By Sabra Anckner, RN, MSN, Associate Director, Clinical & Community Collaboration, Association of Maternal & Child Health Programs (AMCHP)
Occasionally, AMCHP will recap Supreme Court decisions that impact the maternal and child health community. These summaries are not legal advice, and the author is not a lawyer.
Health and Hospital Corporation of Marion County v Talevski asked if individuals using Medicaid to pay for care at nursing homes have the right to sue when their civil rights are violated. The Court ruled 7-2 in favor of the Talevski family’s ability to seek damages.
Background
In 2016, Gorgi Talevski was a resident at a nursing home owned by Health & Hospital Corporation (HHC) of Marion County (Indiana). He and his family sued the facility for violating his rights under the Federal Nursing Home Reform Act (FNHRA). They alleged that he was chemically restrained with sedating medications and transferred to a different facility, far from his family, all without the family’s knowledge or consent.
The Nursing Home’s Argument
Mr. Talevski’s care was paid for by Medicaid. HHC argued that because he was but a “third party beneficiary,” he could not sue for damages. They emphasized HHC’s contract was with Medicaid at the federal level, so only the federal government should be able to make claims.
Typically, when the federal government pays for a state or local government program, if that agency does not comply with federal statutes or regulations, the government may withdraw funding. A well-known example is when the US sought to force states to raise the legal age for drinking alcohol to 21 by withholding highway funds. It worked: within a couple of years, all states raised their drinking age.
If the government were to take that route in this case, HHC – and potentially the State of Indiana – could no longer receive Medicaid funds. That would be disastrous for low-income people in that state and would not further the US government’s goals. It also could have prevented all individuals with Medicaid from going to court when their civil rights are violated.
Section 1983 and the Connection to Maternal & Child Health (MCH)
US Code 42 §1983 is an important part of US law. It says that any state, territorial, or local public agency or employee who deprives a person of their civil rights “shall be liable to the party injured.” It was first enacted during the Reconstruction as a path for formerly enslaved people to take action against the governmental discrimination they faced. While it was ignored for nearly a century during the Jim Crow era, Section 1983 was revitalized with a series of important cases. Both Brown v. Board of Education and Miranda v. Arizona (which established the ‘Miranda warning’) were Section 1983 cases. Today, the law is a crucial tool for individuals to enforce their rights that are granted under other laws, such as FNHRA.
In their brief in support of the Talevski family, the American Public Health Association and others described the importance of Medicaid to low-income families in the United States and the frequent need for individuals to take action under Section 1983 to protect their rights. They feared that had HHC prevailed in this case, the states themselves could have placed restrictions on Medicaid enrollment or coverage to save money, and individuals would have no way to fight for their rights.
The Court’s Decision
The Supreme Court ruled in favor of the Talevski family, in a 7-2 vote, with Justice Ketanji Brown Jackson writing for the majority. Justice Jackson wrote that because FNHRA specifically refers to “residents’ rights,” it is clear that Congress intended for residents to be able to enforce their rights through lawsuits.
While the outcome of this case is a clear win for Medicaid beneficiaries, there remain limitations and challenges. For example, in 2015, the Court ruled that Medicaid providers could not sue states over reimbursement rates for services rendered (Armstrong v. Exceptional Child Center, Inc.).
The Ruling’s Significance
Sadly, Mr. Talevski himself will not benefit; he died as the case made its way through the court system. Nor does this ruling end the fight. Instead, Mr. Talevski’s widow Ivanka Talevski has to return to where the family began seven years ago: the district court, seeking damages before a judge and jury for the harm her husband and family experienced in HHC’s care. A final resolution to the case may still be years away. But thanks to the Talevski family’s fight, the doors to the courts remain open to all families receiving Medicaid services.
