In the case of Watson v. Weeks, the 9th Circuit Court of Appeals reversed a lower federal court decision and ruled in favor of Medicaid recipients whose long term care benefits were terminated in 2003 due to state budget cuts. The Court held the plaintiffs had an enforceable claim under 42 U.S.C. § 1983 to nursing facility level of care, a mandatory service under the Medicaid Act. Opinion - Watson v. Weeks, No. 04-035704 (9th Cir, Feb. 8, 2006).
Under Oregon 's Medicaid program, long term care services are provided to those in nursing homes, and through a Medicaid waiver, to those who live in community based settings, such as assisted living facilities and their own homes. The case was brought by Legal Aid Services of Oregon, Lane County Law and Advocacy Center, the Oregon Law Center, and the National Senior Citizens Law Center. Amicus briefs in support of the plaintiffs were filed by the Elder Law Section of the Oregon State Bar, the National Health Law Program, and AARP.
The Court of Appeals held the Plaintiffs satisfied the requirements of the Supreme Court's §1983 decisions in Blessing v. Freestone and, more recently, in Gonzaga University v. Doe, and have a private right of action to enforce their right to nursing facility level of care, or, in the alternative, under Oregon's waiver, community based long term care. The Court found this claim had the requisite focus on the rights of the individuals affected by the state's cuts. The Court found Congress intended that poor, vulnerable persons who must rely on the Medicaid program for their health care are entitled to their day in court when federally mandated, critical care under the Medicaid Act is at stake.
The Court held the Plaintiffs did not have a private right of action to enforce another provision of the Medicaid Act which requires states to use reasonable standards in determining eligibility. This provision, the Court found, did not focus on individuals, but on the state, so that enforcement lies with the federal government, not private individuals.
The Court's ruling prohibits Oregon and other states in this Circuit from cutting required Medicaid services because of budget constraints, and then trying to prevent the very people who are hurt by the cuts from coming to court for relief.
For more information, contact Steve Skipton (541) 485-1017 x.125.
