On November 8th, the U.S. Supreme Court heard oral arguments for Health and Hospital Corp. of Marion County v. Talevski. The central issue in this case is whether 42 U.S.C. § 1983 provides beneficiaries of federally funded programs with a private cause of action against states to secure rights enacted by Congress pursuant to the Spending Clause. Section 1983 was enacted to provide a federal cause of action for the violation of federal rights by state-level actors. If the Supreme Court denies individuals the § 1983 cause of action, then beneficiaries of federally funded programs, such as Medicaid, will lose their most effective tool for holding states accountable for violations of the rights guaranteed by public benefit programs.

This case arose when Gorgi Talevski, an Indiana resident with dementia, faced abuse while residing at Valparaiso Care and Rehabilitation, a state-run nursing facility. Gorgi’s daughter, Susie, said, “[the nursing facility] treated my dad like trash, like a dog. In fact, dogs are treated better than that.” The Talevskis sued Health and Hospital Corp. of Marion County (HHC), the managed care organization that owns Valparaiso, alleging that HHC violated the Federal Nursing Home Reform Act (FNHRA) by failing to provide Gorgi with adequate care, overmedicating him to keep him asleep, and involuntarily transferring him to facilities hours away from his family’s home. The FNHRA is a revision to the Medicaid Act that creates a list of rights for nursing home residents in an effort to protect them from abuse by providers.

The Talevskis argued, in the U.S. District Court for the Northern District of Indiana, that § 1983 creates a private cause of action for the violation of the rights created by the FNHRA. In response, HHC argued that Spending Clause statutes, such as the Medicaid Act and the FNHRA, are contracts between the federal and state governments, and do not create a private right of action under § 1983. The district court agreed with HHC. On appeal, the Seventh Circuit reversed, interpreting § 1983 to have a broad purpose of providing a remedy for federal statutory violations, including the FNHRA. HHC filed a petition for a writ of certiorari, posing the sweeping question of whether Spending Clause legislation gives rise to privately enforceable rights under § 1983.

Medicaid was created by Congress through Title XIX of the Social Security Act to address the healthcare needs of low-income individuals. Medicaid programming is administered through a partnership between the federal and state governments. The federal government sets the core Medicaid eligibility requirements and benefits, and the states are entitled to federal matching funds to administer the programs within the federal guidelines. Medicaid serves 1 in 5 Americans, providing health and long-term care to low-income families, people with disabilities, and the elderly. Indiana contracted with HHC, a private healthcare provider, to deliver nursing home services to Medicaid beneficiaries, such as Gorgi Talevski.

There are currently two ways to enforce state compliance with federal Medicaid requirements: (1) through oversight from the Centers for Medicare and Medicaid Services (CMS), and (2) through litigation brought by individuals in federal courts. Under the first option, CMS can investigate potential compliance violations and provide suggestions to the state on how to come into compliance, but CMS has few options for enforcement if the state fails to do so. The federal government could withhold funding from the state, but this is an unsatisfactory option because withholding funding would hurt the program beneficiaries further and make it more difficult for the state to comply. Further, CMS does not have the capacity to monitor compliance of all state-run, federally funded programs, which number in the thousands. The negotiation process between the state and CMS is slow, and not always fruitful, so it does not ensure immediate reform or relief for the individuals harmed by the state’s failures.

The second, and primary, means of enforcement for compliance with Medicaid requirements is through § 1983, which provides a cause of action against actors who, “under color of state law,” deprive another of “any rights, privileges, or immunities secured by the Constitution and laws.” In 1980, the Supreme Court held in Maine v. Thiboutot that the “laws” referred to in § 1983 include rights created through state-administered federal entitlement programs. Seventeen years later, in Blessing v. Freestone, the Court narrowed the § 1983 cause of action to situations when (1) the law is intended to benefit particular individuals, including the plaintiff, (2) the right asserted is specific enough to be enforced by the judiciary, and (3) the statute clearly imposes a binding obligation on the state. Parties have used § 1983 for decades to privately enforce the rights promised by the Medicaid Act.

As noted in various amicus briefs submitted in support of Talevski, a ruling that § 1983 does not provide a private right of action for Spending Clause legislation would strip protections from millions of low-income, federal program beneficiaries. Federal enforcement of state compliance is not enough to protect the rights of beneficiaries, which is why Congress intended for individuals to be able to hold state governments accountable in administering federal entitlements. This ruling would not only harm Medicaid beneficiaries, but also recipients of Medicare, Supplemental Nutrition Assistance Program (SNAP), Children’s Health Insurance Program (CHIP), Temporary Assistance to Needy Families (TANF), and more. If the Supreme Court rules against Talevski, crucial safety net programs created under the Spending Clause will be left without an effective enforcement mechanism.