Panel Unpacks Supreme Court Case With Far-Reaching Implications For Medicaid and Beyond

Four people are seated at a table in front of a chalkboard. A woman is standing, talking. A screen in front of the chalkboard has a projection of two additional panelists.
Solomon Center Interim Executive Director Jennifer Huer (standing) speaks at a panel on Health and Hospital Corporation of Marion County v. Talevski. Seated are, from left, panelists Maame Gyamfi and Andrew Tutt and students Cat Gassiot ’24, Melisa Olgun ’24. On the screen are panelists Jane Perkins (left) and Ira Burnim.

The Solomon Center for Health Law and Policy hosted a panel April 10 to unpack the recent Supreme Court case Health and Hospital Corporation of Marion County v. Talevski. Four experts on Medicaid law were on hand to discuss the case, in which Supreme Court has been asked to evaluate whether Medicaid beneficiaries can sue in federal court when they believe state officials are violating their rights or if enforcement of state compliance with federal Medicaid rules should be left to the federal Centers for Medicare and Medicaid Services. The case has far-reaching implications, particularly for the administration of federal programs. 

Sitting on the panel were Jane Perkins, Litigation Director, NHeLP; Ira Burnim, Legal Director of the Bazelon Center for Mental Health Law; Maame Gyamfi, Senior Attorney – Litigation for the AARP Foundation; and Andrew Tutt, Senior Associate, Arnold & Porter. Tutt represented the family of the patient named in Talevski.

Perkins began by detailing the history of Section 1983 of Title 42 of the U.S. Code (“Section 1983”) and Medicaid enforcement. When Congress enacted safety net programs in the 1960s under the Spending Clause authority, the law required voluntary programs to comply with federal regulations if the programs received federal funding. However, rules for these programs never explicitly stated that individuals could sue if they were aggrieved. Instead, Section 1983 became a vehicle for injured parties to bring states to court for violations of their federally protected rights. Beginning in the late 1980s, when the court’s composition changed, the court became skeptical of private enforcement through Section 1983. This created many questions about private versus public enforcement of programs created under Spending Clause authority. 

It was against this legal landscape that Tutt argued Marion County v. Talevski before the Supreme Court. The case concerns the late Gorgi Talevski, a man with dementia whose family had placed him in a nursing home. Prior to involuntarily discharging Talevski, the nursing home chemically restrained him with psychotropic drugs, which are barred under the Federal Nursing Home Reform Act (NHRA). After his death, Talevski’s family sued the nursing home’s owner under Section 1983 for depriving Talevski of his federal rights under the NHRA, which established standards for nursing home care.

A federal district court dismissed the case, ruling that individuals enrolled in Medicaid cannot enforce the NHRA. The family appealed to the Seventh Circuit Court of Appeals, which reversed the decision. The nursing home then petitioned the Supreme Court to hear the case. Specifically, the nursing home asked whether a Spending Clause statute can create rights to be enforced by individuals, or if individuals are third-party beneficiaries of a contract. The court granted the nursing home’s petition and heard oral arguments last year. The nursing home argued that all Spending Clause legislation cannot create rights. This argument has implications for not only Medicaid, but for federal safety net programs include the Children’s Health Insurance Program, Social Security, and Supplemental Nutrition Assistance Program.

During the panel, Gyamfi provided background on the Nursing Home Reform Act, which was passed in 1987 after neglect in nursing facilities had reached an acme. The NHRA was created to standardize health and safety for providers and organizations that participated in the Medicaid program, redesign regulatory and inspection processes to foreground quality of care. It also created a bill of rights for nursing home residents, which includes freedom from abuse, unnecessary chemical and physical restraints, and involuntary discharge. If nursing homes receive Medicaid funding (i.e., reimbursement), they must comply with the NHRA.  

Burnim spoke about the disability community’s interests in the case. First, people with disabilities are frequently Medicaid beneficiaries. The Americans with Disabilities Act (ADA) creates the expectation that people with disabilities will be integrated into society — a challenge without access to healthcare and medical equipment. The predecessor to the ADA, Section 504 of the Rehabilitation Act of 1973, is itself a Spending Clause statute. Burman pointed out that this creates concern that enforcement of Section 504 could also be at risk, along with enforcement of Title VI and Title IX.

The panel concluded by discussing the implications of relying on public enforcement of the Nursing Home Reform Act. Panelists highlighted potential issues such as a lack of motivation or incentive for government agencies to regulate the states, changing in federal administrations that might affect how rigorously regulations are enforced, and a chronic lack of resources to enforce regulations.