In the first step of the
Golden State analysis, the
Wilder Court addressed the first issue and concluded “[t]here can be little doubt that health care providers are the intended beneficiaries of the Boren Amendment.”
Wilder, 496 U.S. at 510, 110 S.Ct. at 2517. As to the second issue of the first step,
Wilder held that a binding obligation was imposed upon the states because the language of the Boren Amendment was “mandatory rather than precatory.”
Id. at 512, 110 S.Ct. at 2519. The Court noted the state plan “must” provide certain features and the Secretary of HHS “shall” withhold federal funds from noncomplying states.
Id.; 42 U.S.C. § 1396c. As to the final issue in the first step, the
Wilder Court rejected the notion that the Boren Amendment was too vague and amorphous.
Wilder, 496 U.S. at 519, 110 S.Ct. at 2522. The Court cited the specific factors Congress had outlined in the statute and the federal regulations and noted the “objective benchmark of an ‘efficiently and economically operated facility’....”
Id. Furthermore, the Court acknowledged that Congress gave states considerable discretion, and there could be a “range of reasonable rates,” but concluded that the Boren Amendment language was nonetheless enforceable by the judiciary.
Id. at 519–20, 110 S.Ct. at 2522–23. Accordingly, the
Wilder Court found that the statute did provide a federal right.