Establishing Medicaid as an Enforceable Entitlement

Medicaid is a cooperative federal-state program under which the federal government provides funding to states to provide medical assistance to eligible low-income individuals.  Full access to Medicaid is critically important to many people with disabilities who rely on it not only for health care, but also for access to home and community-based services which enable them to live in the community and avoid institutionalization.   DRP has a long history of protecting and expanding access to Medicaid through litigation.

Throughout the 1980s and 1990s, the United States Supreme Court grappled with whether individuals could bring lawsuits to enforce their rights under various federal laws, with mixed success for the plaintiffs although generally Medicaid beneficiaries were able to pursue claims to enforce many provisions of the federal Medicaid statute.   After a 2002 Supreme Court decision seemed to change the framework to determine when private individuals can enforce federal statutes against state actors, many states – including Pennsylvania – tried to argue that Medicaid beneficiaries should no longer be able to enforce provisions of that statute.  Pennsylvania initially succeeded in such a challenge in Sabree v. Richman (2004), a class action filed by DRP for individuals with intellectual disabilities to assert their rights to services under the state’s Medicaid Plan.  The district court agreed with Pennsylvania that the newer Supreme Court decision meant that the plaintiffs could not proceed with their claims.  But on appeal, the Court of Appeal for the Third Circuit reversed.  The Medicaid Act provides that states must provide medical assistance services to all eligible individuals, and that medical assistance must be provided with reasonable promptness.  The Third Circuit held that this language unambiguously conferred rights on individuals that could be enforced in federal court.  This case established Medicaid services as an entitlement to all who are eligible and paved the way for many Medicaid cases to follow.  The federal courts have confirmed the enforceability and entitlement to services in other DRP cases, including Leonard v. Mackereth (2014) and S.R. v. DHS (2018).