By Marcia Coyle

Health care providers cannot sue states over Medicaid reimbursement rates that they contend are too low to ensure delivery of services under the federal-state program for poor and low-income individuals, a divided U.S. Supreme Court ruled on Tuesday.

In a 5-4 decision in Armstrong v. Exceptional Child Center, the majority led by Justice Antonin Scalia said the U.S. Court of Appeals for the Ninth Circuit was wrong when it held the providers had “an implied right of action” to seek injunctive relief.

The supremacy clause, Scalia wrote, forbids courts from giving effect to state laws that conflict with federal laws. “It is equally apparent that the supremacy clause is not the ‘source of any federal rights,’ and certainly does not create a cause of action,” he wrote. “It instructs courts what to do when state and federal law clash, but is silent regarding who may enforce federal laws in court, and in what circumstances they may do so.”

That silence, and the “conspicuous absence” of any mention of private enforcement rights against the states in the preratification historical record, “militates strongly” against the providers’ argument, he wrote.

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David Gans, civil rights director at the Center for Constitutional Accountability, said, “Make no mistake, the practical effects of this ruling are enormous for ordinary Americans. The court today turned its back on the principle of access to our federal courts, leaving low-income people seeking access to health care to the vagaries and limitations of the executive branch.”

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