The Dean and scholars at the George Washington University (GW) Milken Institute School of Public Health (Milken Institute SPH) filed an amicus brief on August 6 in support of a court case pending petition for certiorari (Supreme Court review). In the case, Legacy Community Health Services v Smith, the United States Court of Appeals for the Fifth Circuit upheld a decision by the Texas Medicaid program to withhold payment to a community health center for care furnished to Medicaid beneficiaries on an out-of-network basis.
The amicus brief is accompanied by an analysis prepared by Dr. Leighton Ku, a professor of health policy and management at Milken Institute SPH, and colleagues — part of the issue brief series prepared by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative — that estimates the national implications of the appellate court’s decision for community health centers and their patients.
“This case raises significant questions of federal law regarding longstanding federal Medicaid policies governing payment for covered services furnished by federally qualified health centers,” said Ms. Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the scholars represented on the amicus brief.
Dr. Ku, Ms. Rosenbaum and other authors of the issue brief estimate that the impact of the Texas payment policy, if adopted by other states using comprehensive Medicaid managed care arrangements and applied broadly to all non-emergency care furnished by health centers excluded from managed care organization (MCO) networks, could reduce total community health center revenue for affected health centers nationwide by 4.3 percent to 8.6 percent annually. Such reductions would have a measurable impact on patient care and staffing.