U.S. Supreme Court preserves right to sue to enforce state compliance with Medicaid requirements

6/8/2023 11:44:29 AM   

In a monumental case that represented an existential threat to America’s social safety net, the United States Supreme Court today issued a 7-2 ruling that preserved the ability of people to sue government agencies and other state defendants to vindicate individual protections and rights secured under federal laws, including watershed civil rights and social welfare laws.

In this case—Health and Hospital Corp. v. Talevski— the Court was tasked with answering  the critical question of whether Spending Clause legislation can be privately enforced through an 1870s law known as Section 1983. The law was enacted to bolster enforcement of federal protections of individuals against state infringements in the wake of the Civil War. Today, it is used broadly by individual litigants to compel state governments to honor rights and benefits created under federal law. Talevski put at issue whether such actions are permissible. It thus stood to potentially strip individuals of long-standing federal protections that were established originally in the post-Civil War era.

The California Medical Association (CMA) filed an amicus brief in the case to draw attention to Talevski’s potential impact on patients and providers. For decades Section 1983 has been applied to Medicaid laws, but the U.S. Supreme Court could have stripped beneficiaries and providers of their right to access the courts to enforce state compliance with Medicaid requirements that are aimed to improve care, increase access, and protect patients and providers.

Medicaid provides critical medical care to millions of Americans through millions of health care providers. Like many other federal social programs, Medicaid was established under Congress’s Spending Clause powers, through which the federal government provides federal support for states to implement social programs so long as they comply with the program requirements. Although Medicaid and other similar Spending Clause programs do not recognize the right of beneficiaries to sue states to enforce program compliance, U.S. Supreme Court precedents dating back to 1968 have recognized the applicability of 42 U.S.C. section 1983 as means for private enforcement of Medicaid and other Spending Clause programs.

"Today’s ruling preserves the critical role that private enforcement plays in fulfilling the promise of Medicaid, one of the country’s most important social programs that has delivered beneficial medical care to millions of needy Americans for decades ,” said CMA President Donaldo Hernandez, M.D. “The health equity implications of eliminating such a core legal protection would also have been devastating, as Medicaid helps to assure access for a predominantly low-income population—with a disproportionate number of people of color.”

Organized medicine and physicians, on behalf of themselves and patients, have utilized Section 1983 to ensure the benefits and promises of Medicaid programs are met. Talevski threatened this important legal right and potentially could have shifted oversight and enforcement of Medicaid requirements solely into the hands of the U.S. Department of Health and Human Services, which itself admits that it does not have the resources to displace private enforcement of Medicaid.

CMA’s amicus brief presented organized medicine’s perspective on these issues and underscored the important role that physicians and medical associations have played in ensuring that Medicaid works as designed by Congress.

Members of Congress, including House Speaker Nancy Pelosi (D-CA), also filed a brief in this case, telling the court that reversing the Seventh Circuit Court’s decision—and decades of precedent—would have impeded Congress’ intention to provide efficient and effective means of redress for violations of Medicaid law, and impinged on congressional authority and imperil the separation of powers between Congress and the Court.

With the fundamental threat to Section 1983 private enforcement of Medicaid requirements averted, CMA can continue to serve physicians and their Medicaid patients using all available advocacy tools, including litigation against state agencies when needed.

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