Dan Gorenstein: The Supreme Court is expected to release a decision later this year that could overturn precedent and have huge implications for the 80 million plus people on Medicaid and those enrolled in other government programs.

The case, Health and Hospital Corporation of Marion County v. Talevski, asks whether beneficiaries in public programs can sue states if they believe their rights have been violated.

That legal path has been open for decades…but may soon close.

Today, a spin into civil rights law as justices consider whether people enrolled in entitlement programs can sue to enforce the benefits or care they’re guaranteed.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

DG: The federal government gives states hundreds of billions of dollars each year to run their Medicaid programs.

With this money states must cover medical care for certain populations – people with low-incomes including kids and people with, disabilities,

For the past 55 years, beneficiaries have successfully gone to court under one civil rights law to enforce these terms. Like making sure Medicaid paid for lifesaving medications or home care for people with disabilities.

The Talevski case is calling that legal precedent into question.

Joining us to talk about the case and its potentially seismic implications is Side Effects Public Media Health Equity Reporter Farah Yousry in Indianapolis.

So, Farah, before we get into the legal question at hand let’s first understand the facts. Gorgi Talevski, the man at the center of the case, was put in a nursing home by his family. Why did they do that?

Farah Yousry: Gorgi was in his mid 70s when his daughter Susie noticed he started to forget things. It was a slow and gradual process. His dementia progressed to the point that on more than one instance, Susie and her mom feared for his safety. In 2016 they decided to find a nursing facility.

Susie Talevski: We thought we were doing something to help him and he would be close to us. Right. So, we can go see him on a regular basis, daily basis, if necessary. And we could bring him home occasionally, you know, and we felt like he would be safe. But that’s not what happened. Really. It was a big mistake. Right?

FY: Dan, as far as Susie and the rest of her family were concerned Gorgi was being neglected by the staff at the Valparaiso Care and Rehabilitation nursing home. He quickly lost his ability to walk and feed himself. And according to court documents, the family says that he was overmedicated to keep him sedated instead of actually caring for his dementia.

DG: Farah that sounds pretty grim. What did the nursing home say about all of this?

FY: The nursing facility defended their actions in part saying that Gorgi needed the medication because he was being violent towards staff.

The family went to the health department and filed a complaint about what was happening to Gorgi. But that didn’t amount to much.

Eventually the family puts Gorgi in another nursing home.

Susie ultimately decides to sue that first Indiana nursing home for violating their fathers’ right. Claiming he was overmedicated and abused. The case bounces through the lower courts for years and Gorgi ends up dying about five years after first entering the nursing home. That was in 2021.

DG: So, turning to the legal part of the case. The Talevski family sued using a law that gives people the right to go to court if they feel a government has violated their civil rights. Can you tell us a little bit about this law, please?

FY: Yes, so Dan this is a common law, Medicaid beneficiaries, or their families, use if they believe their rights are being violated. For example, if they aren’t getting the medical care or the medications they’re entitled to.

The federal civil rights law called Section 1983 goes back as far as the 1800s. And people have used the law to protect a range of civil rights. For example, in freedom of expression cases, police brutality and to enforce their rights in entitlement programs like Medicaid and food stamps, the Supplemental Nutrition Assistance Program.

DG: Ok so if for decades people have been suing under this law and it seems like courts have agreed it’s established precedent. Why are the justices reconsidering it now?

FY: Since the late 1960s and early 1970s the Supreme Court ruled that people in programs like Social Security, and Medicaid could sue under this law to get the benefits they’re entitled to.

But in the last 20 years there have been clues the Court was open to a theory among some legal experts that people on these programs can’t go to court to enforce Medicaid and other entitlement programs. The theory is that because the federal government is giving states money to run these programs, then the contract is between these two governments. And the people getting the benefits don’t have any right to sue. And that’s the basis of Indiana’s argument in this case.

Attorney Chris Schandevel with the Alliance Defending Freedom supports Indiana’s argument. He says this question is about contracts and gives an analogy to building a shopping mall.

Chris Schandevel: So we sign this contract and I start the building process. I clear the land, I lay the foundation, we’re both satisfied, you know, things are moving forward in a good timely fashion. But then say a member of the community decides, hey, I don’t think the shopping mall is getting built fast enough. And I really want to use it, you know, should that third party be able to file a lawsuit in federal court against me and say that I’m not holding up my end of the deal in the contract I made with you. We would say that basic fairness says no. That’s between the two of us to decide. The same should apply to contracts between the federal government and the states.

FY: Questions over whether beneficiaries can use this law to sue state Medicaid programs have been bubbling up in the last few years because of a series of cases. In these cases, Medicaid recipients are challenging whether states can exclude Planned Parenthood from state Medicaid programs. Lower courts came to different conclusions on this issue. At the same time this Talevski case raised similar questions about whether individuals can enforce Medicaid statutes. And the justices voted to hear it.

DG: After the break, attorneys react to oral arguments and the potential impact if the justices close this legal door for patients.

MIDROLL

DG: We’re back with Side Effects Public Media’s Health Equity Reporter Farah Yousry discussing a Supreme Court case that questions whether more than 80 million Medicaid beneficiaries can still go to court to get the benefits and care they’re guaranteed. 

Farah I know you’ve been talking with legal scholars about this case and many were surprised the court even took it. That said, based on the oral arguments last November, how are these experts reading the sort of tea leaves out there?

FY: Yea Dan, after the arguments many of the people I talked to took a cautious sigh of relief. Because it seemed that from the justice’s lines of questioning, they were skeptical of the Indiana public health agency’s argument, you know, that beneficiaries lack the right to sue.

And so, these legal experts told me based on the justices’ questions, they expect the court will keep allowing Medicaid patients and other federal government program recipients to go to court under this law.

At the same time, they also said it’s possible the justices might side with Indiana on a narrower question specific that has to do with nursing homes. It’s whether patients can bring suits against state-owned nursing facilities specifically. A decision on this question would impact just 1 in 10 nursing home residents nationwide, mainly in two states: Indiana and Pennsylvania. That’s where most nursing homes are state owned.

DG: I understand experts think it’s unlikely that the court’s going to strike down precedent. But can you give me a sense of the real-world implications if the court does end up siding with Indiana?

FY: I can’t overstate how big of a deal; legal experts think this would be.

Jane Perkins is a civil rights attorney at the National Health Law Program which represents many people on Medicaid.

Jane Perkins: The reach of an adverse decision would be catastrophic…It would leave these programs really standing out there without a true enforcement mechanism.

FY: What Jane is saying is that if beneficiaries can no longer sue if they believe their rights are being violated, all of a sudden there’s a lot less accountability for these programs, right?

Now, a bunch of former senior federal health officials said in a court filing that the federal government relies on these civil rights lawsuits to point out problems.

For example, in 2015, this law was used by Medicaid beneficiaries in Indiana to help thousands of people get access to a lifesaving Hepatitis C medicine that had been restricted to only the sickest patients.

On the other side – from Indiana’s perspective, a ruling in the states favor could protect them from these lawsuits, and save money. Since they would no longer have to spend time and resources fighting them in court.

DG: If the Supreme Court rules in Indiana’s favor are patients out of luck? Do they have other recourses here?

FY: So, there are other tools, people can complain to health departments or other agencies like the Talevski’s did originally. These complaints work sometimes. But whatever the fix the department proposes or does, it will only help that one person. Bigger civil rights lawsuits really allow for system changes that can impact hundreds or even thousands of people who are dealing with the same problem.

There are also malpractice lawsuits but those are often very complicated and expensive. And it’s extremely hard to determine who to sue: the nurse, the doctor, the pharmacist. One attorney told me that on average medical malpractice cases in Indiana take about two years and it’s hard for patients to win those cases.

DG: Farah, final thing. When do we expect we will get a decision?

FY: The court is expected to release a decision on this case sometime this spring or summer. Sometimes they save their bigger decisions till late June so it could be a while.

DG: Farah, thanks so much for your reporting on this. I really appreciate it.

FY: Thank you, Dan.

DG: I’m Dan Gorenstein. This is Tradeoffs.