Medicaid and Beneficiary Enforcement: Maintaining State Compliance with Federal Availability Requirements

When states accept federal funding to administer a joint federal-state program, what assurance is there that they will conform to the requirements of governing federal law? This question takes on a new urgency in the Medicaid context since the section 1983 lawsuits that have historically monitored state compliance with fundamental federal Medicaid requirements may now be impermissible due to recent legislative developments. Anticipating a scramble to find alternative means of enforcement, a novel solution - using administrative hearings to compel states to conform to the federal requirements - may prove to be the most appropriate remaining mechanism for bridging the impending accountability gap.