42 U.S.C. § 1396c

Operation of State plans

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If the Secretary, after reasonable notice and opportunity for hearing to the State agency administering or supervising the administration of the State plan approved under this subchapter, finds—(1) that the plan has been so changed that it no longer complies with the provisions of section 1396a of this title; or(2) that in the administration of the plan there is a failure to comply substantially with any such provision;the Secretary shall notify such State agency that further payments will not be made to the State (or, in his discretion, that payments will be limited to categories under or parts of the State plan not affected by such failure), until the Secretary is satisfied that there will no longer be any such failure to comply. Until he is so satisfied he shall make no further payments to such State (or shall limit payments to categories under or parts of the State plan not affected by such failure).(Aug. 14, 1935, ch. 531, title XIX, § 1904, as added Pub. L. 89–97, title I, § 121(a), July 30, 1965, 79 Stat. 351.)Editorial NotesConstitutionality

For information regarding the constitutionality of section 121(a) of Pub. L. 89–97, enacting this section, see the Table of Laws Held Unconstitutional in Whole or in Part by the Supreme Court on the Constitution Annotated website, constitution.congress.gov.

Notes of Decisions

Cited in 199 cases (23 in the last 5 years), 1969–2026 · leading case: Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012).

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Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012). · cites it 8× “The threatened loss of over 10 percent of a State’s overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion. The Government claims that the expansion is properly viewed as only a modification of the existing…”

Planned Parenthood of AR, etc. v. Cindy Gillespie, 867 F.3d 1034 (8th Cir. 2017). · cites it 6× “Under that authority, the Secretary has required States to give providers the right to appeal an exclusion from the Medicaid program.”

Wilder v. Virginia Hosp. Assn., 496 U.S. 498 (1990). · cites it 4× “42 U. S. C. § 1396c (1982 ed.). The Secretary has expressed his intention to withhold funds if the state plan does not comply with the statute or if there is "noncompliance in practice.”

Planned Parenthood of Grt TX v. Courtney Ph, 981 F.3d 347 (5th Cir. 2020). · cites it 6× “91 42 U.S.C. § 1396c. 21 Case: 17-50282 Document: 00515648975 Page: 22 Date Filed: 11/23/2020 No.”

State of Tenn. v. United States Dep't of State, 931 F.3d 499 (6th Cir. 2019). · cites it 4× “42 U.S.C. § 1396c. The Medicaid Act provides for a system of administrative and judicial review for HHS's decisions concerning state plans and a determination to reduce or withhold a state's FMAP.”

Armstrong v. Exceptional Child Ctr., Inc., 135 S. Ct. 1378 (2015). · cites it 3× “42 U.S.C. § 1396c. As we have elsewhere explained, the "express provision of one method of enforcing a substantive rule suggests that Congress intended to preclude others.”

Suter v. Artist M., 503 U.S. 347 (1992). · cites it 4× “, at 512 (citing 42 U. S. C. § 1396c). [2] In substantially identical language, the Adoption Act, too, requires States to live up to the commitments stated in their plans.”

Doe v. Kidd, 501 F.3d 348 (4th Cir. 2007). · cites it 4× “§ 1396a, sets forth several criteria that a "State plan for medical assistance" must satisfy in order to gain federal approval and enable the Secretary to disburse federal funds.”

Sabree Ex Rel. Sabree v. Richman, 367 F.3d 180 (3rd Cir. 2004). · cites it 4× “42 U.S.C. § 1396c. individuals . . . . There is no dispute that plaintiffs 42 U.”

Florida Ex Rel. Attorney Gen. v. United States Dep't of Health & Human Servs., 648 F.3d 1235 (11th Cir. 2011). · cites it 4× “Under 42 U.S.C. § 1396c, a state whose plan does not comply with the requirements under § 1396a will be notified by HHS of its noncompliance, and "further payments will not be made to the State (or, in [HHS's] discretion.”

Pharm. Rsch. & Mfrs. of Am. v. Walsh, Acting Comm'r, Maine Dep't of Human Servs., 538 U.S. 644 (2003). · cites it 2× “1, 17 (1981), is set forth in the Act itself: termination of funding by the Secretary of the Department of Health and Human Services, see 42 U. S. C. § 1396c. Petitioner must seek enforcement of the Medicaid conditions by that authority — and may seek and obtain relief in the…”

Safe Streets All. v. Hickenlooper, 859 F.3d 865 (10th Cir. 2017). “See 42 U.S.C. § 1396c. Providers seeking more generous payments could try to persuade the Secretary to exercise that authority, but the Secretary’s decision not to take such a step could be successfully challenged in court under the Administrative Procedure Act (APA) “only when…”

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— 42 U.S.C. § 1396c(2) — 6 cases

Planned Parenthood of AR, etc. v. Cindy Gillespie, 867 F.3d 1034 (8th Cir. 2017). “Under that authority, the Secretary has required States to give providers the right to appeal an exclusion from the Medicaid program.”

Planned Parenthood of Grt TX v. Courtney Ph, 981 F.3d 347 (5th Cir. 2020). “91 42 U.S.C. § 1396c. 21 Case: 17-50282 Document: 00515648975 Page: 22 Date Filed: 11/23/2020 No.”

North Carolina v. Heckler, 584 F. Supp. 179 (E.D.N.C. 1984).

Planned Parenthood of Grt TX v. Courtney Ph (5th Cir. 2020).

— 42 U.S.C. § 1396c(A)(2) — 1 case

Ramey v. Rizzuto, 72 F. Supp. 2d 1202 (D. Colo. 1999).

— 42 U.S.C. § 1396c(l) — 2 cases

Jennings Ex Rel. Jennings v. Alexander, 518 F. Supp. 877 (M.D. Tenn. 1981).

Minnesota v. Heckler, 718 F.2d 852 (8th Cir. 1983).

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