Blum v. Yaretsky

Background

A group of Medicaid patients sued New York officials after nursing-home committees recommended transfers to lower-cost facilities and the State prepared to reduce payments. The patients said they were moved or threatened with moves without adequate written notice or a hearing and that this violated their right to due process. Lower courts issued injunctions and a consent judgment protecting some transfer-related procedures.

Reasoning

The central question was whether private nursing homes’ discharge and transfer decisions could be treated as the State’s actions under the Fourteenth Amendment. The Court said no: the decisions at issue were made by private administrators and physicians, and New York’s regulations, payment system, and review requirements did not amount to coercion or joint state decisionmaking sufficient to call those private acts “state action.” The Court also held the patients could challenge facility-initiated transfers to lower levels of care but not hypothetical transfers to higher levels of care.

Real world impact

The decision narrows when federal constitutional due-process protections apply to nursing-home transfers and discharges that affect Medicaid benefits. Patients who want notice and hearings must rely more on state regulations, administrative processes, or private remedies than on federal constitutional claims. The Court declined to decide whether state or federal rules themselves require particular procedures.

Dissents or concurrances

Justice Brennan’s dissent argued the State’s detailed forms, review committees, funding, and pervasive regulation make nursing homes agents of the State, and so transfers should be subject to constitutional review.