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Click here for the full text of this decision FACTS:Medicaid, codified at 42 U.S.C. � 1396 et seq., is a cooperative federal-state program through which the federal government provides financial assistance to states so that they may furnish medical care to needy individuals. Although participation in the program is voluntary, participating states must comply with certain requirements imposed by the Medicaid Act and regulations promulgated by the secretary of Health and Human Services. To qualify for federal assistance, a state must submit to the secretary and have approved a plan that contains a comprehensive statement describing the nature and scope of the state’s Medicaid program. The state plan is required to provide, among other things, methods and procedures for the payment of care and services under the plan necessary to assure their availability to the Medicaid population to the same extent as they are available to the general population in that geographic area. Section 1396a(a)(30)(A) of the Medicaid Act sets out the requirement that Medicaid recipients must be assured of “equal access” to medical assistance with the general populace in respect to plan-specified care and services “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.” The state of Texas, the court stated, elected to participate in the Medicaid program and designated the Health and Human Services Commission to administer its plan. The Texas Medicaid program is financed through a joint federal-state arrangement, in which every $1 of state funds disbursed for Medicaid is matched by approximately $2 of federal funds. The HHSC compensates Medicaid providers through two programs: 1. the traditional fee-for-service program; and 2. the managed care program. Under the fee-for-service program, health care professionals are reimbursed based on fee schedules established by HHSC. Under the managed care program, HHSC administers payments to participating managed care providers, such as health maintenance organizations, using capitation or per-head rates, which are fixed amounts paid to the participating providers on a per-member, per-month basis. The capitation rates vary according to market prices in each geographic area. Plaintiff Equal Access for El Paso is a nonprofit corporation located in El Paso County, composed of individuals interested in the provision of health care in the El Paso geographic area. Its purpose is to develop health care resources and access to health care in that area. On Oct. 24, 2003, Equal Access for El Paso, on behalf of its members, brought suit in U.S. District Court for the Western District of Texas against HHSC. Also joining in this suit were several individual Medicaid recipients residing in El Paso, who sued as individuals on their own behalf and on behalf of their respective children, as well as three health-care providers suing on their own behalf and on behalf of their Medicaid recipient patients and enrollees. Together, these plaintiffs alleged that HHSC set deficient Medicaid reimbursement and capitation rates, resulting in inadequate access to medical services for Medicaid recipients who live in the El Paso area as compared to the rest of the state and as compared to individuals covered by private insurance in the El Paso area. The plaintiffs alleged that inadequate reimbursement and capitation rates, when combined with the relatively high percentage of Medicaid recipients in the El Paso area, created a financial incentive for physicians to relocate and practice in other communities in the state and for physicians practicing in the El Paso area to seek out patients covered by employer-sponsored insurance. In the district court, plaintiffs originally brought suit under 42 U.S.C. �1983, alleging violations of six provisions of the Medicaid Act and also alleging several constitutional violations. HHSC then filed a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(1) for lack of subject matter jurisdiction and, in the alternative, Rule 12(b)(6) for failure to state a claim. The district court denied HHSC’s 12(b)(1) motion, finding that the plaintiffs had standing, but granted its 12(b)(6) motion, dismissing all of the plaintiffs’ claims with the exception of the recipients’ claim under �1396a(a)(30)(A)’s “Equal Access” provision. The district court denied the defendant’s motion with respect to the Equal Access claim, because the court determined that �1396a(a)(30)(A) conferred on Medicaid recipients an individual federal right enforceable through �1983. On interlocutory appeal, HHSC contended that �1396a(a)(30)(A) does not create a federal right of action enforceable through �1983. HOLDING:Reversed and remanded to the district court with directions to enter a judgment dismissing all claims with prejudice. Section 1983, the court stated, imposes liability on anyone who, under color of state law, deprives a person of any rights, privileges or immunities secured by the Constitution and laws. The �1983 remedy encompasses violations of rights secured by federal statutory as well as constitutional law. Accordingly, the court noted that “it is rights, not the broader or vaguer ‘benefits’ or ‘interests,’ that may be enforced under the authority of” �1983. Once a plaintiff demonstrates that a statute confers an individual right, the right is presumptively enforceable by �1983, the court stated. The court noted that in the U.S. Supreme Court’s 2003 decision in Gonzaga University v. Doe, the Supreme Court stated that a statutory provision fails to confer enforceable rights when it lacks language showing the requisite Congressional intent to create new rights; when it speaks only in terms of institutional policy and practice, not individual concerns; and when it has an aggregate focus and is not concerned with whether the needs of any particular person have been satisfied. Applying the foregoing principles, the court concluded that �1396a(a)(30)(A) does not confer individual private rights that are enforceable under �1983. The Equal Access provision, the court stated, speaks only in terms of institutional policy and practice, has an aggregate rather than an individualized focus, and is not concerned with whether the needs of any particular person or class of individuals have been satisfied. OPINION:Dennis, J.; Dennis, Clement and Prado, JJ.

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