The US Supreme Court recently affirmed that private parties can enforce federal Medicaid law against noncompliant states. The 7-2 majority in Health and Hospital Corporation of Marion County et al v Talevski held that the Federal Nursing Home Reform Act of 1987 (FNHRA), which amended Medicare and Medicaid to protect nursing facility residents, could be enforced by patients and would not be restricted solely to federal agency actions.1 This decision was the best of all possibilities, though it largely maintained the status quo, because other outcomes had potential to cause severe disruption in Medicaid and beyond.