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Last May the US Supreme Court agreed to review the case of Health and Hospital Corp. v. Talevski, which was brought by the wife of a Medicaid patient with dementia who sued his nursing home, alleging abuse and violations of his rights.

The nursing home successfully argued in a lower court that federal rules for Medicare and Medicaid recipients originate from the government’s spending powers and amount to contracts between the government and providers. By that reasoning, individuals can’t sue for the entitlements the program promises.

But the 7th U.S. Circuit Court of Appeals last year reversed the decision, finding precedent for a right to sue, including situations in which hospitals took states to court over Medicaid reimbursement rates.

The outcome could decide if tens of millions of people in public welfare programs can go to court if essentials like health care and food are endangered. The outcome of the case could extend beyond Medicaid, to CHIP, the Supplemental Nutrition Assistance Program, Head Start and other programs, Oral argument in the case is set for November 8, 2022.

The Amicus Brief filed by the California Advocates for Nursing Home Reform (CANHR), a nonprofit organization that represents the interests of approximately 100,000 California nursing home residents and their families, AARP and a number of other organizations provided a view of arguments in favor of SCOTUS sustaining the 7th Circuit ruling that allows individual suits against operators.

Regulatory enforcement alone cannot do the job. Regulatory enforcement determines facilities’ compliance with standards. It does not vindicate a resident’s individual entitlement to quality care or violations of their rights. In addition, regulatory enforcement has failed to stop many pervasive harms, including illegal discharges and chemical restraints. Moreover, even if regulatory enforcement functioned perfectly, which it does not, it still would not compensate residents for harms that result from facilities’ violating their rights.”

Thus, residents must be able to go to court to enforce their rights themselves. A decision affirming their ability to enforce their rights under Section 1983 will give residents the mechanism they need to hold government-run facilities accountable for violating their rights.”

And CalMatters reports on another disruption to health care delivery. It says that more than 1.7 million Medi-Cal patients may get a new insurance provider in the coming months as a result of the state’s first-ever competitive bidding process, but critics and some providers fear the change will cause major disruptions to care.

California’s Department of Health Care Services last month announced its intent to award $14 billion-worth of Medi-Cal contracts to three companies – Health Net, Molina and Anthem Blue Cross – down from nine.

The new contract includes strict new quality standards for patient outcomes and financial penalties for providers that do not meet the goals. But the selections have raised questions about whether the plans can actually meet the new quality standards. Over the past decade, health outcomes and quality metrics have stagnated or gotten worse for Medi-Cal enrollees, and the three winners, which have current contracts across two-thirds of the state, maintain spotty track records.

Losing bidders have submitted appeals in more than half the counties where bidding took place, claiming competitors overpromised their Medi-Cal services and that the Department of Health Care Services implemented an unfair scoring system.

One such appeal came from Community Health Group, the largest Medi-Cal provider in San Diego County and one of the highest-performing insurance plans in the state. It lost the initial bid to Health Net and Molina.