United States Court of Appeals For the Seventh Circuit ____________________ No. 21-2325 SAINT ANTHONY HOSPITAL, Plaintiff-Appellant, v. ELIZABETH M. WHITEHORN, in her official capacity as Director of the Illinois Department of Healthcare and Family Services, Defendant-Appellee,* and MERIDIAN HEALTH PLAN OF ILLINOIS, INC., et al., Intervening Defendants-Appellees. ____________________

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. On Remand from the Supreme Court of the United States. No. 1:20-cv-02561 — Steven C. Seeger, Judge. ____________________

SUBMITTED DECEMBER 29, 2023 — DECIDED APRIL 25, 2024 ____________________

* We have substituted the new director as the named defendant pur- suant to Federal Rule of Appellate Procedure 43(c)(2). 2 No. 21-2325

Before WOOD, HAMILTON, and BRENNAN, Circuit Judges. HAMILTON, Circuit Judge. We first addressed this appeal in 2022, when we reversed in part the district court’s dismissal of the case and remanded for further proceedings. Saint An- thony Hospital v. Eagleson, 40 F.4th 492 (7th Cir. 2022). Defend- ant petitioned for a writ of certiorari. The Supreme Court held the case while it considered Health & Hospital Corp. of Marion County v. Talevski, 599 U.S. 166 (2023), which presented similar issues concerning the use of 42 U.S.C. § 1983 to enforce certain provisions in the Federal Nursing Home Reform Act amend- ments to the Medicaid Act. After deciding Talevski, the Court granted defendant’s petition in this case, vacated our earlier decision, and remanded for reconsideration in light of Talev- ski. 143 S. Ct. 2634 (2023) (mem.). Such a “GVR” order calls for further thought, but it does not necessarily imply that the lower court’s previous result should be changed. E.g., Klikno v. United States, 928 F.3d 539, 544 (7th Cir. 2019); see generally Lawrence v. Chater, 516 U.S. 163, 166–70 (1996) (per curiam) (discussing GVR practices). Upon remand, the parties submit- ted statements of position and we ordered further briefing. We have taken a fresh look at the appeal in light of Talevski. We again reverse the dismissal of plaintiff’s central claim and remand for further proceedings. By way of introduction, in recent years, Illinois moved its Medicaid program from a fee-for-service model, where a state agency pays providers’ medical bills, to one dominated by managed care, where the state pays private insurers to pay medical bills for Medicaid patients. Most patients of plaintiff Saint Anthony Hospital are covered by Medicaid, so Saint Anthony depends on full, timely Medicaid payments to keep its doors open and provide care to patients. Saint Anthony No. 21-2325 3 says it is now in a dire financial state. Over four years from 2015 to 2019, it lost roughly 98% of its cash reserves, allegedly because managed-care organizations (MCOs) repeatedly and systematically delayed and reduced payments it was owed for treating patients covered by Medicaid managed care. Saint Anthony contends in this lawsuit that Illinois offi- cials owe it a duty under the federal Medicaid Act to act to push MCOs to make timely and full payments. In a thought- ful opinion, the district court dismissed the suit for failure to state a claim for relief. Saint Anthony Hospital v. Eagleson, 548 F. Supp. 3d 721 (N.D. Ill. 2021). We continue to see the case differently, however, especially at the pleadings stage. Under the standards of Talevski and related precedents, Saint An- thony has alleged a viable claim for relief und