The U.S. Supreme Court case West Virginia University Hospitals, Inc. v. Robert Casey, Governor of Pennsylvania et al., 1990 revolved around the issue of whether states could be required to reimburse hospitals for costs incurred in providing services to Medicaid patients that were not covered by the state's Medicaid plan but were mandated by federal law. The court ruled in favor of West Virginia University Hospitals (WVUH), stating that while states have considerable discretion in determining which optional services their Medicaid plans will cover, they are still obligated under federal law to pay for all medically necessary services provided to eligible individuals regardless of whether these services are included in the state’s plan or not. This ruling affirmed WVUH's right as a provider participating in a State’s Medicaid program to challenge a State’s reimbursement scheme and clarified how far-reaching federal mandates can be when it comes to healthcare provision.

In the dissenting opinion for West Virginia University Hospitals, Inc. v. Casey, Justice Blackmun argued that the majority's decision was inconsistent with Congress' intent in enacting 42 U.S.C §1988 and undermined its purpose of ensuring effective access to judicial process for civil rights plaintiffs. He contended that expert fees are an integral part of litigation costs and should be included within "attorney’s fees" as per Section 1988. The majority's interpretation would discourage potential civil rights litigants due to high cost of securing necessary experts, thus undermining enforcement of federal civil rights laws. Furthermore, he criticized the majority for not adhering to traditional statutory interpretation principles by ignoring legislative history supporting a broader reading of “attorney’s fees”. Lastly, he disagreed with their reliance on Alyeska Pipeline Service Co., arguing it did not apply because Congress had explicitly authorized fee-shifting in this context.