The Supreme Court opinion in Armstrong v. Exceptional Child Center came down on March 31st. The fact that the court held that Medicaid providers may not sue to enforce Medicaid's access provisions (requiring states to set payment levels that are sufficient to attract enough providers to serve the Medicaid beneficiary population) is interesting and important in and of itself to those of us who wonder just how Medicaid expansion is going to work out in "how low can you go" states like California.
What is also interesting is the the majority has bought into Idaho's argument that even failure to comply with a federal Medicaid condition of participation is not a violation of federal law appropriate for injunctive relief for providers but, rather, amenable to the remedy of an agency-imposed complete loss of federal funding for Medicaid.
In an article in Modern Healthcare, Harris Meyer talks about how the majority's acceptance of the "gun to the head" coercion test in National Federation of Independent Businesses vs. Sebelius does not seem to extend to the same gun to the head argument in Armstrong. Justice Scalia, for the Armstrong majority, disparages just such a coercion analysis as raised in Justice Sotomayor's Armstrong dissent.
So, whatever coercion meant in NFIB, it may not mean that all all-or-nothing mechanisms for Medicaid participation are coercive. This case does muddy the waters for those of us wondering if the opinion in King v. Burwell will clarify the coercion doctrine further.
As Harris Meyer notes, that's some case of coercion whiplash theory court watchers are developing.
I'm told most people with whiplash recover in a matter of months, say just about in time for the release of the opinion in King v. Burwell.
Missouri State of Mind 