Today was actually a good day for liberals at the Supreme Court.
The biggest news is that the Court did not gut the Voting Rights Act in a case that was being brought by the State of Alabama. The big health policy news is that individuals who are on Medicaid do have a general private cause of action to sue when they are getting screwed by a clinical provider that is not following Medicaid rules:
Victory in #Talevski! The Court found that the FNHRA provisions at issue unambiguously create § 1983-enforceable rights, & discerned no incompatibility between private enforcement under §1983 & the remedial scheme that Congress devised. #SCOTUS https://t.co/A1aFsqavtQ
— Madeline T. Morcelle (she/her) (@madeline4health) June 8, 2023
I AM SO NOT A LAWYER !!!!
But it is not unusual for Medicaid beneficiaries to receive services that don’t meet Medicaid guidelines or requirements or to not receive services that they are legally entitled to. It has been very common for these beneficiaries to sue on their own behalf to force the provision of appropriate services. A nursing home (remember, Medicaid pays for a substantial portion of all nursing home days) failed to provide appropriate care. They got sued. The nursing home argued that there was not an express authorization for Medicaid beneficiaries to sue for services in the law that regulates Medicaid paid nursing home care. The nursing home argued that the only penalty was a spending clause clawback and not a behavior change.
The Supreme Court said NOPE! There is a private right to sue for appropriate service provision.