On Monday, October 3, 2011, the U. S. Supreme Court heard oral arguments in the case of Douglas v. Independent Living Center of Southern California, dealing with the central issue of whether patients and providers can sue in federal court when a state cuts its Medicaid payment rates. Media coverage of the oral arguments indicated the Justices appeared divided on the issue. One of the concerns to some of the Justices is that California instituted the cuts without first seeking the approval of the U.S. Department of Health and Human Services (DHHS). Throughout the long history of the Medicaid program, the issue of when and/or whether private citizens and/or providers can sue in federal court to challenge provisions of the federal statute and/or regulations has long been debated in the courts without a clear answer. The issue has become critical lately as states struggle to control Medicaid costs during budgetary shortfalls.