Pivotal Supreme Court Decision and its Impact on Nursing Home Law

By Eli B. Vine and Kathleen M. Klein

Long term care facilities may now find themselves defending a whole new type of claim, following a landmark ruling by the United States Supreme Court.

On June 8, 2023, the high court published its decision in Health and Hospital Corp. of Marion County et al. v. Tavelski. In a 7-2 opinion, the Court addressed whether the family of a nursing home resident on Medicaid has a right to bring a civil rights suit against the state-owned care facility concerning his care. This has been a closely watched patients’ right case, given its potential to allow for new types of claims against nursing facilities that take Medicaid or Medicare.

Facts and Procedural History

The wife of a long-term care facility patient filed suit after her husband’s condition declined. The wife claimed that his treatment, including the use of psychotropic drugs, caused his rapid decline, and violated the minimum standards of care that facilities must follow under Medicaid regulations. She attempted to bring a civil rights claim, under Section 1983, against the facility. The nursing home argued that such a claim, tied to Medicare or Medicaid standards, could not be heard because the Medicare and Medicaid rules amounted to contracts between the government and providers, thus a private cause of action was not available. A district court had ruled in the nursing home’s favor, dismissing the suit, but the 7th U.S. Circuit Court of Appeals reversed that decision, allowing the claim.

The Supreme Court’s Ruling

Section 1983 provides a vehicle for individuals to enforce rights guaranteed to them under federal programs. Previously, courts had defined, and in some cases narrowed, individuals’ ability to use Section 1983 to protect certain Medicaid rights under a variety of decisions in various contexts, from upholding private rights of actions for certain early screening benefits, to denying such an action to challenge exclusion of Planned Parenthood from state Medicaid programs (see Gee v. Planned Parenthood of Gulf Coast Inc., 2017).

The Supreme Court’s majority opinion in this case opens the door to civil rights suits by Medicare and Medicaid patients against long-term care facilities for violations of the Federal Nursing Home Reform Act, or “FNHRA.” In an opinion penned by Justice Ketanji Brown Jackson, the Court affirmed the existence of a private right of action. Though Section 1983 was enacted in the aftermath of the Civil War to protect individuals’ rights, i.e., civil rights and equal protection, the Court found that its language applies to “all laws” and therefore applied to Medicare and Medicaid laws, as well. Now, in sum, the Court has found that Medicaid laws (here, the FNHRA), which establish minimum standards of care for nursing homes to participate in Medicaid, may be enforced by individual residents through Section 1983. Specific to this case and the FNHRA, the Court here concluded that the law establishes two unambiguous federal rights for nursing home residents: the right to be free from any physical or chemical restraints unrelated to treatment; and the right to be protected against arbitrary transfers that fail to satisfy specified conditions including advance notice.

Learning Points: The case attracted substantial attention and prompted the filing of numerous amicus briefs, both for and against private actions under Section 1983. Since its recent publication, patient advocacy groups have been quick to applaud the decision, stating that the ruling will allow patients a mechanism to enforce quality in nursing homes, and soften what was previously considered a strict test to do so.

From long term care facilities’ perspective, the ruling could force a variety of new considerations. Care providers and nursing homes may need to weigh whether accepting Medicaid or Medicare patients into their facility is worth the risk. The ruling may alter nursing homes’ view on whether to challenge citations or regulator violations, as opposed to simply paying the fines. The decision may impact the insurance market, as it may have an effect on providers’ efforts to limit liability associated with nursing home care. Finally, whether courts expand on this decision in the future to find other rights arising from the FNHRA enforceable remains to be seen, but that is the direction in which this case points, and it is a direction we can expect long-term care plaintiffs to attempt to guide the development of future precedent.