Alexander v. Lewis

Issue: (1) Whether 42 U.S.C. § 1396p(d)(4) imposes a mandatory obligation on states to exclude certain trusts from eligibility determinations, such that Medicaid recipients and their trusts may pursue a private cause of action to enforce this provision; and (2) whether recipients and their trusts may maintain such an action under the Constitution"s Supremacy Clause by asserting that Section 1396p(d)(4) preempts a state law that requires that these trusts be counted.obligation on states to exclude certain trusts from eligibility determinations, such that Medicaid recipients and their trusts may pursue a private cause of action to enforce this provision. 2. Whether recipients and their trusts maintain such an action under the Constitution"s Supremacy Clause by asserting that " 1396p(d)(4) preempts a state law that requires that these trusts be counted.