117 Yale L.J. 1374 (2008).

When states accept federal funding to administer a joint federal-state program, what assurance is there that they will conform to the requirements of governing federal law? This question takes on a new urgency in the Medicaid context since the § 1983 lawsuits that have historically monitored state compliance with fundamental federal Medicaid requirements may now be impermissible due to recent legislative developments. Anticipating a scramble to find alternative means of enforcement, a novel solution—using administrative hearings to compel states to conform to the federal requirements—may prove to be the most appropriate remaining mechanism for bridging the impending accountability gap.