Rulings Trim Legal Leeway Given Medicaid Recipients

In a series of rulings, federal judges are limiting the ability of poor people to turn to the courts to fight for Medicaid benefits to which they believe they are entitled.

The judges, following guidance from the Supreme Court, are ruling that Medicaid recipients cannot use the courts to enforce a provision of the law that says they should have the same access to health care services as “the general population.”

While the federal courts are still full of Medicaid litigation, it is proving more difficult for beneficiaries to prevail.

Medicaid provides health insurance to more than 50 million low-income people. The court decisions are raising questions about what it means to have health insurance, if the terms of such coverage cannot be enforced.

The rulings, in more than a dozen cases, affect millions of people and involve a wide range of services like nursing home care, home health visits and preventive care for children.

The issue is technical but critically important: whether individuals can enforce the Medicaid law or other statutes that provide benefits to millions of Americans.

John G. Roberts Jr., President Bush’s nominee for the Supreme Court, was an early advocate for that point of view, long before the recent trend emerged. He endorsed it in a memorandum in 1982, as a 27-year-old aide to Attorney General William French Smith. Since then, Mr. Roberts has been involved in several of the most important Supreme Court cases limiting the use of private lawsuits to enforce federal statutes.

At issue is the meaning of a 19th-century civil rights law known as Section 1983. The law allows individuals to sue state officials who violate rights secured by federal law or the federal Constitution. For decades, courts have allowed use of this law to enforce rights that have nothing to do with traditional civil rights.

People denied coverage or benefits may be able to pursue their claims before a state hearing officer. But many protections of the Medicaid law cannot be enforced in that way.

The name of that law, the Family Educational Rights and Privacy Act, suggests that Congress thought it was creating some sort of right.

For the complete article go to http://www.nytimes.com/2005/08/15/politics/politicsspecial1/15medicaid.html?th&emc=th.