339 F. Supp. 2d 631 - Clark v. Richman’s Empirical Analysis

Citation profile

2 federal appellate · 1 district · 4 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 17 citing decisions cite the case generally; a passage count includes only decisions quoting that exact language verbatim.

1. “A plain reading of § 1396a(a)(10)(A) supports [the defendant’s] interpretation [that it does not require the Commonwealth to provide services directly]. Section § 1396a(a)(10)(A) requires the Commonwealth to make “medical assistance” available to eligible individuals. “Medical assistance” means “payment of part or all of the cost of [the enumerated types of] care and services.” 42 U.S.C. § 1396d(a) (emphasis added). Section 1396a(a)(10)(A) arguably speaks of more than payment, though, as it requires the Commonwealth, through its MA program, to “provide for making medical assistance available, including at least the care and services listed in paragraphs (1) through (5), (17) and (21) of section 1396d(a)” available to eligible individuals. 42 U.S.C.. § 1396a(a)(10)(A) (emphasis added). Obviously, the issue is whether the “including at least the care and services .... ” language of § 1396a(a)(10)(A) expands the definition of “medical assistance” beyond simply payment for services to include actual provision of services. We do not believe § 1396a(a)(10)(A) imposes an obligation on the Commonwealth to provide any services directly. The most reasonable interpretation of § 1396a(a)(10)(A) is that medickl assistance, i.e., financial assistance, must be provided for at least the care and services listed in paragraphs (1) through (5), (17) and (21) of section 1396d(a). To read the provision any other way would mean that the definition of medical assistance would be expanded, for purpo”

   1 later decision quote this exact passage · from the majority
   e.g. 368 F. Supp. 2d 740 - Westside Mothers v. Olszewski

2. “The statutory entitlement to reasonable promptness of medical services (42 U.S.C. § 1396a(a)(8)) is not infringed by the maldistribution (as it seems to the plaintiffs) of ICF/DDs across the state. It is not as if the plaintiffs require relocation to such a facility on an emergency basis, in which event the remoteness of any such facility from their homes, where they are living at present, would deprive them of prompt treatment. Even if they did require emergency treatment, their theory of violation would be a considerable stretch because the statutory reference to “assistance” appears to have reference to financial assistance rather than to actual medical services, though the distinction was missed in Bryson v. Shumway, 308 F.3d 79 , 81, 88-89 (1st Cir.2002), and Doe v. Chiles, 136 F.3d 709, 714, 717 (11th Cir.1998). Medicaid is a payment scheme, not a scheme for state-provided medical assistance, as through state-owned hospitals. The regulations that implement the provision indicate that what is required is a prompt determination of eligibility and prompt provision of funds to eligible individuals to enable them to obtain the covered medical services that they need, see 42 C.F.R. §§ 435.911 (a), .930(a)-(b); a requirement of prompt treatment would amount to a direct regulation of medical services.”

   1 later decision quote this exact passage · from the majority
   e.g. 368 F. Supp. 2d 740 - Westside Mothers v. Olszewski

3. “[[Image here]] provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan (including but not limited to utilization review plans as provided for in section 1396b(i)(4) of this title) as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area ....”

   1 later decision quote this exact passage · from the majority
   e.g. Armstrong County Memorial Hospital v. Department of Public Welfare