CDA disappointed with Supreme Court Medicaid ruling

The U.S. Supreme Court has ruled that providers cannot sue states or state officials in an effort to increase Medicaid reimbursement rates. In a 5-to-4 decision, justices indicated that complaints about low reimbursement rates should instead be filed with the Centers for Medicare and Medicaid Services, the federal agency that oversees the Medicaid program.

The ruling, which stems from the Idaho case Armstrong v. Exceptional Child Center Inc., is a blow to health care providers who have sought injunctive relief to reimbursement cuts implemented by states. Noting that the decision leaves providers without sufficient remedies to resolve reimbursement issues, dissenting justices stated, “The Court’s error today has very real consequences.”

“While CDA is disappointed with the ruling, we are evaluating its implications and will continue to explore ways to ensure low-income patients have adequate access to dental care,” said CDA President Walt Weber, DDS. “Denti-Cal patients experience significant barriers to care as outlined in a recent state audit highly critical of the program. We are working to educate lawmakers on the need for significant improvements to the program that the state has failed to address.”

The recent state audit revealed serious problems with Denti-Cal, including a lack of oversight, an inadequate provider network and low reimbursement rates. The audit showed most children enrolled in the program did not receive dental care in 2013.

CDA will continue to advocate for changes to the state’s Denti-Cal program, including better oversight and the need to address reimbursement rates for providers, which are among the lowest in the nation.