On June 8, 2023, the Supreme Court decided the case Health and Hospital Corporation of Marion County v. Talevski and found that private lawsuits can be brought to enforce some conditions that federal Medicaid law imposes on states and healthcare providers. The Court’s ruling was 7 to 2. The Talevski decision preserves long-standing precedent that Medicaid beneficiaries have the right to sue when states violate their rights. This article describes the Talevski case, the rights of third parties to sue to enforce parts of Medicaid, and the implications of the case for Pennsylvania Medicaid recipients.
Gorgi Talevski (who is now deceased) was a resident of an Indiana state-run nursing home. Nursing home staff forcibly sedated him with six psychotropic drugs without his family’s knowledge or consent and also tried to transfer him to a different facility involuntarily. Talevski’s family sued the nursing home on his behalf under the Federal Nursing Home Reform Act (FNHRA), which establishes minimum standards of care which nursing homes must adhere to in order to participate in Medicaid.
While the facts of Talevski’s case may seem localized and discrete, the legal issues that the Supreme Court considered implicated several crucial rights for Medicaid recipients. Federal Medicaid law imposes conditions that states must meet in order to receive federal funding for Medicaid. This establishes a sort of contract between the federal government and the states. Additionally, a federal law known as Section 1983 provides a way for individuals to sue the government when they claim that a state violated their federal rights, including their rights under Medicaid law.
In the Talevski case, the parties’ arguments stemmed from different interpretations of the obligations that this legal framework establishes. The Talevskis argued, in keeping with precedent, that the FNHRA is enforceable through Section 1983. However, the nursing home argued that Section 1983 did not apply to them, Medicaid, or federal safety net programs. They contended that individuals and third parties were not part of the original “contract” between the federal government and states and therefore, individuals should not have a private right of action against parties governed by that contract.
Fortunately for Medicaid recipients, the Supreme Court ruled in favor of Talevski. The Court rejected the defendants’ argument and preserved Medicaid recipients’ right to sue under Section 1983. This ruling is a win for Medicaid recipients both in Pennsylvania and nationwide. If the Court had ruled the other way, it would have made portions of federal Medicaid law virtually unenforceable to private citizens.
The ruling comes at an especially timely moment of Medicaid upheaval in the wake of the COVID-19 public health emergency (PHE). Throughout the PHE, Medicaid maintained all enrollees in continuous coverage and largely did not disenroll anyone, even those who were no longer eligible. When the PHE ended in April, this Medicaid coverage protection ended as well. In the twelve months beginning in April, Pennsylvania will review all Medicaid recipients’ eligibility and will disenroll those who are no longer eligible. It is especially important to preserve Medicaid recipients’ rights as Medicaid conducts its comprehensive review.
Anyone who needs assistance with accessing Medicaid benefits can contact PHLP's Helpline at 1-800-274-3258.