Wash. State Health Care Auth. v. Ctrs. For Medicare & Medicaid Servs.

State licensure and scope of practice standards must be tied to “factors external to the Medicaid program.” Planned Parenthood Ariz. Inc. v. Betlach, 727 F.3d. 960, 971 (9th Cir. 2013).

The Washington State Health Care Authority’s (HCA) Amended State Plan added Dental Health Aid Therapists (DHATs) to the list of providers eligible for Medicaid reimbursement. The plan limited DHATs’ practice to tribal licensing requirements. The Center for Medicare and Medicaid Services (CMS) denied the Amended State Plan. CMS argued that the plan violated the Medicaid free choice of providers statute because only some Medicaid recipients would have access to DHAT services. Petitioners appealed the denial. State licensure and scope of practice standards must be tied to “factors external to the Medicaid program.” Planned Parenthood Ariz. Inc. v. Betlach, 727 F.3d. 960, 971 (9th Cir. 2013). Applying Betlach, the Court reasoned that the Amended State Plan limited DHATs’ practice to tribal members only, regardless of whether they were Medicaid recipients. The plan distinguished between tribal and non-tribal members, which is a factor external to the Medicaid program. Thus, the Amended State Plan did not violate the free choice of providers statute because it “[did] not distinguish between Medicaid and non-Medicaid recipients.” Petition granted and remanded to CMS with instructions to approve Petitioners’ Amended State Plan.