Health and Hospital Corporation of Marion Cty. v. Talevski
The Supreme Court ruled that nursing home residents can use the federal civil rights law known as § 1983 to sue publicly owned nursing homes that illegally chemically restrain or improperly transfer them — rejecting arguments that federal Medicaid-linked welfare statutes are categorically off-limits for such lawsuits.
The decision reaffirms a decades-old rule that all federal laws, including those that attach conditions to federal funding, can be enforced by individuals in court, and preserves an important legal avenue for vulnerable people in government-run care facilities.
How it got here: The federal district court dismissed the lawsuit; the Seventh Circuit reversed; the nursing home petitioned for certiorari, which the Supreme Court granted.
The Case in Depth
What happened
Gorgi Talevski, an elderly man with dementia, was placed in a county-owned Indiana nursing home in 2016. Staff began giving him multiple powerful antipsychotic drugs — medications outside physicians later confirmed were being used as chemical restraints, not to treat his symptoms. When the family complained, the nursing home retaliated by trying to permanently transfer Mr. Talevski to a distant facility without advance notice to him or his family. His wife sued the nursing home under a federal civil rights law, claiming violations of his rights under the Federal Nursing Home Reform Act.
The question before the Court
Can nursing home residents sue a publicly owned nursing home in federal court to enforce specific rights the Federal Nursing Home Reform Act guarantees them?
The Court's answer
Yes — Nursing home residents can use the federal civil rights law known as § 1983 to enforce their rights under the Federal Nursing Home Reform Act.
The Court rejected two arguments against allowing the lawsuit. First, it reaffirmed that § 1983 covers all federal laws — including those enacted under Congress's power to attach conditions to federal funding — dismissing the nursing home's argument that such laws resemble contracts, and that third-party beneficiaries of contracts generally couldn't sue in the 1870s when § 1983 was enacted. Second, applying its established standard for deciding when federal statutes create individually enforceable rights, the Court found that the two FNHRA provisions at issue — protecting residents from unnecessary chemical restraints and guaranteeing advance notice before transfers — use explicit, individually focused rights-creating language that clearly satisfies that standard. The Court also found no incompatibility between the FNHRA's administrative enforcement scheme and § 1983 suits, because the FNHRA lacks the kind of exclusive private judicial remedy that would block an additional path to court.
Curious how the Court got there? See the step-by-step legal reasoning →
Why it matters
Residents of county- or state-run nursing homes who are illegally chemically restrained or improperly transferred can now sue directly in federal court, rather than relying solely on state and federal inspectors. The ruling also preserves § 1983 as a tool for enforcing a range of federal benefit programs that attach conditions to Medicaid and other federal funding.
What changes now
The case goes back to lower courts for further proceedings, where the Talevski estate can pursue the § 1983 claims on the merits. More broadly, the decision leaves in place a legal path for residents of publicly owned nursing homes to sue in federal court over violations of their FNHRA rights. The constitutional questions Justice Thomas raised about the spending power and anti-commandeering doctrine — which could unsettle the entire framework — remain open for a future case.
What this does not decide
The ruling covers only publicly operated nursing homes, since § 1983 requires action by someone acting under state authority — the vast majority of nursing homes are privately owned and would not be covered. The Court also expressly set aside deeper questions about whether Spending Clause legislation can constitutionally create legally binding rights or whether § 1983 enforcement of such rights might violate anti-commandeering limits.
Concurrences and dissents
Concurrence — Justice Gorsuch
Justice Gorsuch agreed with both conclusions the Court reached and said he largely followed Justice Barrett's reasoning to get there. He wrote separately to flag two questions he believed were not fully addressed by either side: whether rights created by Spending Clause statutes are truly 'secured' against the States within the meaning of § 1983, and whether enforcing such rights could violate the Constitution's anti-commandeering principle. He called those questions for another day.
Concurrence — Justice Barrett
Justice Barrett joined the Court's opinion in full but wrote separately to underscore three points. First, the 1980 Thiboutot holding that 'laws' means all federal laws remains good law. Second, the Gonzaga standard is a genuinely high bar — many Spending Clause statutes will not satisfy it, and since Pennhurst only two such statutes had ever been found to do so. Third, courts should carefully consider whether a statute's remedial scheme displaces § 1983 using ordinary interpretive tools, looking at a wide range of contextual clues beyond whether the statute has an explicit private judicial remedy.
Dissent — Justice Thomas
Justice Thomas wrote separately to argue a more fundamental point: Spending Clause legislation cannot 'secure' rights 'by law' within the meaning of § 1983 at all. He contended that the spending power is purely a power to spend, carrying no sovereign regulatory authority, and that spending conditions operate as contractual offers, not binding federal law. He argued that treating them as binding federal law would unconstitutionally commandeer the States, and called on the Court to re-examine Thiboutot and the entire framework for § 1983 enforcement of spending statutes.
Dissent — Justice Alito
Justice Alito agreed with the majority that the FNHRA's two provisions create individual rights under Gonzaga, but disagreed on the second step: in his view, the FNHRA's detailed enforcement regime — including federal inspections, civil monetary penalties, state enforcement obligations, a resident grievance process, and a carefully balanced federal-state division of authority — collectively constitute a comprehensive scheme incompatible with § 1983 suits. He argued that allowing § 1983 would swallow the statute's calibrated remedial balance and remove enforcement from the state and federal authorities Congress empowered.
How the Court got there
The legal reasoning, step by step
- The Court began with the threshold question: does the word 'laws' in § 1983 — which gives people a cause of action against state actors who violate 'any rights secured by the Constitution and laws' — include federal statutes enacted under Congress's power to spend and attach conditions to funding? Reaffirming its 1980 decision in Maine v. Thiboutot, the Court said yes: 'laws' has no modifier and means all federal laws.
- The nursing home argued that because Spending Clause legislation is 'in the nature of a contract,' and because third-party beneficiaries generally could not sue on contracts at common law in the 1870s, § 1983 must contain an implicit carveout for Spending Clause statutes. The Court rejected this on two grounds: (a) the historical claim about third-party beneficiary law was contestable and too ambiguous to overturn major precedents; and (b) § 1983 is fundamentally a tort claim, not a contract claim, so 19th-century contract law principles should not control.
- Even when § 1983 can reach a Spending Clause statute, not every such statute creates individually enforceable rights. Under the Court's 2002 Gonzaga framework — the governing test for when federal statutes create § 1983-enforceable rights — a provision must 'unambiguously confer' individual federal rights: it must be phrased in terms of the persons benefited, use rights-creating language, and have an unmistakable focus on the benefited class, not just the federal–state funding relationship.
- Both FNHRA provisions satisfied Gonzaga. They are embedded in a section expressly titled 'Requirements relating to residents' rights'; they use explicit rights language (residents' 'right to be free from' unnecessary restraints; 'transfer and discharge rights'); and their text — including the exceptions — remains focused on the welfare of individual nursing home residents throughout.
- Finally, even rights unambiguously created can be shielded from § 1983 enforcement if Congress crafts a comprehensive enforcement scheme that is incompatible with individual § 1983 suits. The Court found no such incompatibility here: unlike statutes in prior cases (Rancho Palos Verdes, Sea Clammers, Smith) that had their own private judicial rights of action with mandatory presuit procedures, the FNHRA has no private cause of action, no presuit exhaustion requirement, and no tailored remedial framework that § 1983 would distort. The FNHRA's savings clause even states its remedies are 'in addition to those otherwise available under State or Federal law.'
Doctrinal impact
Cases affected by this decision
Reaffirms Maine v. Thiboutot (448 U.S. 1)
The Court explicitly declined to overrule the holding that 'laws' in § 1983 means all federal laws, not just civil rights laws.
Reaffirms Gonzaga Univ. v. Doe (536 U.S. 273)
The Court applied Gonzaga's demanding test — unchanged — as the governing standard for when a federal statute creates § 1983-enforceable rights.
Distinguishes Rancho Palos Verdes v. Abrams (544 U.S. 113)
The FNHRA lacks the private judicial remedy and presuit procedures that made § 1983 incompatible with the statute in Rancho Palos Verdes.