Challenged by explosive growth in Medicaid enrollment and devastating budget shortfalls, Medicaid provider payments have become a primary target of many state budget-cutting measures. This has left many of the sixty million Americans who rely on Medicaid without access to needed care. Traditionally, Medicaid beneficiaries and providers have relied on the courts to enforce Medicaid’s equal access provision and prevent harsh provider rate cuts. However, due to factors such as contradictory circuit interpretations of Medicaid’s equal access provision, the unresolved question of whether Medicaid beneficiaries or providers are able to bring an equal access suit, and a number of pragmatic and ethical considerations, current judicial enforcement mechanisms are not able to adequately address equal access violations. This Note concludes that only a transparent, adequately financed federal regulatory scheme can ensure equal access for Medicaid beneficiaries.