A federal judge's ruling that Medicaid beneficiaries can't sue state officials over eligibility may seriously affect the rights of millions of poor people who rely on the federal-state health program, consumer advocates and public health experts warned last week.
In a case with widespread national repercussions, U.S. District Judge Robert Cleland in Detroit ruled that Medicaid recipients in Michigan are barred from filing suit against state officials, even though the federal government requires all states to comply with federal laws before receiving funding for the Medicaid program. He ruled that the state retains its sovereign immunity against lawsuits
"This could do enormous harm to Medicaid beneficiaries," warned Ron Pollack, executive director of Families USA, a nonpartisan healthcare advocacy group in Washington. "It means (beneficiaries are) powerless to make sure that the states fulfill their obligations under federal law.
"To say (beneficiaries) have a right without a remedy is really to say they have no right at all," he added.
The decision, handed down March 26 and first reported last week in the New York Times, has already been cited in similar cases in other states. It may give states new powers to limit access to the program.
Richard Levinson, M.D., associate executive director of the American Public Health Association, said the ruling will allow states to "set their own rules about Medicaid benefits and ... deny benefits that the federal law clearly seems to grant (beneficiaries)."
"This is totally unacceptable," he said. "I agree with other critics (of the decision) who say this makes Medicaid no longer an insurance program. I'm not sure what kind of a program it is if benefits can be denied."
The case involved a lawsuit filed in 1999 by a group of parents demanding that their children receive a comprehensive package of health benefits known as "early periodic screening, diagnosis and treatment." Federal Medicaid law mandates that eligible children receive any care they need to correct medical or dental problems diagnosed through routine, periodic examinations.
The children's parents, seeking an injunction against state officials to prevent them from allegedly violating the Medicaid laws, cited a 19th century civil rights law permitting legal action against state officials who violate U.S. statutes or constitutional protections.
Though federal statutes are the "supreme" laws of the land, the supremacy clause is essentially relinquished when Congress uses its spending power to enact programs such as Medicaid, Cleland said. The judge said Michigan and the federal government "are on equal constitutional footing, and neither has any power to compel the other" in this case.
Gerilyn Lasher, a spokeswoman for the Michigan Department of Community Health, denied that the agency withheld any services from the Medicaid beneficiaries. She called the judge's decision "accurate and correct," saying the state was prepared to "demonstrate our complete involvement" in providing the disputed services to those who are eligible.
Lawyers for the parents are expected to appeal the decision. A spokesman for HCFA, which administers the Medicaid program, said the decision is under review.