On January 6, 2023, Manatt attorneys filed an amicus brief on behalf of the Medicaid Health Plans of America in the U.S. Supreme Court in support of the petition for certiorari in Saint Anthony Hospital v. Eagleson. Saint Anthony Hospital concerns the ability of Medicaid providers to sue state Medicaid agencies in federal court in order to challenge reimbursement the providers receive from Medicaid managed care organizations (MCOs).
In this case, the U.S. Court of Appeals for the Seventh Circuit held that providers dissatisfied with the timeliness of MCO payments can sue states under the prompt payment requirement in Section 1932(f) of the Social Security Act, 42 U.S.C. § 1396u-2(f). Section 1932(f) requires that states’ contracts with Medicaid MCOs include prompt payment requirements unless MCOs and providers reach a different agreement. The Seventh Circuit decision implies a judicially enforceable obligation for states to guarantee prompt payment, thereby permitting Medicaid providers to sue states when they are dissatisfied with their MCO payments, at least in the case of “systemic” problems.
A Manatt team including Manatt Health Partners Stephen Libowsky and Michael Kolber and Associate Marina Shvarts filed an amicus brief on behalf of Medicaid Health Plans of America in support of a petition filed by the Illinois Department of Healthcare and Family Services seeking review of the Seventh Circuit decision. The brief highlights the practical impact of the decision, which could destabilize the Medicaid managed care system serving tens of millions of enrollees. The brief argues that Medicaid providers have sufficient existing avenues to challenge late payments and that there is no evidence that MCOs routinely pay providers late.
Read the full brief here.