Health and Hospital Corp. of Marion County v. Talevski
Whether rights created by the Federal Nursing Home Reform Act — a statute enacted under Congress's Spending Clause power — can be privately enforced by individuals through lawsuits brought under 42 U.S.C. § 1983.
The Decision
7-2 decision · Opinion by Ketanji Brown Jackson · 2023
Majority Opinion— Ketanji Brown Jacksonconcurring ↓dissent ↓
In a 7–2 decision authored by Justice Ketanji Brown Jackson, the Supreme Court ruled in favor of Talevski, holding that rights created by Spending Clause statutes can indeed be enforced through § 1983. The Court affirmed the Seventh Circuit's decision.
The majority's reasoning began with the plain text of § 1983 itself. The statute allows lawsuits against state actors who violate rights secured by the 'Constitution and laws' of the United States. Justice Jackson emphasized that a statute enacted under the Spending Clause is, without question, a federal law — it is passed by both houses of Congress and signed by the President just like any other statute. The fact that it conditions federal funds on state compliance does not strip it of its status as a 'law' within the meaning of § 1983.
The Court also grounded its decision heavily in precedent and historical practice. For over four decades, the Court had recognized § 1983 as a vehicle for enforcing rights under Spending Clause legislation. HHC was effectively asking the Court to overrule a long line of settled cases, and the majority found no persuasive reason to do so. The Court noted that while the Spending Clause framework does have contractual features — states voluntarily agree to conditions when accepting federal money — this does not mean the resulting obligations fail to create legal rights. Statutes are statutes regardless of which enumerated power Congress relied upon to enact them.
Finally, applying the established framework for determining whether a statute creates individually enforceable rights (derived from Blessing v. Freestone and refined in Gonzaga University v. Doe), the Court concluded that the two FNHRA provisions at issue — the right to be free from unnecessary chemical restraints and the right to proper transfer and discharge procedures — were sufficiently clear, specific, and individually focused to create rights enforceable under § 1983. They were phrased in terms of what individual residents are entitled to, not merely as broad policy directives to the federal government.
The practical effect of the ruling was significant: it preserved the ability of millions of Americans who benefit from Medicaid and other federal spending programs to go to court and hold state actors accountable when those programs' protections are violated.
Concurring Opinions
Justice Neil Gorsuch wrote a concurring opinion joining the majority but emphasizing the textual and historical foundations for the holding, noting that the plain language of § 1983 and its origins in Reconstruction-era civil rights legislation supported the conclusion that all federal statutes — regardless of the constitutional power underlying their enactment — qualify as enforceable 'laws' under § 1983.
Dissenting Opinions
Clarence Thomas
Justice Thomas argued that § 1983 should not be available to enforce Spending Clause statutes at all. He contended that the original meaning and historical understanding of § 1983 did not encompass obligations that arise from what are essentially voluntary contractual agreements between the federal government and states, and that the Court's precedents allowing such suits were wrongly decided.
- Spending Clause statutes impose conditions on the receipt of federal funds, creating obligations that are contractual in nature between the state and federal government — not individual legal rights that private parties can enforce.
- The Court's prior decisions permitting § 1983 enforcement of Spending Clause statutes departed from the original understanding of § 1983 and should be reconsidered rather than perpetuated.
- Allowing private enforcement expands federal judicial power at the expense of state sovereignty in a way inconsistent with the cooperative federalism model underlying Spending Clause programs.
Amy Coney Barrett
Justice Barrett wrote separately in dissent, arguing that even if some Spending Clause provisions could theoretically be enforced through § 1983, the particular FNHRA provisions at issue in this case did not create the kind of unambiguously conferred individual rights necessary to support a § 1983 claim. She expressed concern that the majority applied the rights-creating test too loosely.
- The test for whether a statute creates individually enforceable rights under § 1983 requires that Congress speak with a clear voice — and the FNHRA provisions at issue were better read as institutional standards for nursing facilities rather than as conferring personal rights on individual residents.
- Expanding § 1983 liability based on broadly worded regulatory requirements risks converting every Spending Clause condition into a basis for private litigation, which was not Congress's intent.
Background & Facts
Gorgi Talevski was an elderly man suffering from dementia who lived at Valparaiso Care and Rehabilitation, a nursing facility in Indiana operated by the Health and Hospital Corporation of Marion County (HHC), a municipal entity. His wife, Ivanka Talevski, alleged that the facility mistreated him in two significant ways: staff repeatedly administered powerful psychotropic drugs to sedate and control him — a practice known as chemical restraint — and the facility transferred him to other institutions without following required procedures or giving proper notice.
These practices, Mrs. Talevski argued, violated specific protections established by the Federal Nursing Home Reform Act (FNHRA), which Congress passed in 1987 as an amendment to the Medicaid Act. The FNHRA was enacted after widespread reports of abuse and neglect in nursing homes and established a bill of rights for nursing home residents. Among those rights were freedom from unnecessary chemical restraints and the right to be discharged or transferred only under specified conditions and with proper notice. Because the Medicaid Act is a Spending Clause statute — meaning Congress conditions the receipt of federal funds on states agreeing to follow certain rules — the nursing home's obligation to respect these rights arose from its participation in the Medicaid program.
Mrs. Talevski filed suit under 42 U.S.C. § 1983, the federal civil rights statute that allows individuals to sue state actors who violate rights secured by the Constitution or 'laws' of the United States. The federal district court dismissed her claims, but the U.S. Court of Appeals for the Seventh Circuit reversed, holding that the FNHRA provisions at issue did create individually enforceable rights that could be pursued through § 1983.
The Supreme Court agreed to hear the case because HHC raised a sweeping argument that had never been fully resolved: that no statute enacted under Congress's Spending Clause power could ever give rise to individually enforceable rights under § 1983. This argument, if accepted, would have upended decades of practice and shut the courthouse door on countless claims by individuals who relied on protections embedded in federal spending programs like Medicaid.
The Arguments
HHC argued that because the Medicaid Act and the FNHRA are Spending Clause statutes — which operate essentially as contracts between the federal government and states — they do not create the kind of individually enforceable 'rights' that can be sued upon under § 1983. In HHC's view, the obligations states assume under these programs are contractual commitments to the federal government, not rights belonging to individual beneficiaries.
- Spending Clause statutes function like contracts: the federal government offers money, and states voluntarily agree to conditions — this contractual framework means any obligations run to the federal government, not to individual people.
- The Court's precedent in Pennhurst State School v. Halderman emphasized the contractual nature of Spending Clause legislation, and allowing § 1983 suits would be inconsistent with that framework.
- Permitting private enforcement through § 1983 would impose unanticipated liability on states and municipalities, undermining the voluntary nature of the Spending Clause bargain and creating obligations states never knowingly accepted.
Talevski argued that § 1983 plainly covers violations of any 'laws' of the United States, and Spending Clause statutes are undeniably federal laws. The FNHRA's provisions protecting nursing home residents from chemical restraints and improper transfers are clear, specific, and individually focused — making them enforceable rights under well-established legal tests.
- The text of § 1983 refers broadly to rights secured by the 'Constitution and laws' of the United States — there is no carve-out for laws enacted under the Spending Clause.
- The Supreme Court had already allowed § 1983 enforcement of Spending Clause statutes in multiple prior cases spanning decades, including Wright v. Roanoke Redevelopment and Wilder v. Virginia Hospital Association.
- The specific FNHRA provisions at issue use rights-creating language focused on individual residents, satisfy the test for individually enforceable rights, and were specifically designed to protect vulnerable nursing home residents from abuse.