The Idaho Medicaid program scored a victory in the United States Supreme Court today, and did it by persuading normally liberal Justice Breyer to enter the conservative tent reliably inhabited by Justices Scalia, Thomas, Alito, and Roberts.

Idaho in-home health care providers have long complained that the State Medicaid program flouted the federal Medicaid Act’s mandate to “assure that payments are … sufficient to enlist enough providers” to make care for Medicaid patients equally available with care to the general public.  The providers sued to enjoin Medicaid authorities to set rates meeting that standard.  The district court gave the providers summary judgment, and the Ninth Circuit affirmed, ruling that the Supremacy Clause of the United States Constitution provided an implied right to sue.

The Supreme Court disagreed, ruling that the providers do not have a private right of action under either the Medicaid Act or the United States Constitution.  Writing for the majority, Justice Scalia said that Congress had provided, in the Medicaid Law itself, the sole, exclusive remedy for the alleged violation: Health & Human Services Secretary’s power to withhold Medicaid funds from the State.  He further wrote that the Supremacy Clause confers no private cause of action.

Justice Sotomayor wrote for the liberal minority (minus their usual ally, Justice Breyer) emphasizing some practical problems with the majority’s approach.  The Secretary is too busy to effectively monitor compliance of all the Medicaid programs of all the States.  And shutting off all Medicaid funds to a State program is so draconian that it isn’t really workable as an exclusive remedy for a program’s refusal to comply with the federal law.

The case is Armstrong v. Exceptional Child Center (No. 14-15).