In November 2022, the United States Supreme Court will hear oral arguments on Health and Hospital Corporation of Marion County v. Talevski. This case poses the question of whether the Supreme Court should re-examine its holding that spending clause legislation permits private lawsuits in federal court to enforce rights under 42 U.S.C. § 1983.
The Talevski case involves a family’s lawsuit under Section 1983 alleging violations by a nursing facility of the Federal Nursing Home Amendments Act of 1987 (FNHA). However, many are concerned that the Supreme Court’s decision could impact other laws, such as those governing health benefits provided through Medicaid.
Section 1983 provides a means by which Medicaid enrollees (and other recipients of state-run federal aid programs) can file lawsuits in federal court to enforce their rights when unlawful state policies contravene federal requirements or cause other harm.
The Role of CMS
Currently, the Medicaid system is administered on a state-by-state basis. The Centers for Medicare and Medicaid Services is tasked with overseeing each state’s system of Medicaid administration. However, it has very limited powers to correct improper policies or wrongs committed by states to those seeking Medicaid benefits.
The powers it does have require states to have the benefit of a long adjudication process through administrative hearings before any sanctions can be implemented. The sanctions themselves are not particularly appealing, as they involve catastrophic consequences such as denial of funding to a state, which could affect millions of people at one time.
Access to Federal Intervention
Beneficiaries of Medicaid also have no private rights to federal intervention under the Social Security Act in instances where they are being deprived of assistance to which they are entitled. Section 1983 has changed this dynamic and allows injured persons to seek federal judicial review of their specific situations. This can lead to a quicker administration of justice and individualized relief.
For example, if a person’s Medicaid eligibility is wrongfully terminated, they can access the federal court system and get a decision on their denial faster than through any administrative hearing process. The court also has the power to impose financial and other sanctions. The same would be true in situations where a state Medicaid plan wrongfully denies payments for treatments that federal rules state should be covered or where a state delays reviewing Medicaid applications for an unreasonable amount of time.
If Section 1983 access is eliminated for the FNHA in the Talevski case, the same could happen to Section 1983 access regarding disputes related to other federal statutes. This could lead to a fundamental shift in Medicaid policy, affecting millions. Many believe states will be empowered to implement policies that may favor their fiscal policies and harm individuals, knowing it will take years before such policies may be reversed with no sanctions in the interim.