LTC Bullet: Beneficiaries Can’t Enforce Medicaid Law

Tuesday May 15, 2001

Seattle—

A federal judge in Michigan has ruled that Medicaid beneficiaries do not have standing to sue the Medicaid program for benefits. This recent decision, in the case of Westside Mothers v. Haverman, should be a wake-up call to seniors and their advisors planning for long-term care. In addition to Medicaid’s notorious reputation for problems with access, quality, reimbursement, discrimination and institutional bias, here is another reason to save, invest and insure for long-term care in order to avoid welfare dependency. Whether or not the decision is overturned on appeal, it reflects the growing uncertainty surrounding the future of the Medicaid program.

According to the New York Times (May 13, 2001), District Court Judge Robert Cleland ruled on March 18, 2001 that "poor people may not sue state officials to force them to provide benefits guaranteed under the federal Medicaid law." The decision, reports the paper, has already been cited by other states in similar cases.

According to the article, "Judge Cleland said the Medicaid program was a contract between two sovereigns, the federal government and the state of Michigan. Medicaid recipients are beneficiaries of the contract, but have no right to enforce it in court, he said." Specifically, Judge Cleland ruled that Section 1983 of the U.S. Code does not authorize lawsuits against states or state officials for failure to carry out the terms of a grant program such as Medicaid. Instead, the decision clarified that only the federal government has standing to enforce Medicaid law against non-conforming states.

Sara Rosenbaum, a professor of health law policy at George Washington University, responded in the article by stating, "If the ruling stands, it is the end of the Medicaid program as a source of insurance." Conversely, Carol Isaacs of the Michigan Department of Community Health (which administers Michigan’s Medicaid program) affirmed the state’s support for the decision and commented that it "could have impact well beyond Michigan."

Source: Robert Pear, "Ruling in Michigan Bars Suits Against State Over Medicaid," New York Times, May 13, 2001 at http://www.nytimes.com/2001/05/13/national/13MEDI.html?searchpv=day01