Do Medicaid patients have rights in cases of improper care? And when it comes to making sure that residents of nursing homes, particularly those residents who are on Medicaid, are being properly cared for, whose job is it to enforce the standards of care? Do the families of residents have any standing before the court in cases where mistreatment is alleged?

Surprisingly, based on the way federal law has traditionally been interpreted, only the government has had the right to enforce care standards, often leaving aggrieved families little legal recourse. But in a lopsided 7-2 decision earlier this year, the U.S. Supreme Court rejected that precedent and gave residents and their families a powerful new weapon against nursing homes that fail to provide adequate care: the unquestioned right, even for those on Medicaid and Medicare, to bring lawsuits against nursing home operators.

We read several articles about this important development, including this piece from the Wall Street Journal penned by reporter Jess Bravin. While the case law may seem obscure, the outcome appears to be a clear victory for those residents (and their families) who have been victimized by substandard nursing home care. (Please note that a subscription may be required to access the Wall Street Journal article.)

7-2 Court Decision Upholds Medicaid Patent Rights

“A 7-2 Supreme Court upheld the right to sue nursing homes that mistreat Medicaid patients,” Bravin writes, “rejecting arguments that federal law permits the government alone to enforce standards of care.” Writing for the court, Justice Ketanji Brown Jackson cited a U.S. law dating from the Reconstruction era, commonly called Section 1983, which was originally intended to protect individuals from abuse by state governments.

The Court majority ruled that this same Section 1983 provides legal protection and court standing to those under the care of federal spending programs such as Medicaid. That protection includes the right to sue nursing home operators for alleged maltreatment.

A related ABC News account further explained that, in this case, the Supreme Court was being asked to interpret how Section 1983 relates to the Federal Nursing Home Reform Act, a 1987 law that governs nursing homes that accept federal Medicare and Medicaid funds. “The court was being asked to answer whether a person can use Section 1983 to go to court with claims their rights under the nursing home act are violated,” said the ABC News analysis. “The answer is yes, the court said.”

Supreme Court Case Involved Alleged Mistreatment

According to the Wall Street Journal, the case before the Supreme Court concerned a dementia patient who since has died, a man named Gorgi Talevski. “His family placed him in Valparaiso Care and Rehabilitation, a public facility owned by the Health and Hospital Corporation of Marion County, Indiana,” the article explains. “Talevski deteriorated after admission to the facility, losing the ability to eat by himself, or speak in English, reverting to his native Macedonian language.” 

Talevski, his family argued, had been heavily medicated. When they sought a transfer to other facilities, the family had further disputes with the nursing home over Talevski’s care. The man’s wife, Ivanka Talevski, “filed suit against the Health and Hospital Corporation of Marion County, the Indiana public agency that owned the facility. The lawsuit alleged that by using chemical restraints and other actions, the facility violated Talevski’s rights under the Federal Nursing Home Reform Act.”

At first, the family’s case was denied because of the ruling by a federal district judge that they had no standing before the court. “[The judge] dismissed the case on grounds that individuals had no right to privately enforce the nursing-home law,” the Wall Street Journal reports. “In July 2021, the Seventh U.S. Circuit Court of Appeals, in Chicago, reversed that decision. The nursing-home operator appealed to the Supreme Court, which heard arguments in November.”

Nursing Home Law Gives Medicaid Residents “Expansive” Rights

In explaining the Court decision, the Wall Street Journal article cited Justice Jackson’s assertion that the language used by Congress to protect vulnerable residents of nursing homes was “expansive.” Justice Jackson specifically cited the Federal Nursing Home Reform Act which, says the article, “gave [patients] particular rights, including to be free from unnecessary chemical or physical restraints and unjustified transfers from the facility.” 

But the loophole which the nursing home operator in the Talevski case sought to exploit, the Wall Street Journal explains, was the provision in the nursing-home law that authorizes federal and state officials to enforce its provisions when it comes to the care of Medicare and Medicaid patients. “It is silent on whether individuals can do so,” the article asserts. 

Nevertheless, the Supreme Court wasn’t buying that argument. The ability to sue regarding violations under Section 1983 is “routine unless the statute made clear that enforcement was reserved for the government,” says the article. Considering the deep ideological divisions on the court, the decision was remarkably one-sided. “Chief Justice John Roberts and Justices Sonia Sotomayor, Elena Kagan, Brett Kavanaugh and Amy Coney Barrett joined Jackson’s opinion,” says the Wall Street Journal. “In a concurring opinion, Justice Neil Gorsuch agreed with the result. Justices Clarence Thomas and Samuel Alito dissented.”

Far-Reaching Implications for Medicaid Patient Rights

As is often the case with major court decisions, this one could have repercussions that go far beyond the specifics of the particular finding.

One analysis that appeared on the website of McKnight’s Long-Term Care News stated, “The ruling, experts had predicted, could have far-reaching implications for millions of people, beyond those living in nursing homes, who rely on all kinds of federal benefits managed by government partners.”

It’s also clear that the ruling puts nursing home operators on notice. An article on the ruling published on the website of The Hill quoted a spokesperson from the Health and Hospital Corporation of Marion County (HHC), losers in the Supreme Court case, who acknowledged that the ruling clearly expands patients’ rights in court.

“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,” the spokesperson said.

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We have big news! The long-awaited book by Rajiv Nagaich, called Your Retirement: Dream or Disaster, has been released and is now available to the public.  As a friend of AgingOptions, we know you’ll want to get your copy and spread the word.

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Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness about a problem that few are willing to talk about, yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more.

Rajiv then offers a solution: LifePlanning, his groundbreaking approach to retirement planning. Rajiv explains the essential planning steps and, most importantly, how to develop the framework for these elements to work in concert toward your most deeply held retirement goals.

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(originally reported at www.wsj.com)