24 F. Supp. 2d 955 - Smith v. Palmer’s Empirical Analysis

Citation profile

3 federal appellate · 6 district · 1 state decisions

Most-quoted passages

The sentences later courts lift from this opinion, ranked by how many decisions quote each — the parts of the opinion doing the work. These counts are smaller than the citation total above because most of the 14 citing decisions cite the case generally; a passage count includes only decisions quoting that exact language verbatim.

1. “(a) The plan must specify the amount, duration, and scope of each service that it provides for— (1) The categorically needy; and (2) Each covered group of medically needy. (b) Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose. (c) The Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service under §§ 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition. (d) The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures.”

   2 later decisions quote this exact passage · from the majority
   e.g. Bryson v. Shumway · 57 F. Supp. 2d 736 - Smith v. Rasmussen

2. “In 1965, the federal Medicaid program was created when Congress added Title XIX to the Social Security Act, 42 U.S.C. § 1396 et seq., “for the purpose of providing federal financial assistance to states that choose to reimburse certain costs of medical treatment for needy persons.” Harris v. McRae, 448 U.S. 297, 301 , 100 S.Ct. 2671 , 65 L.Ed.2d 784 (1980). Although participation in the Medicaid program is entirely voluntary, once a state elects to participate, it must comply with federal statutory and regulatory requirements. Id. at 301 , 100 S.Ct. at 2671 ; Weaver v. Reagen, 886 F.2d 194, 197 (8th Cir.1989) (“Although a state’s participation [in the Medicaid program] is voluntary, once a state chooses to participate in the program it must comply with federal statutory and regulatory requirements.”). Federal and state governments finance Medicaid programs jointly, but state governments actually administer the programs. Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498, 502 , 110 S.Ct. 2510 , 110 L.Ed.2d 455 (1990). Pursuant to Title XIX, participating states must provide financial assistance for medical services to the “categorically needy,” which include the aged, blind, disabled, and needy individuals with dependent children. 42 U.S.C. § 1396a(a)(10)(A); see Beal v. Doe, 432 U.S. 438 , 440 n. 1, 97 S.Ct. 2366 , 53 L.Ed.2d 464 (1977). Although not required to do so, participating Medicaid states may also opt to provide medical services to the “medically needy.” 42 U.S.C. § 1396a”

   1 later decision quote this exact passage · from the majority
   e.g. 57 F. Supp. 2d 736 - Smith v. Rasmussen

3. “Initially, because the court concludes that 42 U.S.C. § 1396a(a)(17) creates a federal right, which is further defined in 42 C.F.R. § 440.230 (b), that is sufficiently definite to be enforced under § 1983 and because Congress did not intend to foreclose private enforcement of the Medicaid statute, plaintiff Smith states a cause of action under § 1983 for violation of § 1396a(a)(17). The court also concludes that plaintiff Smith has generated a material question of fact as to whether sex reassignment surgery is a medically necessary treatment for plaintiff Smith’s gender dysphoria. Finally, the court concludes that plaintiff Smith has generated a genuine issue of material fact as to whether the Iowa Department of Human Services’ reliance on the Iowa Foundation For Medical Care’s report [to exclude Medicaid coverage for sex reassignment surgery] was a reasonable exercise of discretion. Therefore, defendant Palmer’s Motion For Summary Judgment is denied.”

   1 later decision quote this exact passage · from the majority
   e.g. 57 F. Supp. 2d 736 - Smith v. Rasmussen