Document ID: ./input/supremecourt_opinions/opinions/22pdf/21-806_2dp3.pdf
Page Number: 34

2 

HEALTH AND HOSPITAL CORPORATION OF MARION 
CTY. v. TALEVSKI 
THOMAS, J., dissenting 

such, a conditional exercise of the spending power is noth-
ing  more  than  a  contractual  offer;  any  “rights”  that  may 
flow from that offer are “secured” only by the offeree’s ac-
ceptance and implementation, not federal law itself.

Since  Maine  v.  Thiboutot,  448  U. S.  1  (1980),  however,
this  Court  has  ignored  that  fundamental  distinction,  per-
mitting third parties who benefit from spending conditions 
to enforce them in §1983 suits against state actors.  In doing 
so,  it  has  created  a  constitutional  quandary:  If  spending 
conditions  that  benefit  third  parties  are  laws  and  secure 
rights  in  the  same  manner  as  ordinary  lawmaking  under
Congress’  sovereign  legislative  powers,  then  such  condi-
tions  would  contradict  the  bedrock  constitutional  prohibi-
tion against federal commandeering of the States.  We es-
cape 
this  quandary  only  by  recognizing  spending 
conditions, not as rights-securing laws, but as the terms of 
possible contracts that secure rights only by virtue of an of-
feree’s  acceptance—the  very  conclusion  compelled  by  the 
traditional  understanding  of  the  spending  power.    The 
choice between these alternatives is stark and unavoidable: 
Either spending conditions in statutes like FNHRA are not 
laws that secure rights cognizable under §1983, or they are 
unconstitutional  direct  regulations  of  States.  The  Court 
must, at some point, revisit its understanding of the spend-
ing power and its relation to §1983. 

I 
This  case  arises  from  a  §1983  suit  to  enforce  FNHRA’s
spending conditions against a county-owned nursing home 
that  receives  federal  funding.    Enacted  under  Congress’
spending  power,  FNHRA  conditions  the  receipt  of  federal 
Medicaid funding by States and nursing facilities on com-
pliance with a broad range of requirements.

These  conditions  largely  consist  of  requirements  that
funding recipients protect certain “rights” of nursing-home
residents.  In a subsection entitled “[r]equirements relating