Supreme Court Upholds Medicaid Recipients’ Right To Sue States Over Federal Violation

In a landmark decision, the Supreme Court ruled in favor of Medicaid recipients in the case of Health and Hospital Corporation of Marion County et al. v. Talevski. The case in question centered around the accusation made by Ivanka Talevski, the wife of nursing home patient Gorgi Talevski, against the Indiana health system. 

Ivanka Talevski claimed that the health system violated a 1987 federal law that governs nursing homes that receive federal funding. The law has a provision that prohibits nursing homes from using psychotropic drugs for nonmedical reasons. 

The Supreme Court announced its ruling of 7-2 to protect the right of Medicaid nursing home residents to seek relief in federal court when state officials fail to meet a certain quality of care. This ruling has significant implications for the Medicaid program and its beneficiaries.

Background

In 2016, Gorgi Talevski moved to a nursing home. In 2019, his wife, Ivanka Talevski, filed a lawsuit alleging that he was subjected to inappropriate psychotropic drugs and involuntary transfers, violating the federal nursing home law. Unfortunately, Gorgi Talevski passed away in 2021.

The 1987 federal law governing nursing homes that receive federal funding includes provisions that can be enforced through lawsuits. Despite this, the hospital system asked the Supreme Court to eliminate a Medicaid patient’s ability to bring forward such lawsuits, claiming that Medicaid patients lack standing because they are third parties in a contract between the state and federal government. However, the court denied their request.

Justice Ketanji Brown Jackson stated that the 1870 statute protects enforcement actions taken by any person deprived of “any rights secured by the Constitution and laws.” Jackson wrote, ” ‘Laws’ means ‘laws,’ no less today than in the 1870s, and nothing in petitioners’ appeal to Reconstruction-era contract law shows otherwise,”. Justices Samuel A. Alito Jr. and Clarence Thomas dissented.

According to Larry Levitt, executive vice president for Health Policy at KFF, a health think tank formerly known as the Kaiser Family Foundation, the case also provides the federal government with another way to enforce Medicaid requirements on states. Levitt noted that without the ability to sue, the federal government could only enforce the Medicaid statute by withholding funding, which is rarely done.

Supreme Court Decision

Justice Ketanji Brown Jackson’s first major majority opinion was marked by a 7-2 decision in favor of upholding a lower court’s ruling in the case of Health and Hospital Corporation of Marion County v. Talevski. 

The ruling allows the daughter of Gorgi Talevski to sue an Indiana health care system. Advocates had previously described the case as an “assault” on the rights of the elderly, people with disabilities, and their families. The decision is seen as a significant victory for these groups.

Despite advocates’ efforts to pressure the parties involved to drop or settle the case, their fears that the court would weaken a major civil rights enforcement mechanism were not realized. Disability and aging advocates still emerged victorious, with the decision allowing Talevski’s surviving family to proceed with their lawsuit. The implications of this case are far-reaching and extend beyond a single lawsuit.

Additionally, the Supreme Court’s majority dismissed the argument the Health and Hospital Corporation of Marion County put forward that people cannot sue government programs that violate government spending. 

Had this argument been accepted, it would have significantly weakened a primary enforcement mechanism for various federal programs. The court’s decision to reject this argument is seen as a significant victory for those seeking to ensure that federally-funded programs are administered fairly and safely.

Implications

The Medicaid Act sets forth certain requirements for states participating in the program, including providing certain medical services to Medicaid beneficiaries. The Act also requires states to establish procedures for determining the medical necessity of services and to notify Medicaid beneficiaries of their right to appeal adverse decisions. These requirements ensure that Medicaid beneficiaries receive the healthcare services they need.

The Court’s decision in Health and Hospital Corporation of Marion County et al. v. Talevski ensures that Medicaid beneficiaries have the means to enforce these requirements. It allows them to bring lawsuits against states and healthcare providers who fail to provide the required services or deny coverage without proper justification.

Conclusion 

The Supreme Court’s decision in Health and Hospital Corporation of Marion County et al. v. Talevski is a significant victory for Medicaid recipients and the Medicaid program. The issue of nursing home abuse is severe, and it is crucial that victims and their families are aware of their rights and can find the best legal representation for their cases. This case demonstrates that having an adept lawyer can make all the difference. 

Nursing home abuse victims and their families must understand their rights and take the necessary steps to ensure those rights are protected. With the help of Circeo Law Firm, victims can seek justice and hold those responsible accountable for their actions. Don’t let nursing home abuse go unchecked–reach out to an attorney for nursing home abuse to help you fight back and get the justice you deserve. Schedule a free consult today.