Preserving Medicaid Recipients’ Right to Sue Is the ‘Best of All Possibilities’.

Preserving Medicaid Recipients’ Right to Sue Is the ‘Best of All Possibilities’
The Supreme Court recently ruled that long-term care residents at state-run facilities receiving Medicaid should be able to sue for poor quality of care. Maintaining this civil right is critical for these residents’ health and access to justice, writes Nicole Huberfeld in a new viewpoint in JAMA.
The conservative-majority US Supreme Court has overturned several precedents over the past year in landmark decisions that have ended the right to an abortion, limited the Environmental Protection Agency’s power to curb carbon emissions, and most recently, allowed businesses to refuse service for same-sex weddings to prevent “government compelled speech.” But on June 8—in a quieter, but no less important, case—the Court upheld decades of precedent that permits Medicaid recipients living in long-term care facilities the right to sue the state-run facilities for poor treatment.
This decision “was the best of all possibilities,” writes Nicole Huberfeld, Edward R. Utley Professor of Health Law, in a new viewpoint published in JAMA.
Other outcomes could have had broad impact on the rights of not only Medicaid recipients, but those who rely on other federal programs for housing, food, and more.
The case stemmed from a civil rights lawsuit alleging that a state-run nursing facility in Indiana mistreated and violated the rights of Gorgi Talevski, a Medicaid patient with dementia. Talevski’s family filed the suit against the Health and Hospital Corporation of Marion County (HHC), the agency that owns the nursing facility, alleging that the facility unlawfully overmedicated Talveski and attempted to involuntarily discharge him. The family argued that these actions violated the Federal Nursing Home Reform Act (FNHRA), which sets quality standards for nursing homes. They sued using Section 1983, a longstanding civil rights law that enables private parties to use federal courts to enforce certain federal rights against states.
HHC argued that Medicaid patients didn’t have a right to sue, but in a 7-2 decision, the Court ruled that government-run nursing homes can be sued by residents if they violate certain resident rights guaranteed by the FNHRA—in this case, the rights to refuse treatment and be free from restraints.
“If HHC had won, it would have undermined enforcement efforts across federal social programs, which often are cooperative federalism programs, and states would have been subject to much less oversight,” Huberfeld writes.
The US Department of Health and Human Services (HHS) has power to withhold funding from state programs that fail to adhere to federal provisions, but this option would present additional challenges, Huberfeld notes.
“Withholding funding is a blunt tool that could harm Medicaid-participating professionals, institutions, and the patients they serve,” she writes. “Furthermore, HHS does not have capacity to investigate each possible violation of the Medicaid Act and relies on private actions to flag questionable state actions to protect the vulnerable populations enrolled in Medicaid.”
The Court’s ruling is also impactful because it occurs at a time when many eligible Medicaid recipients are losing Medicaid coverage that was extended during the now-expired national public health emergency, and they may need to rely on the federal courts for recourse, writes Huberfeld. Maintaining this legal option is particularly critical for this population of vulnerable groups.
“Medicaid covers a disproportionate number of people who are from racial and ethnic minority groups,” Huberfeld writes. “Seeking redress in federal court for enforcement of statutory civil rights is critical for their health and access to justice.”
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