Brief Fact Summary. The Respondent, Yaretsky (Respondent), is a Medicaid recipient who was transferred from a nursing home to a lower level of care in a health related facility after case review by the nursing home’s utilization review committee. Respondent alleges that this transfer was done in violation of his rights and federal law under the Due Process Clause of the 14th Amendment of the United States Constitution (Constitution).
Synopsis of Rule of Law. Private entity decisions are not converted to state action simply because the state reacts to the decision.
In 1975 the URC decided that Respondent should be transferred to a health related facility providing a reduced level of care. Respondent was transferred without notice or benefit of administrative hearing to challenge the decision.
Issue. Did the decision by a nursing home committee to transfer a Medicaid patient to another facility violate his Due Process rights under the Constitution?
Held. No. The decision was based on independent medical judgment made by private parties. The fact that the state responded by adjusting the benefits does not make the state responsible for the decision to transfer the patient. There is no indication that these decisions were influenced by the state’s obligations to adjust payment accordingly.
There is no suggestion that those decisions were influenced in any degree by the State's obligation to adjust benefits in conformity with changes in the cost of medically necessary care.View Full Point of Law