The Supreme Court seemed skeptical on Nov. 8 of an Indiana-based government health care provider’s argument that the family of a Medicaid-eligible nursing home patient was barred by federal law from suing to enforce the man’s legal rights.
Some legal commentators say if the provider wins, Medicaid patients will lose the ability to enforce Medicaid treatment standards, thus endangering the program.
The highly technical case, Health and Hospital Corporation of Marion County (HHC) v. Talevski, court file 21-806, pits the family of a nursing home resident claiming the man was treated poorly against the state of Indiana, which argues that the lawsuit by the man’s estate is baseless because Congress never expressly authorized private enforcement of the relevant federal law.
The spending clause in the U.S. Constitution authorizes Congress to impose taxes and spend money for “the general welfare of the United States.” Medicare and Medicaid are funded under this power.
Medicaid is a joint federal-state program that serves low-income people of all ages and varies from state to state. It’s run by state and local governments within federal guidelines. Each state sets its own rules about eligibility and services. Although patients usually don’t have to pay for covered medical expenses, a small co-payment is sometimes required. Medicare, by contrast, is a federal government health insurance program that covers people aged 65 and older, as well as younger patients with disabilities, and people with end-stage renal disease.
The Federal Nursing Home Reform Act (FNHRA) of 1987 mandates that nursing facilities accepting federal funding must “protect and promote the rights of each resident.” Such facilities may not use physical or chemical restraints and may not transfer or discharge a resident except for specified reasons, according to a SCOTUSblog summary of the case.
Gorgi Talevski was moved in 2016 to Valparaiso Care and Rehabilitation (VCR), a nursing home owned by the petitioner, HHC, a governmental entity, when his dementia made it difficult for his family to take care of him. The nursing home complained that he was violent and aggressive, medicating him and moving him to different facilities several times. The family claimed that Talevski, who has since died, was abused. A state administrative law judge determined that one 2016 transfer violated the FNHRA and ordered the man returned to VCR but the family moved him to another facility.
Talevski’s wife and legal guardian filed what’s known as a Section 1983 civil rights action on his behalf against VCR and the corporation, claiming that his FNHRA rights were violated. A federal district court tossed the suit, but the U.S. Court of Appeals for the 7th Circuit reversed.
HHC wants the Supreme Court to overrule precedents and find that congressional actions under the spending clause can’t be enforced through Section 1983, which is part of the Civil Rights Act of 1871. HHC argues that “courts must read Section 1983 against the background of 1871 common law ... [which at that time] did not allow third-party beneficiaries to enforce contracts, particularly government contracts. It follows that a third-party beneficiary of a spending clause ‘contract’—such as the residents of a facility receiving federal funds and charged with protecting those residents—cannot enforce that contract through a Section 1983 action,” according to the summary.
Talevski attorney Andrew Tutt told the justices that “FNHRA’s text and context show that when Congress enacted the statute in 1987, it wanted to preserve access to all available remedies for FNHRA violations to the greatest extent possible.”
“Congress expressly preserved the ability of nursing home residents to sue to enforce their FNHRA rights in private lawsuits under state tort law,” Tutt said.
Justice Clarence Thomas suggested that current caselaw supported Tutt’s position.
If the state is receiving money from the federal government, it “can require them to do certain things.”
“Then the next step would be: Does it also give a right to a third-party beneficiary to vindicate some of those rights? That’s the way we have done it,” Thomas said.
HHC attorney Lawrence S. Robbins told the justices that Talevski’s family shouldn’t be allowed to sue because when Section 1983 was adopted, it was understood under the common law that third parties “generally could not sue to enforce government contract rights unless the contract clearly specified that the breaching party would be liable to injured third parties.”
“Because the Federal Nursing Home Reform Act contains no such clear statement, it should not give rise to Section 1983 liability. But even if a clear notice rule is not required, the two purported rights that respondent [Talevski] invokes under FNHRA do not give rise to Section 1983 claims,” he said.
Justice Ketanji Brown Jackson suggested to Robbins that the justices lack the authority to do what his client wants.
“Wouldn’t that just be us rewriting the statute?” Jackson said. “Usually we only get to step in and look at common law or whatnot to assist in the interpretation of a statute.”
Justice Elena Kagan told Robbins that the law states “every nursing facility has to ensure that individual rights are respected and lays out in considerable detail what those rights are and say it’s your job to see that those rights are fulfilled.”
Justice Amy Coney Barrett shrugged, saying “I just don’t see the connecting of the dots in your situation.”
Indiana Solicitor General Thomas M. Fisher said HHC’s position was correct.
“Section 1983 Spending Clause cases are unpredictable” and cause problems for states by, among other things, “[disrupting] state efforts to administer complex spending programs using scarce resources.”
Allowing private individuals to enforce federal spending conditions hurts political accountability by taking “officials off the political hook for policy decisions and leaves voters without any elected officials to blame,” Fisher said. The court should “hold that federal spending conditions are not privately enforceable unless Congress expressly so provides.”
