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Protecting Vulnerable Populations: Addressing the Unfair Treatment of Medicaid Beneficiaries

Written by Elizabeth Gilbert

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Medicaid, a program established in 1965 to provide health coverage for low-income people, is an essential part of our healthcare system that serves more than 72 million Americans. The coverage this program provides to vulnerable populations is indeed vital, as one in three children and two in three nursing home residents receive Medicaid, and 41% of births are financed by Medicaid.

Despite Medicaid’s crucial and ubiquitous role in our healthcare system, recipients of its coverage sadly face challenges when it comes to receiving healthcare. A recent study published through the Robert Wood Johnson Foundation revealed that publicly insured and uninsured patients are more likely than other patients to be treated unfairly in healthcare settings because of their coverage type. The study explained that unfair treatment due to health insurance type may have many causes, such as bias and discrimination on the part of providers and office staff members, as well as provider perceptions of or experiences with structural aspects of the Medicaid program. In addition to the unfair treatment associated with their health insurance type, publicly insured and uninsured adults report that other factors also cause them to receive unfair treatment, including their income, disability status, and race and ethnicity.

To combat these challenges, the study noted that measures such as increasing provider payment in Medicaid and reducing administrative barriers that providers face with Medicaid may help, but that additional measures are likely needed to reduce the treatment inequalities that publicly insured and uninsured individuals experience.

The U.S. Supreme Court’s Recent Action to Safeguard Medicaid Beneficiaries’ Rights

On June 8, 2023, the United States Supreme Court in Health and Hospital Corp. of Marion County v. Talevski recognized that Medicaid beneficiaries can sue in federal court under the Civil Rights Act, 42 U.S.C. § 1983, when state officials violate their rights. In 2016, due to the progression of Gorgi Talveski’s dementia, his family members placed him in a county-owned nursing home. While at the nursing home, Mr. Talveski’s condition deteriorated due to the nursing home’s alleged medical maltreatment through the use of chemical restraints and numerous efforts to transfer him to other institutions. Through his daughter, Mr. Talevski sued the nursing home for violating the rights that the Federal Nursing Home Reform Act (FNHRA) guaranteed him as a nursing home resident. Nevertheless, the nursing home argued that the Civil Rights Act cannot be used for statutes like Medicaid.

Advocates worried that the matter had evolved into a question of whether any Medicaid beneficiary has a right to sue to enforce their Medicaid rights, and expressed concern that should the Supreme Court conclude that Medicaid beneficiaries do not have such a right, this would result in a circumstance in which many Medicaid requirements would effectively go unenforced. Fortunately, the Supreme Court did not make such a determination.  Instead, the Court concluded that the FNHRA unambiguously creates rights that are enforceable by the Civil Rights Act. As such, Medicaid recipients can continue to sue in federal court under the Civil Rights Act when state officials violate their rights.

What Steps Can Medicaid Recipients Take To Advocate for Themselves at Medical Appointments?

The organization My Patient Rights provides the following tips to empower patients to advocate for themselves at medical appointments:

  1. Come to the appointment prepared by thinking ahead of time about what your concerns are and the questions you need answered.
  2. Ask your questions in order of importance to ensure your most pressing concerns can be addressed.
  3. Bring someone with you if you are feeling nervous.
  4. Take notes or ask someone with you to take notes.
  5. Take control of your appointment by asking your prepared questions or providing the medical provider with a list of written questions and do not be embarrassed to ask for clarification.
  6. Speak honestly with your medical provider about whether you do not understand something, you do not agree with something that was said, or if you feel misunderstood. Ask follow up questions.
  7. Make a follow up appointment or call the medical provider’s office if you are not feeling better.

What Can You Do if You or a Loved One Are a Medicaid Recipient and Suffer the Consequences of Medical Malpractice?

If you or a loved one are a Medicaid recipient and suffer the consequences of medical malpractice, you should reach out to an attorney right away.  Contact the experienced attorneys at Berkowitz and Hanna, LLC if you have any questions about your legal rights regarding this concern.  To schedule a free, no-obligation consultation, call or contact us online today.