United States Third Circuit

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New Jersey Primary Care Association v. New Jersey Department of Human Services, 12-3220

Summary judgment and preliminary injunction for plaintiff in an action claiming that the State's change in its methodology for calculating Medicaid wraparound payments violated federally-qualified health centers (FQHC)'s right to due process and federal and state law governing Medicaid wraparound payments, resulting in considerable budget shortfalls is: 1) affirmed in part, on the ground that the State's requirement that wraparound payments be contingent on prior manage care association (MCO) payment violated the federal Medicaid statute's requirement that FQHCs timely receive full wraparound payment for all Medicaid-eligible claims and enjoining the State from implementing a policy requiring prior MCO payment absent an adequate process for claim-eligibility verification; and 2) reversed in all other respects.

Appellate Information

  • Decided 07/09/2013
  • Published 07/09/2013




  • United States Third Circuit


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