By: Sarah Somers
Executive Summary
Medicaid applicants and beneficiaries have a choice of forum when eligibility or services are denied, terminated, or reduced. They have the right to a state administrative hearing to challenge a denial, termination, or reduction of eligibility or services, with a right to appeal an adverse decision to state court. They also may bring actions to enforce certain Medicaid provisions under 42 U.S.C. § 1983 in federal or state court. In some instances, it may make sense for a claimant to make an administrative appeal then, at some later point, file an original action in federal court. Under those circumstances, attorneys representing the Medicaid agency may raise a variety of arguments about why the federal court should not hear the suit. In this Fact Sheet, we review the principles of exhaustion, abstention, and preclusion, updating previous publications on these issues, and highlight some notable cases
