Last week, the Supreme Court issued a landmark ruling with critical implications for Medicaid beneficiaries and their families. The decision — Health and Hospital Corporation of Marion County v. Talevski — preserves beneficiaries’ ability to seek the aid of the courts when state actions unlawfully violate their rights.
In Talevski, the family of a deceased man, Gorgi Talevski, claimed that he received abusive treatment at a county-operated nursing home in Indiana and that the abuse violated special Medicaid nursing home rights known as the Federal Nursing Home Reform Act (FNHRA). The FNHRA protects nursing home residents from abuses such as inappropriate use of chemical restraints and arbitrary transfers. The family also claimed that officials failed to address violations despite repeated appeals, including a formal complaint. The family sued under Section 1983, a 150-year-old federal law that allows people to sue when deprived of federal rights. Supreme Court precedent allows the use of Section 1983 to protect federal rights guaranteed through public welfare programs like Medicaid. The family argued that they were entitled to damages following Gorgi’s death because of flagrant and negligent violation of his FNHRA rights. A lower federal court, relying on precedent, ruled that the family could proceed; officials appealed to the Supreme Court. The case specifically hinged on whether the rights created by Medicaid (i.e., special rights explicitly granted to nursing home residents to be free from abuse) are enforceable through Section 1983.
The 7–2 decision in favor of the Talevski family was authored by Justice Ketanji Brown Jackson; it rejected all of the public defendant’s arguments. County officials asserted that despite its clear wording, Section 1983 contains explicit limits tied to the fact that Medicaid is a “spending clause” program — essentially a contract between the federal and state governments — and that Section 1983 does not apply to spending clause statutes. The Court called the county officials’ assertions “at the very least, perplexing” and rejected their claims as unfounded and completely contrary to Section 1983. The Court also rejected officials’ additional argument that — contrary to constitutional requirements — Congress had failed to give states “clear notice” that Medicaid participation could lead to legal liability under Section 1983 if beneficiaries’ rights are violated. It concluded that the very existence of Section 1983 puts states on notice that they can be sued for alleged violations of federal Medicaid rights.
In his dissent, Justice Samuel Alito agreed with the majority that Medicaid gives special rights to nursing home residents but argued that Medicaid itself barred the use of Section 1983 because the nursing home provisions have their own special enforcement pathway. The majority rejected this view on the ground that the special state administrative obligations toward nursing home residents was not a legal substitute for the special protections offered by Section 1983. Furthermore, if Congress means to bar access to Section 1983, it must explicitly say so.
The facts in Talevski underscore Section 1983’s importance. Not only was the record replete with evidence of abuse, it also contained an abundance of evidence showing ineffectual state government response to the terrible conditions in which Gorgi Talevski lived and his family’s repeated, futile efforts to get state officials to respond.
Talevski could not have been decided at a more crucial time, when the special Medicaid continuous enrollment protections enacted as a response to the COVID-19 pandemic are being unwound. As many as 20 percent of current beneficiaries could lose benefits. Despite substantial protections against arbitrary and illegal termination of insurance coverage, early evidence suggests that some states are acting with such haste that millions of children and adults may be unlawfully experiencing termination of benefits. The law that directed states to begin Medicaid unwinding this spring also created safeguards that states must follow and gave the U.S. Department of Health and Human Services Secretary additional oversight authority. But as with FNHRA, there is no guarantee that these special agency oversight and administration responsibilities will be effectively used, nor do these special protections include provisions barring beneficiaries from using Section 1983. The Talevski decision preserves Section 1983 rights in Medicaid unwinding and other situations in which vital federal rights conferred by Medicaid are harmed.
