Court Finds Medicaid Nursing Home Provisions Enforceable Under 1983

Elderly Medicaid recipients represented by the National Senior Citizens’ Law Center and the Office of Kentucky Legal Services Programs, Inc. have won an early victory in the district court’s order denying defendants’ motion to dismiss and granting plaintiffs’ motion for a preliminary injunction.

The class action, Kerr v. Holsinger, No. 0-68-JMH (E.D. Ky. Mar. 25, 2004), was brought on behalf of elderly Medicaid beneficiaries who previously received nursing home or home-based long- term care services and then, without any change in their condition, were denied those services when Kentucky tried to address its budget shortfall. The analysis below focuses on the procedural portion of the opinion upholding jurisdiction under 42 U.S.C. § 1983. 

The court examined and upheld the three causes of action based on§ 1983. The defendants had argued that under Pennhurst State School & Hosp. v. Halderman, 451 U.S. 1, 28 (1981), programs enacted under the Spending Clause are generally unenforceable under § 1983. The court acknowledged the language in Pennhurst, but relied on Wilder v. Virginia Hops. Ass’n, 496 U.S. 498, 511-12 (1990), and Westside Mothers v. Haveman, 289 F.3d 852, 862-63 (6th Cir. 2002), to find that Medicaid provisions can in some circumstances create rights enforceable against state officers through § 1983 if they were intended to benefit the plaintiffs, set a binding obligation on the state, and were not so too vague to enforce.

The court found that all three relevant areas of the Medicaid statute created enforceable rights under § 1983. The nursing home and home-based long term care services were mandatory under Medicaid and required to be provided to eligible individuals who need those services. The services “are clearly intended to benefit Plaintiffs,” and the statute “carefully details the services to be provided.”

Similarly, the provision requiring states to have reasonable standards for determining eligibility consistent with the Medicaid Act is “by its terms ... intended to provide standards upon which individual applicant can rely in the determination of their benefit eligibility by state officials. It is intended to benefit the plaintiffs, and it is a binding obligation on the state agency.” Markva v. Haveman, 168 F.Supp.2d 695, 711 (E.D. Mich. 2001), aff’d 317 F.3d 547 (6th Cir. 2002).

Finally, the court the right to a fair hearing was also a binding obligation on the state intended to benefit the plaintiffs, and was not too vague and amorphous an obligation “in light of the judiciary’s regular review of matters to determine whether an individual has been afforded appropriate procedural due process by a state entity ....”

The court did not directly discuss or cite Gonzaga University v. Doe, 536 U.S. 273 (2002), which the defendants had relied on to argue that the Medicaid statute has no “rights creating” language and fails to confer, in unambiguous terms, enforceable individual rights. The defendants had made the argument that because the statute focuses on what the state must do, it creates no rights for individuals. But of course the state must provide services to individuals. The court apparently agreed with the plaintiffs that Gonzaga had not overruled Wilder but rather had cited it with approval. The court’s analysis of the Medicaid Act shows that the relevant provisions do meet the Gonzaga test. The court noted that the Medicaid services “‘shall be furnished’ to eligible persons and [the nursing home] services ‘must be provided.’” Kerr, slip op. at 11 (quoting the Medicaid Act) (court’s emphasis). Although these mandates are phrased in the passive tense, there is no ambiguity that the provisions mean that the services must be provided to individuals; combined with the eligibility requirements, which are also mandated, the individuals clearly have a right to those services. Indeed, Medicaid is commonly referred to as an “entitlement” program.  It is hard to imagine how an entitlement could not be a right.