Issue Brief: Update on Section 1983 Enforcement of the Medicaid Act

Executive Summary

This issue brief discusses recent trends affecting private enforcement of the Medicaid Act in federal court, focusing on 42 U.S.C. _ 1983.

Advocates continue to encounter problems with state Medicaid programs that are not meeting the requirements of the federal Medicaid Act. When clients are being harmed by ongoing violations of the Act, these offices must consider federal court litigation to obtain injunctive relief. Particularly since the mid 1990s, federal court access has been hampered by a judiciary that is increasingly hostile to individuals who are seeking to enforce the Medicaid Act against the state. 
This Fact Sheet discusses recent trends affecting private enforcement of the Medicaid Act in federal court, focusing on 42 U.S.C. § 1983. 
Background on 42 U.S.C. § 1983
When it was added to the Social Security Act in 1965, the Medicaid Act did not include a provision authorizing individuals to enforce the Act in federal court. However, individuals have traditionally relied upon another federal statute, 42 U.S.C. § 1983. This law confers an express cause of action against state actors who violate ?rights, privileges, or immunities secured by the Constitution and laws.?2
In 1980, the Supreme Court recognized that § 1983 means what it says and, thus, allows injured individuals to enforce federal laws.3 However, the Court has also long-stressed that a plaintiff must assert a violation of a federal ?right,? not merely a violation of federal law.4 The plaintiff must also show that Congress has not foreclosed resort to § 1983 expressly or by including a comprehensive remedial scheme in the federal law.5

The Supreme Court has applied a three-part test to determine whether a federal law creates a federal right: (1) Was the provision in question intended to benefit the plaintiff; (2) Does the provision contain sufficient mandatory language to create a binding obligation on the state or merely express a congressional preference; and (3) Is the provision specific or too vague and amorphous for a court to enforce?6 This is called the Blessing/Wilder test after the Supreme Court cases that applied it. 
In 2002, the Court tightened the enforcement test in Gonzaga Univ. v. Doe, a case involving a spending clause program.7 The National Health Law Program has discussed this case extensively, so it will only be summarized here.8 Writing for the majority, Chief Justice Rehnquist initially noted that spending clause programs are similar to contracts, with the typical remedy for a violation being termination of funding by the federal agency. A provision is not enforceable by a program beneficiary unless Congress has unambiguously manifested its intent to confer individual rights. Moreover, according to the Court, the initial inquiry into whether a statute creates a federal right under § 1983 ?is no different from the initial inquiry in an implied right of action case.?9 The provision must contain ?rights- or duty-creating language? and have an individual rather than an aggregate focus. 
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