Indiana case might cause a lot of problems to elderly, poor and people with disabilities affecting benefit programs like Medicaid

As the U.S. Supreme Court prepares to hear oral arguments in an Indiana case that could have national implications for millions of Americans enrolled in federal safety net programs, local pressure is mounting on the public health agency at the center of the legal battle to withdraw the case entirely.

The court action, according to advocates for the elderly, the poor, and those with disabilities, poses a grave threat to federal benefit programs such as Medicaid.

A ruling by the Supreme Court could lead to the federalization of the majority of medical malpractice lawsuits and related state policies. This means that patients may lose the ability to sue for substandard care.

What is at risk?

The case at issue is Health and Hospital Corporation of Marion County v. Talevski, which was filed in 2019 in federal court in Indiana by the estate of Gorgi Talevski, who resided in Indiana prior to his death.

While residing in a Valparaiso nursing facility, Talevski was allegedly chemically restrained and medicated so that he would fall asleep instead of receiving treatment for his dementia, according to the court petition.

Ivanka, Talevski’s wife, also contended that her husband was illegally transferred to a different care facility, a breach of federal rights provided to nursing home patients.

The lower court decided that Talevski’s estate may sue under the Medicaid provisions of the Nursing Facility Reform Act, but the Health & Hospital Corp. of Marion County (or HHC), which runs the nursing home where Talevski received treatment, appealed that judgment. The local government oversees both the Sidney & Lois Eskenazi Hospital and the Marion County Health Department in Indianapolis. It is also the largest nursing home owner in Indiana, with 78 sites around the state.

If the court rules against them, they will have little legal recourse if they are subjected to mistreatment or abuse or if their benefits are revoked.

HHC stated that its facility took the required measures, citing Talevski’s violent and sexually aggressive behavior toward employees and other inmates.

But HHC went even further, contending that residents of publicly owned, Medicaid-funded nursing homes should not be permitted to sue for civil rights violations.

The justices of the Supreme Court agreed to review the matter. On November 8, oral arguments are scheduled.

It will then be up to the justices to determine whether Medicaid recipients have the right to sue state and local governments, or if they have any recourse at all if their civil rights are violated.

Advocates urge HHC to dismiss the case

Dozens of entities, including former members of Congress and U.S. health department officials, have written briefs in favor of Talevski’s wife and her ability to pursue a lawsuit.

Current members of Congress stated in their briefs that the right to sue is “crucial for efficient administration and oversight” of federal safety net programs such as Medicaid. They stated that reversing this right would have “catastrophic consequences.”

Members of Congress wrote, “Congress allocates billions of dollars annually in federal monies to help states in delivering assistance to the nation’s most vulnerable persons.” “Neither federal nor state authorities have adequate resources to perform comprehensive control of the cash flowing into state initiatives… Both Congress and the states rely on private enforcement of these rights to safeguard vulnerable individuals and organizations.”

However, neither Iowa nor Indiana members signed the brief.

Attorney General Todd Rokita, a Republican, and the attorneys general of twenty-one other states filed a supplemental brief in support of HHC. Iowa is also excluded from this brief.

They argue that cases like Talevski’s “interfere with administration and enforcement processes authorized by Congress” and potentially discourage states from accepting federal funding. The AGs stated that federal requirements already exist for state agencies that accept federal funds for safety net programs.

The Arc of Indiana, an advocacy organization for individuals with intellectual and developmental disabilities, and 91 other state and national advocacy organizations for vulnerable populations are now pressing the HHC board to withdraw the Supreme Court appeal.

Advocates stressed that federal safety net programs have served as a “lifeline for millions of people,” particularly those with disabilities. They point specifically to Medicaid, the Supplemental Nutrition Assistance Program (SNAP), the Children’s Health Insurance Program (CHIP), and Temporary Assistance for Needy Families (TANF) (TANF).

The Arc of Indiana stated in a news release that one in four adults in Indiana have a disability, and many of them rely on these services to live full and active lives. “Private lawsuits – often launched by The Arc and its allies – have frequently been the only alternative for individuals to obtain the necessary treatments, services, and supports. They will have little legal remedy if they are subjected to mistreatment or abuse, or if their benefits are taken away.”

The organization is requesting that the HHC board revisit the subject at their meeting on October 18. It is now unclear if the board will include the case on its public agenda.

The seven-member HHC board is appointed by the Democratic-led offices of the mayor, city-county council, and board of county commissioners of Marion County, Indiana.

Paul Babcock, president and chief executive officer of the agency, did not respond to a request for comment. His legal team contends that the Federal Nursing Home Reform Act does not provide a “private right of action to sue nursing homes or nursing home operators,” he told The Indianapolis Star.

During a public meeting last month, Babcock stated that nursing home patients have “a multitude of different options” for holding health facilities responsible, including submitting a complaint with the Indiana Department of Health.

“We will always be worried about care in our elderly homes… This care level will not change if (HHC) triumphs in this case, he explained. “I do not anticipate a loss of rights.”

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