By Suzy Khimm
At the heart of Paul Ryan’s plan for Medicaid is a tectonic shift in the federal government’s authority over the entitlement. In the Wisconsin Republican’s
proposal to “block grant” the program, states would receive a fixed amount of federal money for Medicaid — and much greater leeway to change the program’s structure — rather than an uncapped, formula-based contribution with many strings attached. The Ryan plan, along with other
more incremental GOP proposals, would fundamentally alter the federal government’s role in structuring, overseeing, and administering Medicaid, abdicating much of this authority to the states.
In the face of such challenges, the Obama administration is quietly taking steps to reassert and strengthen the federal government’s authority over Medicaid. A few weeks ago, the Centers for Medicare and Medicaid Services rolled out a
proposal that could make it more difficult for states to cut rates for doctors, hospitals, and other providers in Medicaid—one of the many ways that cash-strapped statehouses are
trying to save money.
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Some state officials are already bristling at the proposal, saying the new requirements are onerous and needlessly intrude on state authority. “It’s just an enormous amount of work,” Washington state’s Medicaid director
told American Medical News, arguing that the rules would spur more lawsuits over provider rates. But the Obama administration isn’t just standing up to states in asserting its role in overseeing Medicaid — it’s also trying to prevent private individuals from challenging the program.
Last week, the Department of Justice
filed a friend-of-the-court brief at the Supreme Court that opposed the ability of private individuals to sue states for lowering Medicaid provider rates and choking off access to the program. Weighing in on the case, Douglas vs. Independent Living Center of Southern California, Obama’s solicitor general asserted that it was the responsibility of the Department of Health and Human Services, not individuals, to ensure that states are complying with Medicaid’s promise of equal access to care. Essentially, Obama officials are affirming that federal officials “are better equipped than judges to balance that goal
with other policy objectives, like holding down costs,” explains the New York Times’ Robert Pear.
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