Theoretically, Medicaid should be simple. It’s anything but simple. Also, theoretically, the Medicaid program should be administered in the best interests of Medicaid recipients. 42 C.F.R. § 435.902. Anyone who has worked on more than a few Medicaid applications knows otherwise. Still that’s what federal law requires. 42 U.S.C. § 1396a(a)(19) must “provide that State Plans such safeguards as may be necessary to assure that eligibility for care and services under the plan will be determined, and such care and services will be provided, in a manner consistent with simplicity of administration and the best interests of the recipients.” Of course, several courts have held there is no private right to enforce 42 U.S.C. § 1396a(a)(19) using Section 1983 litigation because, as the Second Circuit stated in Backer v. Shah, 788 F3d 341 (2015), “it is too vague and amorphous to create a Section 1983 private right of action. See, e.g., Bruggeman v. Blagojevich, 324 F.3d 906, 911 (7th Cir. 2003) (“[T]he ‘best interests’ provision . . . is insufficiently definite to be justiciable, and in addition cannot be interpreted to create a private right of action[.]”); Harris v. James, 127 F.3d 993, 1010 (11th Cir. 1997) (collecting cases); Cook v. Hairston, No. 90-3437, 1991 U.S. App. LEXIS 28537, 1991 WL 253302, at *5 (6th Cir. Nov. 26, 1991).”