On March 20, 2013, Constitutional Accountability Center filed a brief in the U.S. Court of Appeals for the Fifth Circuit in support of the appellees in Koenning v. Suehs, a case that had important implications for the Spending Clause, preemption, and the private enforcement of federal Medicaid requirements. At issue in Koenning was whether the federal Medicaid statute’s state plan requirements preempted contrary state laws and whether federal requirements were enforceable by Medicaid beneficiaries.

The plaintiffs in Koenning were three Medicaid beneficiaries with severe physical disabilities who were denied power standing wheelchairs by the Texas Health and Human Services Commission (THHSC). Although the plaintiffs’ doctors found the power standing wheelchairs to be medically necessary, THHSC policy explicitly excludes power standing wheelchairs from Medicaid coverage. This categorical denial of coverage ran afoul of the federal Medicaid statute’s requirement that state plans include “reasonable standards.” While Texas contended that Medicaid was “spending legislation” that did “not obligate the States to do anything,” our brief demonstrated that the text and history of the Supremacy Clause and the Spending Clause give federal Medicaid requirements a privately enforceable preemptive effect over contrary state policies.

As described in our brief, the Framers of the Constitution were keenly aware of the dysfunction that had been created by the federal government’s lack of power under the Articles of Confederation. As a result, provisions such as the Spending Clause and the Supremacy Clause were included to fulfill the Framers’ vision of broad federal power. The Spending Clause gives Congress the power to raise and spend funds for broad national goals, and the Supremacy Clause prevents states from frustrating these goals by establishing the Constitution and federal law as the “supreme law of the land.” By entrusting the enforcement of the Supremacy Clause to the judiciary, the Framers also ensured that private citizens would be able to find relief if they were injured by state laws that conflicted with federal laws. In addition to the text and history of the Constitution, there is a large body of precedent that supports the preemptive power of federal spending legislation and the enforcement power of private parties. Previously, in the case of Wos v. EMA, the Supreme Court affirmed the preemptive power of the federal Medicaid statute.

On August 20, 2013, the Fifth Circuit dismissed Koenning as moot, and vacated the district court’s decision. Accordingly, the appellate court did not have the opportunity to rule on the dangerous argument made by Texas that would have weakened Medicaid’s protections.