Nov 4, 2022

Ellen K. Giarratana previously served as Litigation Director at CCLP, where she advocated for the equitable enforcement of legislation, representing community members in litigation in our four focus areas (food, health, income, housing) while working to improve racial equity.

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CCLP Statement on Health and Hospital Corporation v. Talevski

by | Nov 4, 2022

Last term, we watched as the Supreme Court issued rulings that had wide sweeping consequences for individuals across the country. The Court tipped its hat to the second amendment by expanding the ability to carry guns in public while simultaneously decimating the well-established right to privacy grounded in the fourteenth amendment.  

One case that was less covered in the mainstream media, but that dealt a severe blow to civil rights practitioners, was Cummings v. Premier Rehab Keller, P.L.L.C. In short, that case involved a deaf and legally blind patient seeking physical therapy services from a facility in Texas that receives federal funds. The facility refused to provide American Sign Language interpretation, and the patient sued for emotional distress damages under the Rehabilitation Act and the Affordable Care Act.  

The Court, relying on contract law, held that emotional distress damages are suddenly not available under laws passed under Congress’s “spending clause” authority, unless such damages are explicitly provided for in the law.  


The Spending Clause of the U.S. Constitution in part gives Congress the ability to spend money for the “general welfare” of the United States. Often, this is in the form of “conditional grants,” like Medicaid, that give states money so long as the state complies with various federal requirements. So, for example, Cummings would foreclose emotional distress damages under the Rehabilitation Act, the Affordable Care Act, Title VI (prohibiting race discrimination), and Title IX (prohibiting sex discrimination in education). 

Cummings provides a dismal look inside what might happen in the upcoming Supreme Court term with respect to enforcing certain laws.  

On November 8, the Court will hear arguments in Health and Hospital Corporation v. Talevski. Talevski involves a nursing home resident who was given a high dose of psychotropic medications against his will and was repeatedly transferred to facilities far away from his family. 

George Talevski’s family sued the nursing facility for violating federal law by relying on 42 U.S.C. § 1983 – a federal law that allows individuals to sue the government or state actors for civil rights or federal law violations. Section 1983 has consistently been used to ensure that state actors comply with constitutional provisions and federal statutes.  

Nonetheless, the Court has agreed to consider the question of whether individuals harmed by an entity’s failure to follow federal spending clause legislation can sue to enforce their rights under section 1983. 


The Medicaid Act is just one example of spending clause legislation that CCLP regularly relies on to hold state agencies and counties accountable. The Food Stamp Act is another. If the Supreme Court decides that private parties cannot sue to enforce these statutes, it will become increasingly difficult to truly ensure that state agencies are fully compliant with federal law.  

We are right to be worried. Typically, when the Supreme Court agrees to hear a case, it means that there is a novel question of law, or there is some sort of disagreement among lower courts about how to interpret the law. The Court’s function is to resolve those disagreements and act as the ultimate decision maker.  

But in this case, like the recent abortion decision of Dobbs v. Jackson Women’s Health Organization, there is longstanding precedent allowing beneficiaries to enforce their rights in court and thus little disagreement among courts about the interpretation of Section 1983. It is therefore concerning that the Court is even considering the question.  

Given the impact Talevski could have on Coloradan beneficiaries and CCLP’s ability to enforce public assistance laws, CCLP joined the National Health Law Program and forty-two other non-profit organizations in a “friend of the court” – or amicus curiae – brief to explain why the Court should not depart from precedent.  

You can read the brief here. 

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To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.


Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.


Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.


Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.