October 04, 2022
Area(s) of Interest: California Physician's Legal Handbook
The California Medical Association has filed an amicus brief with the United States Supreme Court in a case—Health and Hospital Corp. v. Talevski—that could strip Medicaid beneficiaries and providers of their right to access the courts to enforce state compliance with Medicaid requirements.
Medicaid is a program of monumental importance, providing critical medical care to millions of Americans through millions of health care providers. Like many other federal social programs, Medicaid was established under Congress’s Spending Clause powers, through which the federal government provides federal support for states to implement social programs so long as they comply with the program requirements. Although Medicaid and other similar Spending Clause programs do not recognize the right of beneficiaries to sue states to enforce program compliance, U.S. Supreme Court precedents dating back to 1968 have recognized the applicability of 42 U.S.C. section 1983 as means for private enforcement of Medicaid and other Spending Clause programs.
In Talevski the Court will determine the critical question of whether Spending Clause legislation can be privately enforced through section 1983. In doing so, the Court is considering overturning more than a half century of precedent.
“This Court should preserve the critical role that private enforcement, including by Medicaid providers, plays in fulfilling the promise of one of the country’s most important social programs, which for decades has delivered beneficial medical care to millions of needy Americans,” CMA wrote in its brief. The health equity implications of eliminating such a core legal protection would also be substantial, as Medicaid serves a predominantly low-income population—with a disproportionate number of people of color.
Organized medicine and physicians, on behalf of themselves and patients, have utilized Section 1983 to ensure the benefits and promises of Medicaid programs are met. Talevski threatens this important legal right and potentially could shift oversight and enforcement of Medicaid requirements solely into the hands of the U.S. Department of Health and Human Services, which itself admits that it does not have the resources to displace private enforcement of Medicaid.
CMA’s amicus brief presents organized medicine’s perspective on these issues and underscores the important role that physicians and medical associations have played in ensuring that Medicaid works as designed by Congress.
Members of Congress, including House Speaker Nancy Pelosi (D-CA), have also filed a brief in this case, telling the court that reversing the Seventh Circuit Court’s decision—and decades of precedent—would impede Congress’ intention to provide efficient and effective means of redress for violations of Medicaid law, impinge on congressional authority and imperil the separation of powers between Congress and the Court.
“Disturbing this Court’s Section 1983 doctrine more broadly—by curtailing Congress’ ability to permit private enforcement of Spending Clause legislation and the programs established by that legislation—would have disastrous consequences,” the lawmakers wrote in their brief. "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…Thus, reversal of this Court’s uniform Section 1983 doctrine would leave Spending Clause beneficiaries with little recourse and would egregiously undermine Congress’ purpose in enacting these statutes.”
For more information, see CMA’s amicus brief.