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July 15, 2022

Seventh Circuit Issues Cases on Medicaid Participants’ Right to Sue

The US Court of Appeals for the Seventh Circuit held on July 5 that St. Anthony Hospital in Chicago can sue the Illinois Medicaid agency for allegedly failing to ensure prompt payment to providers by Medicaid-contracted MCOs. This decision sets the stage for multiple similar suits from providers.

Meanwhile, the US Supreme Court has agreed to hear another Seventh Circuit case in which a plaintiff alleged that a public nursing home had violated the Federal Nursing Home Amendments Act with regard to a resident. The family of a resident with dementia sued the Health and Hospital Corporation of Marion County, Indiana, alleging the nursing home violated federal Medicaid law in medicating, transferring, and ultimately discharging the resident. The district court dismissed the case for failure to state a valid claim.  The Seventh Circuit reversed and remanded the case, holding that the plaintiff had stated a valid private cause of action under 42 USC section 1983 against the public long-term care facility. The US Supreme Court will consider whether applicable legislation confers privately enforceable rights under section 1983 and will hear arguments during the 2022-2023 term. 

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