Supreme Court says Medicaid patient's family can sue nursing home
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The family of a nursing home resident on Medicaid has a right to bring a civil rights suit against the state-owned facility over his care, the Supreme Court ruled Thursday in a closely watched patients' rights case.
Why it matters: The 7-2 decision in Health and Hospital Corp. v. Talevski addressed whether people in safety net programs can go to court if health care and other essential benefits are threatened.
Context: The case was brought by the wife of a patient with dementia who was transferred from his facility after his condition rapidly deteriorated and staff claimed he was harassing patients.
- The lawsuit claimed that the facility's treatment led to his decline, including the use of unnecessary psychotropic drugs, and violated his rights.
- The nursing home had argued that a legal challenge tied to Medicare or Medicaid coverage could not be heard because program rules amount to contracts between the government and providers.
- A district court had ruled in the nursing home's favor, but the 7th U.S. Circuit Court of Appeals reversed that decision.
What they're saying: Advocacy groups praised the decision, saying it keeps the door open to private enforcement for patients to receive the care they're entitled to.
- “Over the span of four decades, the Supreme Court has recognized that individuals have the right to enforce provisions of the Medicaid Act in court," said Jane Perkins, litigation director at the National Health Law Program. "As advocates for low-income people, we are relieved that the Court has upheld that right."
- Health and Hospital Corp., an Indiana state entity that operated the nursing home, said its goal with the case was to understand the "status of the governing law" on federal claims regarding nursing homes.
- "With the Court’s definitive answer today that Medicaid-supported nursing home residents have both administrative and federal court remedies for alleged violations, HHC will continue to work to manage those operations safely and effectively and analyze the impact of the decision on those public resources," a spokesperson said in a statement.
Between the lines: Conservative judges and lawyers have argued that health providers or individuals shouldn't be able to sue over Medicaid coverage decisions.
- A ruling limiting the right to go to court could have applied to CHIP, the Supplemental Nutrition Assistance Program, Head Start and other programs, congressional Democrats had argued in a brief they filed last year.
