ISSUE. By interpreting and enforcing law, courts historically have played a vital role in shaping Medicaid policy. Among the thousands of cases interpreting Medicaid's meaning, numerous decisions have led to further statutory and regulatory reforms. GOAL. To review judicial decisions that have been instrumental in shaping Medicaid policy regarding eligibility, benefits, and provider participation and payment; to review the scope and limits of state and federal powers, including powers granted under Section 1115 to approve Medicaid demonstrations; and to review the critical question of whether courts can intervene, prior to federal agency review, to prevent states from implementing potentially unlawful and harmful policies. METHODS. Review of leading Medicaid cases. FINDINGS AND CONCLUSIONS. The courts have shaped virtually all aspects of Medicaid policy, including eligibility, benefits and coverage, access to care, provider participation and payment, and the scope of federal agency demonstration powers under Section 1115. Furthermore, underlying the cases that focus on what federal law requires of participating states is a key threshold question of importance to lawsuits brought against states by beneficiaries and providers: whether, in advance of federal agency review, federal courts can intervene to prevent potentially unlawful state policies from taking effect before they cause immediate and irreparable injury. This question has commanded the attention of a more conservative judiciary, whose rulings increasingly are narrowing access to the courts.
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