Six years after the introduction of the Complément de Traitement Indiciaire (CTI – Additional Index-Based Allowance) under the agreements known as the “Ségur de la Santé”, the question of its scope of application within the public social and medico-social sector had never received a definitive judicial ruling. Although the gradual extension of the scheme progressively reduced areas of uncertainty, one category of professionals remained in a state of ambiguity: administrative, technical and manual-service staff, as well as qualified hospital service workers employed in autonomous public social and medico-social institutions that are not attached to a nursing home (EHPAD) or a public healthcare institution.
In a decision dated 16 April 2026 (No. 501107), the French Council of State (Conseil d’État) definitively dismissed the appeal brought by the National Association of Public Social and Medico-Social Institutions (GEPso), providing long-awaited legal clarity on this issue—albeit clarity that will be disappointing for the staff concerned.
A Fundamental Challenge Based on Equal Treatment
The dispute originated from a bold yet coherent interpretation advanced by GEPso. The organisation argued that Decree No. 2020-1152 of 19 September 2020, by excluding certain categories of staff employed by autonomous social and medico-social institutions from entitlement to the CTI, created an unjustified inequality of treatment between professionals performing comparable duties, depending on whether or not their institution was affiliated with a hospital.
This argument indirectly invited France’s highest administrative court to examine the limits of the regulatory authority’s powers in relation to legislation whose wording, although precise, had never been expressly validated by the courts on this specific point.
The Systematic Rejection of the Applicants’ Arguments
The Council of State’s decision is notable for the rigor with which it successively dismisses each ground of appeal.
First, the Court recalled that the regulatory authority has no discretion to extend the category of beneficiaries, since these were strictly defined by Article 48 of the Social Security Financing Act for 2021. Consequently, the challenged decree does not constitute an autonomous regulatory act that could be amended or annulled by the courts, but merely the faithful implementation of a clearly expressed legislative intent. Any allegation of misuse of regulatory power therefore fails from the outset.
Second, the Council of State noted that the French Constitutional Council, in its Question Prioritaire de Constitutionnalité (QPC) decision of 21 March 2024 (No. 2023-1084), had already confirmed the constitutionality of the relevant legislative provisions. Since no new admissible constitutional challenge had been raised, the administrative court was bound by that prior ruling and could not revisit its merits.
Third, with regard to supranational law, the Council of State firmly rejected reliance on the European Social Charter and European Union directives concerning equal treatment. The
Court reiterated that these instruments apply only to discrimination based on prohibited grounds—such as race, sex, religion, or sexual orientation—and not to differences in compensation schemes arising from an employee’s status or from the nature of the employing institution. Consequently, although the difference in treatment is real, it does not fall within the scope of protection afforded by either European or international legal instruments.
Implications: Legal Certainty at the Cost of a Persistent Divide
The principal contribution of this decision lies in the consolidation of the legal framework applicable to managers of autonomous public social and medico-social institutions. It is now clearly established that the refusal to extend the CTI to administrative and technical staff employed by such institutions does not constitute an unlawful act capable of giving rise to liability on the part of either the State or the institution. Management therefore benefits from greater budgetary and litigation certainty.
This clarification, however, is not without qualification. The decision confirms the legality of a situation that practitioners in the field have consistently described as inequitable. Between three and four thousand professionals remain excluded from a scheme enjoyed by colleagues performing comparable duties in legally similar institutions.
While the Council of State has neither the authority nor the mandate to remedy this disparity—which results from a legislative policy choice—the ruling highlights a structural tension between the formal rigidity of the legal framework governing the hospital civil service and the recruitment and retention challenges faced by autonomous institutions.
