Medicaid is a jointly administered federal and state program offering little to no cost health insurance to thousands of individuals in poverty-stricken areas of the United States. But what good is medical insurance if there are no providers nearby who accept that insurance? For many people living in rural parts of the United States, this is the unfortunate reality. This troubling situation is exacerbated when a state decertifies a Medicaid recipient’s chosen provider for failure to be “qualified” as required by federal law. Both the federal government and the decertified provider could challenge the state’s decertification decision, but neither has much incentive to do so. Whether the Medicaid recipient themself could bring a private suit to maintain access to their provider of choice is subject to a circuit split across the Court of Appeals.
42 U.S.C. § 1983 (“Section 1983”) is the federal statute that Medicaid recipients can, in some circuits, rely on to bring a lawsuit to get their doctor back. Section 1983 provides a right of action when a person is deprived of “rights,” and older jurisprudence limited that term to constitutional rights. But in a series of cases in the 1980s and 1990s, the Supreme Court set forth a framework for extending Section 1983 enforcement to federal statutes passed pursuant to the Spending Clause. That framework has come under attack in recent years, with some justices arguing for a return to the days when there was no Section 1983 enforcement of Spending Clause legislation.
This Note urges the Supreme Court to grant certiorari to decide whether Medicaid’s provision requiring a provider to be qualified is enforceable by private litigants under Section 1983. In arguing that such a right exists, this Note will assess the arguments raised across the circuit split and dive into the history of both Medicaid and Section 1983. Not only would a private right to enforce this provision of Medicaid be of practical importance for Medicaid recipients with limited access to care, but it would also reaffirm the strength of a host of other important government programs passed pursuant to the Spending Clause and bump the United States closer to a view of healthcare as a right rather than a privilege.
* J.D. Candidate, 2023, University of Illinois College of Law; B.A., 2020, Kenyon College. Thank you to the members and editors of the University of Illinois Law Review for their diligent work on this publication. I would like to dedicate this Note to my loving parents for their support throughout my time in law school.
The full text of this Note is available to download as a PDF.