Illustration: Aïda Amer/Axios
A Supreme Court case that takes up Medicaid recipients’ ability to sue providers is providing a new battleground over patients’ rights and could potentially open the door to erosion of the program's benefits.
Why it matters: The outcome could decide if tens of millions of people in public welfare programs can go to court if essentials like health care and food are endangered, experts say. That option is generally more efficient than waiting for the federal government to intervene.
Catch up quick: Justices last May agreed to review the case, Health and Hospital Corp. v. Talevski, which was brought by the wife of a Medicaid patient with dementia who sued his nursing home, alleging abuse and violations of his rights.
- The nursing home successfully argued in a lower court that federal rules for Medicare and Medicaid recipients originate from the government's spending powers and amount to contracts between the government and providers. By that reasoning, individuals can't sue for the entitlements the program promises, per Reuters.
- But the 7th U.S. Circuit Court of Appeals last year reversed the decision, finding precedent for a right to sue, including situations in which hospitals took states to court over Medicaid reimbursement rates.
- A ruling limiting or overturning the right to go to court could extend beyond Medicaid, to CHIP, the Supplemental Nutrition Assistance Program, Head Start and other programs, congressional Democratic leaders wrote in a brief filed Monday.
The big picture: Conservative judges and lawyers have long argued that health providers or individuals shouldn't be able to sue over Medicaid coverage decisions.
- Arguments in the Medicaid case, set for Nov. 8, will come at a volatile time, after the conservative supermajority struck a federal right to abortion and touched off a fierce national debate about equity, both in the health system and in the courts, experts say.
- "The Supreme Court has put the nation at a crossroads where access to abortion and reproductive rights are concerned. Now, it appears, we are also at a turning point on equal justice, looking at a time when state officials will be able to simply suspend Medicaid enrollment or deny covered treatments without having to face the prospects of a court injunction," health law professors Sara Rosenbaum and Timothy Jost wrote earlier this year in Health Affairs.
What they're saying: "Eliminating Congress's right to establish these private enforcement mechanisms will leave federal-state programs with limited oversight. And individual violators will be effectively immunized from suit," the Democratic lawmakers wrote in their amicus brief.
The other side: Indiana is leading 22 states in arguing the court should block private citizens from using the courts to enforce contractual conditions that stem from federal spending laws.
- "Permitting private actions to enforce federal conditions based on implied rights erodes that foundational limitation on Congress's Spending Clause power," the states wrote.