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Covington advises state and local governments on the federal rules and policies governing all aspects of the Medicaid program, including eligibility, services, reimbursement, and federal financing. We regularly assist states to secure plan amendment approvals, respond to federal audits, and challenge deferrals and disallowances. We have extensive experience representing states in administrative proceedings within the U.S. Department of Health and Human Services, including before the Departmental Appeals Board. This firm worked with the National Governors’ Association and a coalition of states in negotiating the terms of the Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991 and ever since has been uniquely involved in issues related to provider taxes and donations, intergovernmental transfers, and disproportionate share hospital payments. A number of states, frequently in cooperation with provider health associations, have called on us to help them structure programs involving certified public expenditures and upper payment limits. We have assisted states in negotiating the terms and conditions of Section 1115 waivers that implement comprehensive reforms of their public health care systems. We have also successfully defended a number of states in federal and state court and in state administrative proceedings in cases brought by hospitals, nursing homes, and other providers to challenge the adequacy of states’ payment rates and reimbursement methods.
Representative Matters
- We represented five states that were facing a total of more than $1 billion in Medicaid disallowances when the Centers for Medicare & Medicaid Services (CMS) concluded that certain state taxes violated Medicaid funding rules. The HHS Departmental Appeals Board rejected CMS’s position and reversed the disallowances.
- On behalf of the Louisiana Department of Health and Hospitals, we secured a favorable Fifth Circuit decision reversing CMS and holding that the state could include the costs incurred by rural health clinics in calculating the uncompensated costs reimbursable by Medicaid.
- We represented the Oklahoma Health Care Authority in appealing a disallowance for school-based services which CMS claimed to be in violation of the “free care” rule. The HHS Departmental Appeals Board held that there was no basis for CMS’s expansive interpretation of the rule, and reversed.
- We successfully defended the New Jersey Department of Human Services in a series of challenges to its Medicaid reimbursement rates for hospitals and the implementation of its hospital rate appeal procedures.
- We have several states in developing and securing federal approval for statewide Section 1115 demonstration projects including Tennessee’s TennCare program and a California waiver covering financing of hospital services for Medicaid and other needy patients which preserved a multi-billion flow of federal funds to the State.
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