members with how commercial health insurance works, and encourages continuous Medicaid enrollment. …

Managing Medicaid, Isaac D. Buck

Saint Louis University Journal of Health Law & Policy

In a steady but rapid march, managed care has come to Medicaid. Privatization has undoubtedly rebuilt the Medicaid landscape across America over the last three decades. Now, as managed care programs administer health care to three-in-four Medicaid beneficiaries nationwide, whether or not managed care is adequately managing America’s largest public insurance program has become an increasingly important question.

Of particular note have been states’ difficulties in constructing and organizing the bidding and selection processes of the private companies tasked with overseeing the administration of private Medicaid plans. Legal challenges to various states’ bid procurement processes have been well documented. These …

Key Issues Facing Medicaid After The Affordable Care Act, Marybeth Musumeci

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Medicaid, Managed Care, And The Mission For The Poor, John V. Jacobi

Saint Louis University Journal of Health Law & Policy

Medicaid has financed care for the poor for five decades. During that time it has balanced two important missions: providing for the particular health needs of the poor, and mainstreaming care for the poor. These roles have been consistent as all insurance payors—public and private—have shifted away from passively funding fragmented care to actively supporting patient-centered coordinated care. But the health needs of the poor go beyond medical interventions; the health status of the poor depends on the provision of social services to address social determinants of health, including housing, nutrition, and employment training services. Unlike non-poor insureds, Medicaid beneficiaries …

On The Expansion Of “Welfare” And “Health” Under Medicaid, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

Medicaid was intended from its inception to provide financial access to health care for certain categories of impoverished Americans. While rooted in historical welfare programs, it was meant to afford the “deserving” poor access to the same sort of health care that other, wealthier Americans received. Yet despite this seemingly innocuous and laudable purpose, it has become a front in the political and social battles waged over the last several decades on the issues of welfare and the safety net. The latest battleground pits competing visions of Medicaid. One vision seeks to transform Medicaid from a health care program into …

Pin The Tail On The Donkey: Beneficiary Enforcement Of The Medicaid Act Over Time, Jane Perkins

Saint Louis University Journal of Health Law & Policy

During the twentieth century, Congress enacted legislation designed to improve the lives of low-income Americans. A number of these laws were enacted by Congress pursuant to the Constitution’s Spending Clause, including the Medicaid Act, which entitles certain low-income individuals to publicly funded health insurance coverage. As enacted in 1965, the Medicaid Act did not include a provision authorizing the statute’s beneficiaries to bring private enforcement actions in court. Since the early 1970s, however, program beneficiaries relied upon the Constitution’s Supremacy Clause or, more frequently, 42 U.S.C. § 1983 for the cause of action allowing them to obtain relief in court. …

Premiums And Section 1115 Waivers: What Cost Medicaid Expansion?, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

States reluctant to adopt the Affordable Care Act’s Medicaid expansion are demanding that the U.S. Department of Health and Human Services grant them Section 1115 demonstration waivers that allow them to charge poor people premiums.

The U.S. Department of Health and Human Services has yielded to these demands, granting five states waivers of long standing federal statutory protections that limit state discretion to impose premiums for Medicaid. These premium waivers present a fundamental problem of law because the Secretary of the U.S. Department of Health and Human Services has no statutory authority to grant Section 1115 waivers that allow states …

Rationalizing Home And Community-Based Services Under Medicaid, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Embracing Justice Roberts’ “New Medicaid”, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Medicaid’S Next Fifty Years: Aligning An Old Program With The New Normal, Sara Rosenbaum

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Sunshine And Accountability: The Pursuit Of Information On Quality In Medicaid Managed Care, Sarah Somers, Jane Perkins, Nhelp .

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Rethinking Medicaid In The New Normal, Sara Rosenbaum, Benjamin D. Sommers

Saint Louis University Journal of Health Law & Policy

No abstract provided.