The Supreme Court appeared reluctant to destroy Medicaid in Health and Hospital Corporation v. Talevski

Most Supreme Court justices didn’t seem likely to take up the truly bizarre legal argument presented to them Tuesday that could ruin the Medicaid program, which provides health insurance to more than 76 million low-income Americans.

In this case, Marion County – Talevski Health and Hospital InstitutionDefendants asked judges not to allow Medicaid patients to sue to enforce the program’s standards—a move that would make all Medicaid law nearly unenforceable. Fortunately for the tens of millions of Americans who relied on Medicaid, it seemed unlikely that most judges would bite into these arguments. Although, based on Tuesday’s arguments, three judges could still sign this massive attack on Medicaid.

While many of the judges seemed conflicted about whether nursing home residents should be able to sue to enforce their rights under Medicaid law, or whether they should pursue their complaints through an administrative process separate from the federal court system, only Judges Clarence Thomas and Samuel Alito, most Talevsky The most radical allegations of the defendants (it is worth noting that Judge Neil Gorsuch, who often voted for Thomas and Alito, remained silent).

Plaintiffs Talevsky Alleges that a nursing home overseen by local government officials in Indianapolis, Indiana violated several provisions of federal law protecting nursing home residents – including a provision prohibiting those facilities from using psychotropic drugs “for the purposes of discipline or convenience and not necessary for the treatment of the resident.” medical symptoms.” It’s still possible for them to lose their case on narrow grounds – the Court may decide that nursing home residents can only use the administrative process to enforce Medicaid law.

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But disastrous for low-income Americans, Talevsky It seems unlikely that there will be defendants wanted in their cases.

this Talevsky defendants want to make federal Medicaid law almost completely unenforceable

Medicaid is a “conditional grant” program, meaning the federal government offers each state a substantial amount of money, but states can only receive that money if they agree to meet a long list of conditions. For example, states that accept Medicaid funds must provide health insurance to a long list of qualifying groups based on their income, age, disability, or family situation. States must also follow more detailed rules governing how Medicaid-funded facilities should operate – such as nursing home rules in the United States. Talevsky.

Under current law, at least some of the terms set out in Medicaid law can be enforced through lawsuits in federal court. For example, if a state refuses to provide Medicaid coverage to someone who is legally eligible, that person will file a lawsuit claiming benefits guaranteed by law.

Congress, in such cases, grants government officials — and, in some cases, private individuals who implement government programs — “any right, privilege, or immunity guaranteed by the Constitution and law.”

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The argument that Chapter 1983 allows lawsuits seeking to enforce Medicaid law, furthermore, is extraordinarily simplistic. 1983. Section allows to prosecute certain individuals who violate rights “guaranteed by the Constitution and law”. Medicaid laws are laws even if they only apply to organizations that receive federal Medicaid funding.

With this, Talevsky Defendants made the historically dubious claim that the 1983 Chapter lawsuits could not be used to enforce Medicaid law because similar lawsuits were not permissible under 19th century contract law. (If this argument sounds weak, it’s because it’s extraordinarily weak. Here I go into more detail about the defendants’ arguments and why they were wrong.)

But only Thomas, and to a lesser extent Alito, have expressed much sympathy for this dubious claim.

Three liberal judges, Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson, in turn beat up lawyers who attacked Medicaid—in a particularly brutal exchange, Jackson accused one of these lawyers of trying to “rewrite” the plain language of the Division. 1983.

Crucially, these liberal judges were joined at one point by Justice Amy Coney Barrett, appointed by a conservative Trump, who told one of the anti-Medicaid lawyers that she “did not see the confluence of dots” in her historical argument.

Meanwhile, Chief Justice John Roberts and Judge Brett Kavanaugh hardly mentioned the question of whether Medicaid law was enforceable. They spent most of their questions doing research How Medicaid law should be enforced and these nursing home rules should be enforced. Talevsky The section should be applied in the 1983 cases or by an alternative method.

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In other words, Roberts and Kavanaugh seemed to assume that the defendants were wrong that the Medicaid law was unenforceable.

To be fair, if Talevsky Even if the most radical arguments of the defendants prevail, the federal government could potentially impose sanctions on states that violate federal Medicaid law. Even in the absence of Chapter 1983 lawsuits, federal health officials have the power to withhold some or all Medicaid funds awarded to states that violate Medicaid statutes.

However, as a practical matter, this remedy is a paper tiger. The federal government has few resources to investigate Medicaid violations. And even if one does come up, federal officials are extremely reluctant to cut a state’s Medicaid funding for the obvious reason: Cutting Medicaid funding means the state has less money to provide healthcare to low-income people. Therefore, if the federal government takes this action, it will essentially punish low-income patients for misconduct by the state government.

But it seems likely that at least six members of the Supreme Court will leave the Medicaid program largely intact. Let’s wait and see what the Supreme Court will say in this decision. Talevsky But a dire outcome for low-income patients no longer seems likely.

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