As of June 2021, Medicaid provided healthcare to over 76 million people who would otherwise not afford it. Medicaid is a conditional program, meaning that states must use government funding in compliance with specific conditions established by Congress. Those conditions include broad requirements (i.e. providing healthcare to certain groups of people) and narrower requirements (i.e., stipulating how facilities funded by Medicaid must be run).
One such narrow condition was created when Congress enacted the Federal Nursing Home Reform Act of 1987 as part of the Omnibus Budget Reconciliation Act of 1987. The Nursing Home Reform Act was enacted in an effort to advance the rights of nursing home residents. The Act established a set of requirements that nursing homes must follow to receive federal funding. It was enacted using Congress’s spending clause power, which allows Congress to spend money collected through taxes on the “general Welfare of the United States.”
The Supreme Court case Health and Hospital Corporation of Marion County v. Talevski raises two questions. First, and more broadly, the case assesses whether individuals have the right to sue in federal courts for violations of rights established through Congress’s spending clause power. Second, and more specifically, the case determines if such rights are guaranteed by the Nursing Home Reform Act.
Facts of the case
Gorgi Talevski was a man suffering from severe dementia. In 2016, Gorgi Talevski’s family admitted him to Valparaiso Care and Rehabilitation (VCR) because they could no longer afford to treat his worsening dementia on their own. VCR is a government nursing facility in Indiana owned by the Defendant, Health and Hospital Corporation (HHC), a municipal entity. VCR claimed that Talevski was an aggressive and uncontrollable patient, so his caregivers used psychotropic drugs as chemical restraints, transferred him between facilities, and attempted to discharge him to a dementia facility all against his will.
Ivanka Talevski, Gorgi’s wife and legal guardian, sued HHC in the U.S. District Court for the Northern District of Indiana under Section 1983 of the Civil Rights Act of 1871. She argued that the Nursing Home Reform Act’s “Rights Against Chemical Restraint and Involuntary Discharge and Transfer” are enforceable under Section 1983 and that HHC violated those rights in their treatment of Gorgi Talevski.
The district court dismissed the case, holding that Medicaid enrollees cannot enforce the Nursing Home Reform Act because the Act established guidelines for the state, not rights for the individual. The Talevski family appealed to the Seventh Circuit Court of Appeals, which reversed the district court’s decision and allowed the case to continue to another court for decision. HHC filed a petition for certiorari, which the Supreme Court granted on May 2, 2022. Oral arguments were heard by the Court on November 8, 2022.
HHC urges the Court to overrule a plethora of precedents, including Wright v. Roanoke Redevelopment and Housing Authority, Wilder v. Virginia Hospital Association, and many more, all of which held that spending clause statutes are enforceable through Section 1983. The argument focused on an error made by previous courts in establishing those precedents. Specifically, spending clause enactments must notify states of every condition that must be fulfilled to obtain funds, including that accepting those funds makes them potential subjects of private suits. Congress did not include the Section 1983 liability as a condition in Medicaid, so private suits are not permissible.
Additionally, HHC cites that upholding the previously mentioned precedents conflicts with Gonzaga University v. Doe and Blessing v. Freestone. In those cases, suing based on a violation of rights requires that the statute in question explicitly established enforceable rights. The Defendants argue that the Nursing Home Reform Act does not do that, so allowing Talevski’s claims would conflict with those precedents.
Andrew Tutt argued on behalf of Talveski, claiming that Congress intended to preserve all remedies to act against the violation of rights established by the Nursing Home Reform Act. Even though Congress did not explicitly include the use of Section 1983, it was included within the intended scope of remedies. Therefore, it need not be explicitly mentioned within the statute because states should already be aware that it is a potential means of remedying the violation of one’s rights. The rights outlined by the Nursing Home Act are clear and its structure does not preclude the use of Section 1983 as a remedy.
If the Court decides in accordance with the Defendants, and private suits regarding spending clause statutes like Medicaid are forbidden, everyone relying on Medicaid would lose many legal safeguards that guarantee them a certain quality of healthcare. Private lawsuits are a means by which people can enforce the protection of their Medicaid rights. However, the Defendants are trying to strip them of their ability to bring such suits. Without that right, the only remaining safeguard would be to cut off funds from non-compliant states or institutions, which is often ineffective due to lack of government resources to investigate individual violations.
States would in effect be able to enforce Medicaid requirements at their discretion, potentially allowing them to cut entire groups of people from receiving benefits. Those groups would not have the ability to file a private suit to protect those rights. Of course, the federal government could cut funding to that state if the violation was clear. However, that would likely result in Medicaid coverage for even fewer people as well as political backlash, making it unlikely under a Democrat or Republican dominated government.
More than half of Medicaid’s beneficiaries identify as Black, Hispanic, Asian American, or another non-white race or ethnicity, and 63 percent of beneficiaries under the age of 60 are women. Thus, the loss of legal safeguards and potential targeting by individual states would impact these groups the most.
A decision that aligns with the Defendants would require the uprooting of a half-century of precedents, but this is something that the Court has done in recent history. The case is currently pending a decision.
James Gaspar is from Oak Park, CA, studying Biology and Philosophy with a certificate in Philosophy, Politics, and Economics.