Health Law and Policy Commons^™

Avoiding Pandora’S Box: Why Federal Nondiscrimination Statutes Do Not Prohibit Health Insurance Coverage Exclusions Of Sex-Rejecting Procedures, Rachel N. Morrison

Catholic University Law Review

There is increasing litigation over whether employer-provided health insurance and state Medicaid plans can exclude coverage of procedures for “gender transitions.” Plaintiffs claim that gender-transition coverage exclusions violate the Equal Protection Clause of the Fourteenth Amendment and federal nondiscrimination statutes. While Fourteenth Amendment claims should be foreclosed by the Supreme Court’s holding in Geduldig v. Aiello, nondiscrimination claims require a separate analysis.

This article shows the proper analysis for whether coverage exclusions of transition procedures violate federal nondiscrimination statutes. Looking to the history of coverage exclusion claims, Part I traces sex and pregnancy discrimination claims challenging coverage exclusions of …

Access To Justice After Medina V Planned Parenthood South Atlantic, Daniel G. Aaron, Nicole Huberfeld

Faculty Scholarship

Access to justice is “the ability of all people to seek and obtain effective remedies through accessible, affordable, … and culturally competent institutions of justice.”¹ Historically, patients and physicians have worked together to protect the integrity of medical care as well as patients’ rights by challenging unlawful government actions in court. Yet the US Supreme Court recently issued decisions that may impede access to justice, potentially empowering federal, state, and local governments to interfere with evidence-based care. We explore constraints on access to justice that may arise after Medina v Planned Parenthood South Atlantic (PPSA) (606 US 357, 2025), …

Could Have Seen That Coming: New York State Department Of Health Taken To Task For Failing To Provide Proper Oversight Of Medicaid Managed Care Provider Networks, Lance Plunkett Jd, Llm

The New York State Dental Journal

A recent audit conducted by the Office of the New York State Comptroller (OSC) found that the New York State Department of Health (NYSDOH) oversight of Medicaid managed care healthcare provider networks was largely illusory and a paperwork sham. This raises the much larger question of whether Medicaid managed care is really serving the population of Medicaid patients. It is already almost a given that it is not serving healthcare providers well.

Spending Programs And The New Roberts Court, Nicole Huberfeld

Faculty Scholarship

The Supreme Court is poised to place new limits on Congress’s spending power at the urging of states vying for regulatory dominance, particularly in health care and public health. This article is the first to highlight and catalog the throughlines of argumentation, which sparked after states successfully challenged the ACA but have grown into opposing more than Medicaid’s cooperative federalism. This means federal and state programs that heavily rely on federal spending power are at risk, so studying this pattern is imperative. The article begins with a descriptive account of increasing spending power challenges, which make use of converging factors …

Regulating For Birth Justice, Jamille Fields Allsbrook

Lewis & Clark Law Review

Impacted persons have shared accounts of traumatic birthing experiences, and advocates have raised the alarm on the urgent need to advance birth justice. Despite this raised awareness, women and birthing people are still dying and suffering unnecessarily. Even more, systems are still structured to impede birthing choices, particularly those from marginalized communities such as Black and Indigenous women. Notably, over 80% of U.S. maternal deaths are preventable, according to federal government data. Ironically, the same laws and systems that have created, perpetuated, and tolerated birth injustices can be leveraged to move the country towards birth justice. On the national level, …

Medicaid's Broken Promise To Children, Jerron R. Wheeler

Faculty Articles

In the United States, poor children's access to necessary healthcare is determined more by geography than medical need. This variation is not the result of thoughtful local tailoring but of excessive state autonomy and passive federal oversight. The result is a fragmented and unequal system that obscures accountability and fails the Nation's most vulnerable children.

Building on scholarship showing how decentralized implementation of federal social programs can erode America's social safety net, this Article examines how one of Congress's most ambitious entitlements for children-Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit has been quietly undermined. In light of …

A Matter Of Life And Death: Give Me All Of Your Money And I'Ll Give You Healthcare, Shilanka I. Lewis

Marquette Law Review

The Medicaid Estate Recovery Program (MERP) is a federal mandate requiring states to recover costs of long-term care and related services provided to Medicaid beneficiaries from their estates after death. This Article explores the core arguments supporting and opposing MERP, offering a balanced analysis of its ethical, legal, and economic dimensions. Proponents argue that estate recovery ensures fiscal responsibility by recouping taxpayer dollars and preventing wealth transfer from those who received public assistance to their heirs. Proponents contend that MERP upholds the principle that Medicaid is a need-based program and a payor of last resort. Conversely, critics argue that MERP …

The Power And Peril Of The Aca's Universality At Fifteen, Nicole Huberfeld

Faculty Scholarship

As part of the symposium "15th Anniversary of the ACA: A Health Equity Review," this essay explores the ACA's mix of private law and public law provisions that rendered measurable improvements in health equity and health outcomes, especially for populations that experienced longstanding health disparities before its enactment.  Congress’s central objective was near-universal health insurance coverage, and the ACA employed a variety of mechanisms to reach that goal. The law’s health equity successes grew from establishing a principle of inclusion across federal statutes. This principle, which I have called “universality,” centered a human right to health approach: No longer would …

Addressing Health-Related Social Needs With Innovative Healthcare Spending, Kelly Naranjo Ms Ccrc, Eric Rochman Mph, Allyson Schiff Ba, Dorella Walters Mpa, Andrea Zaldivar Ed.D, Ms, Anp

Journal of Law and Health

Key objectives: To address the social determinants of health domains "social and community context" and "neighborhood and built environment" via Medically Tailored Meals, a nutrition intervention that includes home delivery, medical nutrition therapy and education, and frozen medically tailored meals provided by the non-profit partner. This intervention targeted Medicaid members exhibiting high healthcare utilization in conjunction with each individual's risk of developing higher morbidity and mortality of existing disease due to co-existing food and nutrition insecurity. The populations served include people living with Type 2 Diabetes, Hypertension, Cardiovascular Disease, Cancer, HIV/AIDS, and End-Stage Renal Disease, among other conditions, whose burden …

Dentistry Likely To Be Affected By Developments Of A Legal Nature, Lance Plunkett Jd, Llm

The New York State Dental Journal

A few new legal developments that affect dentistry have taken place in recent months. Prominent among these is a Big Beautiful Bill that may not be so pretty for New York State.

Another Step In The Anti-Abortion Agenda, Aziza Ahmed

Shorter Faculty Works

Trump’s recently passed “One Big, Beautiful Bill” bars Medicaid reimbursements to Planned Parenthood for one year – a provision now temporarily blocked after Planned Parenthood filed suit. But the measure builds on, and must be read against, the backdrop of Medina v. Planned Parenthood, a recent and disastrous Supreme Court ruling initiated by South Carolina and now poised to inspire copycat efforts in other states. The case starkly illustrates the Court’s continued alignment with an anti-abortion agenda advanced through state governments. As Justice Jackson forcefully argued, the decision forms part of a broader assault on civil rights – and …

Why Medicaid Is Addressing Homelessness With Section 1115 Waivers: A Critical Examination Of The United States' Federalist Mental Health System, Joshua Haas

Washington Law Review

Housing and health care are deeply interconnected, and their systemic relationship profoundly affects individual and societal well-being. Inadequate funding has undermined the American mental health system for decades, leading to gaps in care that have caused lasting harm to vulnerable individuals and society as a whole. This Comment examines the historical connections between homelessness and the American mental health system. It explores the benefits and criticisms of the United States’ federalist approach to health care, particularly focusing on Medicaid and its “section 1115 waivers,” which grant states flexibility to develop innovative, state-specific Medicaid programs. Recently, states began to utilize section …

Privatized Medicaid: An Incentivized System Of Constant Denials, Hannah R. Courtney

West Virginia Law Review

The Medicaid Program was created to fill the gap of what private insurance would not do—provide vulnerable populations with meaningful access to quality health care—but now it has been thrown into the pitfalls of private insurance. Over the last two decades, there has been a significant rise in states contracting with private Managed Care Organizations (“MCOs”) to provide services to a percentage of their Medicaid enrollees. MCOs now make decisions each year to approve or deny millions of requests for Medicaid coverage of health care services using prior authorization. Until now, the criticisms and fears surrounding privatized Medicaid have largely …

Medicaid Unwinding: Due Process Violations And Impacts In Florida, Emma Page

University of Miami Race & Social Justice Law Review

No abstract provided.

Silver Tsunami Or Silver Rush? Extracting Value From Elders, Andrew Milne

Suffolk University Law School Faculty Works

I examine how the United States finances elder care, arguing that the legal processes structuring elder care tend to widen economic inequality and divide the interests of lower-income people against each other along generational, gendered, and racialized lines. I begin with two case narratives drawn from my practice experience as a poverty lawyer for older adults. One narrative involves an elder homeowner, while the other involves an elder renter. Both face crises of unmet care needs, the threat of homelessness, and ultimately the outcome that many older people dread most: institutionalization in a nursing home. I use these narratives as …

Promoting Public Health And Public Safety By Ending The Exclusion Of Incarcerated Children From Access To Medicaid, Eduardo R. Ferrer

Georgetown Law Faculty Publications and Other Works

This essay is a response to Professor Den Houter's article entitled Children are Not Inmates in which she effectively calls eliminating the exclusion of indigent incarcerated children from Medicaid coverage pursuant to the Medicaid Inmate Exclusion Policy (MIEP). This essay affirms and builds upon Professor Den Houter's recommendation. Part I of this response provides additional support for why ensuring system-involved youth receive timely, uninterrupted, high-quality behavioral health services is critical to improving both public health and public safety. Part II analyzes the benefits and risks attendant to excluding indigent incarcerated children from the MIEP. Part III proposes the implementation of …

Just Fix The Damn Payment System!, Frances H. Miller

Faculty Scholarship

This piece takes as a given that we are stuck with our fragmented, inefficient, multi-payor health care system for at least the short run. It then analyzes the deficiencies of three payment mechanisms whereby regulators (including Congress) have invited private sector providers to help ameliorate perceived problems. The first concerns an inadequate supply of nursing home beds in the early ‘70s, the next focuses on Medicare Advantage as a supposedly superior cost containment alternative to traditional Medicare, and the final one involves the ‘devil’s bargain’ struck with the pharmaceutical industry to get prescription drug coverage added to Medicare. All three …

Beyond Medicaid Expansion: Addressing The Sexual And Reproductive Health Crisis In Rural Appalachia, Cheyenne Peters

Marquette Benefits and Social Welfare Law Review

In addition to negatively impacting abortion access, the decision

in Dobbs v. Jackson Women’s Health Organization has forced many

clinics in rural Appalachia that previously provided access to holistic

sexual and reproductive health services, such as contraception

management, sexually transmitted infection (STI) testing, and preventative

cancer screening, to close their doors entirely. This has left

many Appalachians living in rural communities with no option for

accessing sexual and reproductive healthcare. However, many people

were never able to access the care even before the recent provider

shortage due to a lack of adequate insurance coverage. This

article explores how Medicaid expansion …

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.

Clearing The Path: Improving Implementation Of Georgia’S Pathways To Coverage Program, Nicholas Smith

Emory Law Journal Online

Georgia’s Medicaid program is in flux. The State recently launched Pathways to Coverage, a partial Medicaid expansion program for non-disabled adults in households under 100% of the Federal Poverty Line, with eligibility contingent on reporting 80 hours of work per month. Pathways’ rollout coincides with Medicaid “unwinding,” an ongoing post-COVID redetermination process in which thousands of Georgians have already lost coverage. As such, Pathways could play an important role in offsetting the unwinding’s disenrollment effects. But Pathways may also serve as a test case for conservative lawmakers hoping to institute (or reinstitute) work requirements to restrict Medicaid coverage in their …

Supporting Healthy Futures: Capitalizing On Medicaid’S Epsdt Medical Necessity Standard, Teressa Colhoun

Washington and Lee Law Review

Youth mental health is in crisis. Children report increased rates of suicidal ideology, depression, and anxiety. Diagnosis rates soar. Pediatric mental health care remains difficult to access. When services are accessible, they are costly—often sending families into medical debt.

This Note discusses Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) benefit. Specifically, it studies the EPSDT benefit’s creation, structure, and administration. This Note focuses on the context in which the EPSDT benefit operates, particularly how health care financing models impact benefit administration. It suggests that the EPSDT benefit has the capacity to address crucial gaps in pediatric mental health …

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.

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 …

Health Law And Bigotry Distractions, Daniel G. Aaron, Leslie Francis

Utah Law Faculty Scholarship

Bigotry distractions are strategic invocations of racism, transphobia, or negative stigma toward other marginalized groups to shape political discourse. Although the vast majority of Americans agree on large policy issues ranging from reducing air pollution to prosecuting corporate crime, bigotry distractions divert attention from areas of agreement toward divisive identity issues. This article explores how the nefarious targeting of identity groups through bigotry distractions may be the tallest barrier to health reform, and social change more broadly. The discussion extends the literature on dog whistles, strategic racism, and scapegoating.

Desegregating Behavioral Health Care For Medicaid Youth, Caroline M. Marsh, Valarie K. Blake

Saint Louis University Journal of Health Law & Policy

The Supreme Court held in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581, 581 (1999) that it is a violation of the Americans with Disabilities Act (ADA) for states to rely on institutionalized care when home and community-based care is more appropriate. Yet, over a quarter of a century later, states persist in institutionalizing youth experiencing behavioral health disabilities. This article explores Olmstead’s impact thus far on deinstitutionalization of youth behavioral health care, and the limits of Olmstead as a vehicle for lasting change. We argue that, although recent enforcement actions reflect critical change, Olmstead enforcements alone cannot succeed …

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”) …

National Federation Of Independent Business V. Sebelius, 567 U.S. 519 (2012), Elizabeth Weeks, Mary Ann Chirba, Alice A. Noble

Scholarly Works

In National Federation of Independent Business v. Sebelius, decided in 2012, twenty-six states as well as private individuals and an organization of independent businesses challenged the constitutionality of two key components of the Affordable Care Act. The Court upheld the individual mandate but converted the Medicaid eligibility expansion from mandatory to optional for states. Elizabeth Weeks’ feminist rewrite breaks down the public law-private law distinction to get beyond the traditional view of health insurance as a commercial product providing individual financial protection against risk and instead to view it as effecting a risk pool premised on cross-subsidization of the health-care …