Law Commons^™

The Mda’S Michigan Donated Dental Services (Dds) Program: How To Serve The Elderly And Disabled In Your Community And Build Your Team (Without Leaving Your Office!), April Stopczynski

The Journal of the Michigan Dental Association

April Stopczynski, MDA Manager of Access and Prevention, sheds light on the Michigan Donated Dental Services (DDS) program, elucidating its impact on individuals through poignant patient narratives and dentist testimonials. The article illustrates how DDS bridges the gap in dental care for the elderly, disabled, and financially compromised individuals in Michigan. The program not only restores smiles but also transforms lives by providing much-needed dental treatment through volunteer dentists and labs. This article presents the value of DDS for patients, providers, dental team members and the greater community. Information is provided on how to participate in this transformative program.

Governmental Affairs Update: Dental Medicaid, Neema Katibai Jd

The Journal of the Michigan Dental Association

The MDA spearheads an initiative to enhance Medicaid anesthesia services reimbursement, aiming to address the disparity between current rates and commercial standards. Despite recent improvements in Medicaid dental benefits, access to care remains hindered by low anesthesia reimbursement rates. The MDA advocates for a substantial investment to increase reimbursement to 85% of commercial rates, garnering support from various medical associations. This collaborative effort marks a significant stride towards achieving equitable Medicaid reimbursement. Grassroots advocacy is pivotal in influencing state budget decisions, urging constituents to engage with legislators via MDA text alerts.

The Socioeconomic Gap Of Infertility: Medicaid Coverage Of Infertility Treatments In West Virginia, Samantha Wilson

West Virginia Law Review

Infertility treatments have become more accessible and widely used in the last 20 years. As more couples look to these treatments in their struggle to start a family, health insurers are lagging behind in coverage for these options. For the majority of women in the country, paying for infertility treatment out-ofpocket is unrealistic. Not all states have approached this issue but those who have vary in their approach. Some are utilizing either mandate-to-cover for private insurers or Medicaid coverage to attempt to make treatments and diagnosis more accessible. Without policy solutions, the inequality of access between socioeconomic statuses will remain. …

Snitches Get Stitches: An Analysis Of The Eighth Circuit’S But-For Causation Requirement In False Claims Act Litigation “Resulting From” Anti-Kickback Violations, Travis R. Linn

Arkansas Law Review

Following the expansion of Social Security in the 1960s, Congress enacted the Anti-Kickback Statute or AKS in 1972 to ensure that items and services charged to Medicaid were only those necessary to the beneficiary’s health. Part II of this Note will analyze three pieces of legislation and Congress’s reasons for passing them: the FCA, the AKS, and a 2010 amendment to the AKS passed under the Affordable Care Act that connects the two. Part III will analyze the Third and Eighth Circuits’ conflicting interpretations of the 2010 amendment and why the Eighth Circuit’s commitment to textualism has disregarded Congress’s reasons …

Blatant Discrimination Within Federal Law: A 14th Amendment Analysis Of Medicaid’S Imd Exclusion, J. Michael E. Gray, Madeline Easdale

University of Massachusetts Law Review

A discriminatory piece of Medicaid law, the institution for mental diseases (IMD) exclusion, is denying people with serious mental illness equal levels of treatment as those with only primary healthcare needs. The IMD exclusion denies the use of federal funding in psychiatric hospitals for inpatient care. This article discusses the history and collateral implications of the IMD exclusion, then examines it through the lens of the Equal Protection Clause of the Fourteenth Amendment, argues that people with severe mental illness constitute a quasi-suspect class, and that application of intermediate scrutiny would render the IMD exclusion unenforceable.

Legally Alone: The Redeemability Of Guardianship And Recommendations Toward Equitable Access, Patrick Hecker

Northwestern Journal of Law & Social Policy

American adult guardianship needs reform. Thankfully, there is a small but dedicated reform movement that sheds helpful light on problems of underfunding, inattention, and abuse. While the movement’s efforts are needed, this Note argues it is a mistake to focus solely on the ways the guardianship system is sometimes harmful to people who already have access to guardianship. Few reformers consider the needs of people who would benefit from a guardian but do not have anyone to petition the court on their behalf.

This Note first argues that guardianship, despite its detractors, is redeemable. It can be part of a …

Improving Access For Children And Adults With Disabilities Through Enhanced Commercial Benefits, Holli Seabury Edd, Jeff Johnston Dds, Ms

The Journal of the Michigan Dental Association

This article explores the critical issue of accessibility to oral healthcare for people with disabilities in the United States. Delta Dental of Michigan, Ohio, and Indiana has taken a step by providing enhanced commercial benefits to children and adults with disabilities. The article delves into the challenges faced by this vulnerable population, including cost barriers and transition issues, and discusses how expanded benefits and coding, along with special dental care provisions, aim to improve access. It emphasizes the importance of proper benefits verification and presents a case study illustrating the utilization of these benefits. The article highlights the need for …

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 …

Section 1115 Waivers: Innovation Through Experimentation, Or Stagnation Through Routine?, Nicole Johnson

Emory Law Journal

The Medicaid program operates as a federal-state partnership, in which the states agree to meet certain federally mandated requirements in exchange for federal matching funds for program expenditures. These federal matching funds can be anywhere from 50–90% of health care expenses incurred through state Medicaid programs. As such, states have a substantial interest in continuing this partnership and ensuring that their state plans comply with federal requirements. There is a way, though, in which states can gain more freedom in building their individual state plans. Through section 1115 waivers, states can ask the Centers for Medicare and Medicaid Services (“CMS”) …

Deinstitutionalization, Disease, And The Hcbs Crisis, Jacob Abudaram

Michigan Law Review

Primarily funded by Medicaid, home- and community-based services (HCBS) allow disabled people and seniors to receive vital health and personal services in their own homes and communities rather than in institutions like nursing homes and other congregant care facilities. The HCBS system is facing a growing crisis of care nationwide; more than 600,000 people are waitlisted for services, thousands of direct care workers are leaving the industry, and states are not committed to deinstitutionalization. The COVID-19 pandemic has highlighted and exacerbated these problems, as people in institutional settings face infection and death at far higher rates than those housed outside …

Decolonizing Equal Sovereignty, Rosa Hayes

William & Mary Journal of Race, Gender, and Social Justice

In Shelby County v. Holder, 570 U.S. 529 (2013), the Supreme Court announced that a tradition of equal sovereignty among the states prohibits unwarranted federal intrusions into state sovereignty and invoked this newly created doctrine to strike down Section 4(b) of the Voting Rights Act. Scholarly critiques in Shelby County’s immediate aftermath debated the constitutional validity of the Court’s equal sovereignty reasoning and warned of the dire threat the VRA’s effacement posed to voting rights—concerns that recent litigation have vindicated.

But other recent litigation suggests that, abstracted from its problematic and consequential origins, equal sovereignty may be deployed …

False Claims: The Coordinated Exploitation Of The United States Government By The Healthcare Industry, Grady Mcmichen

Journal of Law and Health

The False Claims Act (FCA) has a long-standing history of protecting the United States government from being defrauded by merchants and other parties submitting claims for repayment. Affording Americans who have enrolled in Medicaid and Medicare expansion plans the same protection afforded to the federal government will allow for action to be brought to prevent large hospital networks from engaging in price-fixing behaviors. Implementing this change will have the effect of reducing healthcare prices for all Americans.

Applying the False Claims Act at the price-fixing level will have the largest affect; however, it is still important to iron out procedures …

N Y State Dent J April 2022

The New York State Dental Journal

In the April 2022 issue, the reader will find the following feature articles:

• Responding to Online Social Media Posts
• Diode Laser-Assisted Abscission and Low-Level Laser Therapy for Treatment of Mucocele Literature: Update and Case Report
• White Sponge Nevus
• Effects of New York State’s Medicaid Orthodontic Policy Changes on Approved Orthodontic Treatment Complexity

This issue includes regular columns with regional news impacting the New York membership including: editorial and perspectives columns, legal, association activities, component news, continuing education opportunities, and classifieds.

Sb 338: Amendments Relating To Medicaid Postpartum Coverage, Ivona Relja, Meredith Elkin

Georgia State University Law Review

This Act amends Medicaid postpartum coverage for mothers from a period of six months to one year. The Department of Human Services will provide postpartum care Medicaid coverage to mothers for a period of one year following the date pregnancy ends.

An Attempt To Bring Modern Workplace Realities To The Social Security Disability Adjudication System, Robert E. Rains

Dickinson Law Review (2017-Present)

No abstract provided.

Treating A Public Health Crisis For Rural Moms – A Comparative Analysis Of Four Rural States Addressing Maternal Opioid Misuse With Medicaid Innovation Models, Jason Semprini

Online Journal of Rural Research & Policy

Objective As we enter the third decade of the opioid crisis, opioid misuse continues its devastating toll on young women, specifically mothers on Medicaid in rural areas. The evolving Medicaid policy landscape has led to coverage and benefit expansion, yet gaps remain for pregnant women with opioid misuse. Further, the myriad of state specific policy decisions related to maternal eligibility and substance abuse benefits have created a seemingly disjoint policy arena for tackling a specific subgroup’s unmet needs. This policy scan aims to investigate the newly implemented 1115 demonstration model for Maternal Opioid Misuse by comparing the approaches of four …

Buffering Against Vicissitudes: The Role Of Social Insurance In The Covid-19 Pandemic And In Maintaining Economic Stability, Renée M. Landers

Georgia Journal of International & Comparative Law

No abstract provided.

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 …

The Long-Term Gender And Race Issues In Long-Term Care, Brendan Williams

Lincoln Memorial University Law Review Archive

Women outlive men, and, as a consequence, comprise the majority of residents in both the home health and nursing home long-term care settings. Their caregivers are also overwhelmingly-women -- 92% of nursing assistants in nursing homes, for example. And those caregivers are largely non-white. Long-term care has long been regarded as "women's work," beginning with its slavery antecedents in the home setting. This article explores the connection between the devaluing of long-term care, which is largely state-funded through Medicaid, and the gender and race dynamics of long-term care.

“Waiving” Goodbye To Medicaid As We Know It: Modern State Attempts To Transform Medicaid Programs Through Section 1115 Waivers, Chandler Gray

Washington and Lee Law Review Online

This Note explores recent state efforts to reshape their respective Medicaid programs through Section 1115 waivers. Specifically, this Note looks at states that wish to convert their Medicaid program to a block grant through Section 1115 waivers. Examining the lawfulness of these waivers requires analyzing the language and application of both the Medicaid Act and the Administrative Procedure Act. This Note argues that any use of Section 1115 waivers to implement a block grant program would be a violation of the Medicaid Act and thus unlawful. Further, federal approval of such programs would be deemed arbitrary and capricious. To justify …

Mhpaea & Marble Cake: Parity & The Forgotten Frame Of Federalism, Taleed El-Sabawi

Dickinson Law Review (2017-Present)

No abstract provided.

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 …

Sb 106 - Patients First Act, Jasmine Nicole Becerra, Leanne E. Livingston

Georgia State University Law Review

The Patients First Act amends both Title 49 and Title 33 of the Official Code of Georgia Annotated, which allows the state to apply for two federal waivers. One being the Section 1115 waiver to the Social Security Act. The second being the Section 1332 waiver to the Affordable Care Act. Section 1115 waivers apply to Medicaid and may be sought to include a maximum income threshold up to 100% of the Federal Poverty Level. The Section 1332 innovation waiver applies to insurance coverage generally.

Contracting For Healthcare: Price Terms In Hospital Admission Agreements, George A. Nation Iii

Dickinson Law Review (2017-Present)

This article discusses the application of contract law principles to the relationship between hospitals and patients to determine how much patients owe for the health care they receive. For patients who are covered by in-network health insurance the exact nature of the contract created with the hospital usually is not relevant to the patient’s financial obligation because the patient’s contract with the hospital is superseded by the contract between the patient’s health insurer and the hospital. Nevertheless, even in-network patients are financially impacted, via increased insurance premiums, by the contract analysis discussed here, and for the increasing number of patients …

Tax, Class, Women, And Elder Care, Nancy E. Shurtz

Seattle University Law Review

As the fastest-growing urban area in the United States—and due to its emerging national influence in commercial real estate development and leasing through transformational transactions such as Amazon’s recently completed national HQ2 search—the City of Seattle and related Washington State laws addressing the use of dual agency in commercial transactions present a unique backdrop for examining the findings and recommendations from a 2014 commercial real estate conflicts of interest research study and attendant report, described below, more than four years after its publication. In November 2014, a published research study report made a number of key observations about the existence …

Humanizing Work Requirements For Safety Net Programs, Mary Leto Pareja

Pace Law Review

This Article explores the political and policy appeal of work requirements for public benefit programs and concludes that inclusion of such requirements can be a reasonable design choice, but not in their current form. This Article’s proposals attempt to humanize these highly controversial work requirements while acknowledging the equity concerns they are designed to address. Drawing on expansive definitions of “work” found in guidance published by the Centers for Medicare and Medicaid (“CMS”) and in various state waiver applications, this Article proposes that work requirements be approved for Medicaid (as well as other benefit programs) only if they encompass various …

The Inexorable Expansion Of Medicaid Expansion, Brendan A. Williams

Northern Illinois University Law Review

Medicaid expansion to non-elderly adults under the Affordable Care Act (ACA) has come a long way since the U.S. Supreme Court made it optional in its landmark 2012 NFIB vs. Sebelius ruling, and 2018, in particular, was a banner year. In 2018 four states expanded Medicaid, three of them "red states" doing so by voter ballot. Expansion-favoring Democrats were also elected to replace expansion-opposing Republican governors. Strikingly, this success came just a year after Medicaid expansion, and the ACA as a whole, was only saved by a single U.S. Senate vote. This article examines the early pushback by states against …