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SCOTUS to Weigh In on Medicaid Beneficiaries’ Right to Choose their Provider

Client Alert
January 2, 2025

The Supreme Court of the United States (SCOTUS) recently granted a petition filed by the state of South Carolina to determine whether Medicaid recipients have the right to choose their provider without state interference. Section 1902(a)(23) of the Social Security Act generally requires state Medicaid programs to permit Medicaid beneficiaries to seek care from any institution, agency, community pharmacy, or provider that is qualified and willing to deliver care to beneficiaries.

South Carolina filed its petition in response to a Fourth Circuit ruling that prevented South Carolina’s Medicaid program from terminating its provider agreement with Planned Parenthood. In the Fourth Circuit case, Planned Parenthood South Atlantic argued that Section 1902(a)(23) of the Social Security Act gives Medicaid beneficiaries the right to seek care from any qualified and willing provider and that it was not Congress’ intent for states to intrude on a Medicaid patients’ personal decisions about medical care. Arguments will take place this spring; SCOTUS will consider the merits of the case and issue a decision by the end of the summer.

If you have questions about the Supreme Court’s decision to determine whether a Medicaid beneficiary has an enforceable right to challenge a state’s determination that a provider is unqualified, please contact Member Daphne Kackloudis at dlkackloudis@bmdllc.com, Attorney Jordan Burdick at jaburdick@bmdllc.com, or Attorney Kate Crawford at khcrawford@bmdllc.com.

MedicaidHealth LawHealthcareDaphne KackloudisKatherine CrawfordJordan Burdick
Client Alert

Ohio House Bill 537: Proposed Regulations for Midwives and Birthing Centers

January 28, 2026House Bill 537, introduced in the Ohio House of Representatives, proposes a comprehensive regulatory framework for certified nurse-midwives, certified midwives, licensed midwives, and traditional midwives. The legislation would clarify scope of practice, establish licensure standards, and impose new requirements for freestanding birthing centers and home births. Healthcare providers and facilities should be aware of the proposed changes and their potential operational impact.Client Alert

Proposed Health Information Privacy Reform Act Expands Protections Beyond HIPAA

January 26, 2026The Health Information Privacy Reform Act (HIPRA) seeks to extend privacy protections to health data not covered under HIPAA, including data collected by apps and wearables. HIPRA introduces broader definitions of protected health information, strengthens privacy and security requirements, establishes patient notification rights, and sets national de-identification standards. Companies processing health data should monitor developments to ensure compliance.Client Alert

Medicare Updates on Skin Substitutes: LCDs Withdrawn, Payment Changes Take Effect

January 23, 2026Medicare’s planned Final Local Coverage Determinations (LCDs) for skin substitutes were withdrawn in late December 2025, meaning previous coverage rules remain in effect. The 2026 Medicare Physician Fee Schedule introduces a single payment rate of approximately $127.14 for these products. Providers should review implications for diabetic foot and venous leg ulcer treatments.Client Alert

Understanding the Seven Core Elements of an Effective Healthcare Compliance Program

January 22, 2026The Affordable Care Act requires healthcare providers participating in Medicare, Medicaid, and CHIP to maintain an effective compliance program. Guidance from the Department of Health and Human Services and the Office of Inspector General outlines seven core elements that form the foundation of these programs, from written policies and compliance oversight to auditing, training, and corrective action. This alert highlights each element and explains how practices can tailor compliance programs to their size and risk profile while meeting federal expectations.Client Alert

Preventing a Board Investigation

January 21, 2026Healthcare professionals in Ohio are subject to licensing board investigations that can lead to disciplinary action. Staying compliant with regulations, documenting carefully, and operating within your professional scope can help prevent issues. If contacted by a board, working with an attorney is critical to protect your license and rights.
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