Court of Appeals To Consider Whether Medicaid Beneficiaries Can Force States To Provide Federally Mandated Benefits

The U.S. Court of Appeals for the 6th Circuit is set to hear oral arguments on Jan. 24 in the case of Westside Mothers v. Haveman, under which a group of Michigan parents sued state officials for injunctive relief, alleging that the state's Medicaid program denied their children early and periodic screening, diagnostic and treatment services, a comprehensive Medicaid benefits package for children under age 21 (George Washington University Center for Health Services Research and Policy release, 1/22). In May, U.S. District Court Judge Robert Cleland ruled against the parents, saying that Medicaid beneficiaries may not sue states to force officials to provide benefits required by federal Medicaid law. Cleland ruled that Medicaid is a "contract" between "two sovereigns" -- the federal government and individual states -- and that "Congress may not force states into being its agents." He added that although Medicaid beneficiaries benefit from the program, they "have no right to enforce [Medicaid law] in court" because of the state's sovereign immunity from lawsuits, granted under the Constitution (Kaiser Daily Health Policy Report, 5/14/01). In anticipation of the appeals court's review of the case, the George Washington University Center for Health Services Research and Policy has released an analysis of nine court cases in which other states raised the same defense that Michigan officials did -- that Medicaid beneficiaries do not have the right to sue the state for denial of benefits (George Washington University Center for Health Services Research and Policy release, 1/22). The analysis states that in all nine cases, the courts rejected that defense and Cleland's reasoning, continuing to adhere to other precedents. Prior to the Westside Mothers case, courts held that "in certain instances ... individuals can bring a lawsuit for injunctive relief (rather than monetary damages) against federal officials who are alleged to have violated their federal rights." According to the analysis, courts relied on two principles in the nine cases to reject states' arguments. One, the courts "affirmed the rights of Medicaid beneficiaries to bring a lawsuit" under a federal civil rights law (42 U.S.C. 1983) that grants individuals the right to go to court to protect federal legal rights granted by the Constitution or federal law. And two, the courts denied states' arguments to dismiss the cases, following a 1908 Supreme Court precedent that says state officials who violate federal law are not protected by the 11th Amendment's "shield of immunity" because they are "acting outside the scope of their official status." If the appeals court upholds Cleland's ruling, the decision would "overturn nearly a century of federal constitutional law and thousands of cases," the analysis concludes (Rosenbaum/Sonosky, "Caselaw Developments in the Aftermath of Westside Mothers v. Haveman: Emerging Trends," 1/22). The analysis is available online. Note: You must have Adobe Acrobat to view the analysis.