Judge Orders Idaho Health and Welfare to Improve Rates for Medicaid Providers


Five Idaho corporations providing basic life skills such as bathing, eating and laundry to disabled children and adults have won a summary judgment from U.S. District Court Chief Judge Lynn Winmill against Idaho's Department of Health and Welfare and its Division of Medicaid.

"The law is clear that budgetary concerns cannot form the sole basis for reimbursement rates," wrote Winmill in a ruling that has wide-ranging implications for Medicaid-reimbursed service providers throughout Idaho.

The plaintiffs, in their complaint, challenged Health and Welfare's "inaction, or failure to amend existing reimbursement rates," which had been set in July 2006. But according to today's ruling, subsequent studies "reveal that actual provider costs exceed the 2006 rates." Health and Welfare had argued that insufficient funding from the Idaho Legislature kept it from properly adjusting the rates.

But Winmill wrote that Idaho's budget constraints aren't an excuse to deny appropriate reimbursement. Winmill wrote that it "may in fact force the Idaho Department of Health and Welfare to reallocate funds from other programs," to properly pay the providers but "the Court need not wait for evidence of low quality care or insufficient access to services before intervention is warranted."

You can read the full decision and order here mediciad_ruling.pdf.