High court remands Medicaid case to lower court

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The Indiana Supreme Court ordered a Marion Superior Court to let Medicaid recipients involved in a decades-long lawsuit present evidence to demonstrate the transportation they may be entitled to by law and if they have been or will be denied services because of lower pay rates to Medicaid transportation providers.

The high court granted transfer Monday and released a 7-page per curiam opinion in Anne W. Murphy, et al. v. Jannis Fisher, et al., No. 49S02-1008-CV-463, a suit first filed in 1992 by Medicaid recipients and transportation service providers when federal officials found the state’s Medicaid transportation costs were high, leading the state to implement lower pay rates to those that provide Medicaid transportation services.

The plaintiffs sued under the federal Medicaid statute, 42 U.S.C. Section 1396a(a)(30)(A), arguing the reimbursement rates were so low they violated the law and the recipients’ access to medical care was reduced in violation of the statute.

The trial court ordered the state to increase the reimbursement rate, but ordered that the higher rate be applied prospectively; the trial court didn’t enter any specific relief for the recipients except that the state must pay the plaintiffs’ attorney fees. The Indiana Court of Appeals reversed and directed judgment for the state, finding neither plaintiff group had a private right of action to challenge the reimbursement rates.

The Supreme Court summarily affirmed the lower appellate court’s ruling that the transportation providers do not have a private right to sue the state based on Gonzaga University v. Doe, 536 U.S. 273 (2002). The justices also agreed that the Medicaid recipients do have a right to sue. The state had conceded in the trial court that the recipients had a private right of action and the state invited any court error with respect to the right of recipients to sue for relief in this case, wrote the justices.

“We acknowledge the State’s argument that the rights of Medicaid recipients may have been in a state of flux at the time the State filed its trial court brief in 2004, but the issue appears to have been in play by that time, and federal circuit courts of appeal began issuing decisions applying Gonzaga before the State filed its opening appellate brief. Accordingly, the State will be held to its concession that Recipients have a private right of action in this case,” the justices wrote.

The high court ordered the trial court to allow the recipients to present evidence establishing the transportation to which they may be entitled under Section 30(A), that they have been or will be denied the services to which they are entitled, and what relief they are due. Any relief will be prospective only.

Justice Frank Sullivan did not participate in the ruling.


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