U.S. Supreme Court hears Indiana case on rights of Medicaid beneficiaries

The U.S. Supreme Court heard an Indiana case Tuesday that could determine whether Medicaid beneficiaries can sue in federal court if they believe their rights are being violated or whether the Centers for Medicare & Medicaid Services (CMS) should make that determination. 

In the case of Health & Hospital Corporation of Marion County (HHC) v. Talevski, justices explored 1870s law and the Nursing Home Reform Act of 1987, spanning over a century of precedent.

“The issue here, I think… exactly under what circumstances the private administrative remedy in the statute precludes (Section) 1983 (of the U.S. Code),” Justice Brett Kavanaugh said. 

“(Health and Hospital Corp. of Marion County) continues to say that we got all the relief we were seeking – we got none of the relief that we were seeking,” said Andrew Tutt of Washington D.C. “This family was crying out for help and using every possible lever at their disposal. Section 1983 was the last resort.”

Section 1983, originally derived from 1871 code, allows individuals to sue government entities that individuals believe violated their legal rights in the context of civil rights deprivations in some states following the Civil War, as detailed by Justice Ketanji Brown Jackson.

“I don’t understand how you can interpret an express grant of authority to go to court, to enforce rights created by law… and say we have to limit the current right under common law,” Jackson said.

Despite being the most junior member of the court, Jackson spent the most time questioning the presented arguments Tuesday, speaking for roughly 15 minutes, followed by Kavanaugh.

The case for HHC

HHC argues that individuals don’t need to sue government entities, such as public nursing homes, because other avenues for relief exist.

The case stems from the treatment and death of Gorgi Talevski at a Valparaiso nursing home operated by HHC. His family filed a lawsuit alleging the facility used psychotropic drugs to chemically restrain the man and moved him involuntarily to another facility.

HHC petitioned the U.S. Supreme Court to hear the case and settle whether Talevski, and other Medicaid beneficiaries, can seek relief in a federal court. But advocates warn the case could have a resounding impact on other government welfare programs. 

Over the course of the 90-minute hearing, the attorney for HHC, Lawrence Robbins of New York City, spoke for just under 30 minutes. His introductory appeal, interspersed with questions from the majority of justices, took nearly 40 minutes. 

“It is surpassingly odd to imagine that we would have more exacting obligations on the very thin slice of state nursing homes that get federal money under this program,” Robbins said, referring to an argument filed by Indiana’s Thomas Fisher.

Fisher, a solicitor general with the Indiana Attorney General’s Office, filed in support of HHC. 

Impact feared

The case’s outcome would have a unique impact on Indiana’s nursing home population, since 93% of all long-term care facilities are government owned. Nationwide the rate is roughly 6.5%. HHC owns 78 facilities, including the Valparaiso institution. 

Legal and public health experts have warned that letting CMS, and its parent agency Health and Human Services (HHS), oversee enforcement of rights under Medicaid would jeopardize care for millions since the agency doesn’t have the capacity or funding to complete the task.

Tutt — representing the Talevski family — noted that seven medical malpractice attorneys had declined the case in Indiana due to the state’s low cap on malpractice suits, which means that even a winning team is limited in what they can recover.

The case has attracted the attention of several medical associations, former and current members of Congress, trial lawyers, healthcare providers, the American Cancer Society, disability rights advocates, AARP and more – many of whom submitted amicus briefs in support or against Talevski. 

A ruling in the case is expected at the end of the Supreme Court’s term in June 2023.