139 S. Ct. 408
SCOTUS2018Background
- Medicaid recipients and providers challenged state decisions to exclude or refuse to list certain Medicaid providers under 42 U.S.C. §1396a(a)(23), claiming an enforceable private right under 42 U.S.C. §1983.
- Multiple cases reached the courts of appeals; the Fifth Circuit affirmed that recipients have a §1983 right to challenge a State’s provider-qualification determinations (case below), while other circuits are split.
- The petition for certiorari (No. 17–1492) was denied by the Supreme Court on December 10, 2018.
- Justice Thomas dissented from the denial, arguing the Court should resolve an entrenched and consequential circuit conflict about whether §1396a(a)(23) confers private rights enforceable under §1983.
- The dispute implicates nationwide Medicaid administration, state fiscal and regulatory decisionmaking, and the proper framework for identifying §1983 causes of action.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §1396a(a)(23) creates an individual right enforceable through §1983 | Medicaid recipients: statutory language confers a concrete, enforceable right to qualified providers, so §1983 suits lie | States: statute creates programmatic duties, not private rights; permitting §1983 claims intrudes on state Medicaid administration | Supreme Court denied certiorari; lower courts remain split (majority of circuits say §1983 claim exists; some circuits disagree) |
| Whether circuit courts are in conflict on the §1983 issue | Plaintiffs: lower-court holdings recognizing §1983 right reflect proper interpretation and protect beneficiaries | States: conflicting decisions warrant the Court’s review to provide uniform rule and prevent nationwide litigation costs | Denial of certiorari left circuit split unresolved; Justice Thomas urged review to resolve it |
| Whether recognition of §1983 claims circumvents state administrative remedies and burdens States | Plaintiffs: direct federal suits are necessary to vindicate beneficiaries’ federal rights without undue state obstruction | States: §1983 suits allow providers/patients to bypass state exhaustion and impose financial and administrative burdens on States | Denial leaves lower-court approaches intact; dissent emphasized practical burdens on States |
| What standard governs implying a §1983 cause of action (framework confusion) | Plaintiffs: prior Supreme Court language permitted recognition of rights enforceable under §1983 without overly rigid criteria | States: Gonzaga and subsequent decisions tightened standards; lower-court confusion requires clarification from this Court | Denial preserves existing uncertainty; Justice Thomas criticized the Court’s prior equivocation and called for clarification |
Key Cases Cited
- Thompson v. Keohane, 516 U.S. 99 (1995) (Supreme Court role in resolving important circuit conflicts)
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (standards for discerning statute-created rights enforceable under §1983)
- Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498 (1990) (Medicaid Act and federal reimbursement principles)
- Planned Parenthood of Kan. v. Andersen, 882 F.3d 1205 (10th Cir. 2018) (court recognizing §1983 claims under §1396a(a)(23))
- Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017) (case below recognizing §1983 right)
- Does v. Gillespie, 867 F.3d 1034 (8th Cir. 2017) (holding no §1983 private right under §1396a(a)(23))
- Planned Parenthood of Ariz., Inc. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (recognizing §1983 enforceability)
- Planned Parenthood of Ind., Inc. v. Comm'r, Ind. State Dep't of Health, 699 F.3d 962 (7th Cir. 2012) (recognizing §1983 enforceability)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (recognizing §1983 enforceability)