Member grievances in Medicare+Choice programs: a review of Grijalva v. Shalala

On May 3, 1999, the U.S. Supreme Court overturned the decision of the Ninth Circuit Court of Appeals in the case of Grijalva v. Shalala. In Grijalva, the U.S. District Court in Arizona had handed down, and the Ninth Circuit Court had upheld, one of the most far-reaching decisions, greatly expanding the rights of Medicare beneficiaries enrolled in HMOs (i.e., Medicare + Choice plans) for filing grievances against their HMOs. This article explores the implications of the Supreme Court's decision, and the expanding appeal rights of Medicare beneficiaries and other HMO members under recently enacted state laws, as well as under the proposed Patient's Bill of Rights now being debated in Congress.