540 U.S. 431 (2004), 02-628, Frew v. Hawkins

Docket Nº:No. 02-628
Citation:540 U.S. 431, 124 S.Ct. 899, 157 L.Ed.2d 855, 72 U.S.L.W. 4123
Party Name:Frew v. Hawkins
Case Date:January 14, 2004
Court:United States Supreme Court

Page 431

540 U.S. 431 (2004)

124 S.Ct. 899, 157 L.Ed.2d 855, 72 U.S.L.W. 4123




No. 02-628

United States Supreme Court

January 14, 2004

Argued October 7, 2003



As a participant in the Medicaid program, Texas must meet certain federal requirements, including that it have an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for children. The petitioners, mothers of children eligible for EPSDT services in Texas, sought injunctive relief against state agencies and various state officials, claiming that the Texas program did not meet federal requirements. The claims against the state agencies were dismissed on Eleventh Amendment grounds, but the state officials remained in the suit and entered into a consent decree approved by the Federal District Court. In contrast with the federal statute's brief and general mandate, the decree required state officials to implement many specific proposals. Two years later, when the petitioners filed an enforcement action, the District Court rejected the state officials' argument that the Eleventh Amendment rendered the decree unenforceable, found violations of the decree, and directed the parties to submit proposals outlining possible remedies. On interlocutory appeal, the Fifth Circuit reversed, holding that the Eleventh Amendment prevented enforcement of the decree because the violations of the decree did not also constitute violations of the Medicaid Act.


Enforcement of the consent decree does not violate the Eleventh Amendment. Pp. 436-442.

(a) This case involves the intersection of two areas of federal law: the Eleventh Amendment and the rules governing consent decrees. The state officials argue that a federal court should not enforce a consent decree arising under Ex parte Young, 209 U.S. 123, unless it first identifies at the enforcement stage, a violation of federal law such as the EPSDT statute itself. This Court disagrees. The decree here is a federal court order that springs from a federal dispute and furthers the objectives of federal law. Firefighters v. Cleveland, 478 U.S. 501, 525. The petitioners' enforcement motion sought a remedy consistent with Ex parte Young and Firefighters and accepted by the state officials when they asked the court to approve the consent decree. Pennhurst State School and Hospital v. Halderman, 465 U.S. 89, in which this

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Court found Ex parte Young's rationale inapplicable to suits brought against state officials alleging state law violations, is distinguishable from this case, which involves a federal decree entered to implement a federal statute. Enforcing the decree vindicates an agreement that the state officials reached to comply with federal law. Federal courts are not reduced to approving consent decrees and hoping for compliance. Once entered, that decree may be enforced. See Hutto v. Finney, 437 U.S. 678. Pp. 436-440.

(b) The state officials and amici state attorneys general express legitimate concerns that enforcement of consent decrees can undermine sovereign interests and accountability of state governments. However, when a consent decree is entered under Ex parte Young, the response to their concerns has its source not in the Eleventh Amendment but in the court's equitable powers and in the direction given by Federal Rule of Civil Procedure 60(b)(5), which encompasses an equity court's traditional power to modify its decree in light of changed circumstances. See, e.g., Rufo v. Inmates of Suffolk County Jail, 502 U.S. 367. If a detailed order is required to ensure compliance with a decree for prospective relief that in effect mandates the State to administer a significant federal program, federalism principles require that state officials with front-line responsibility for the program be given latitude and substantial discretion. The federal court must ensure that when the decree's objects have been attained, responsibility for discharging the State's obligations is returned promptly to the State and its officials. The basic obligations of federal law may remain the same, but the precise manner of their discharge may not. If the State establishes reason to modify the decree, the court should make the necessary changes; otherwise the decree should be enforced according to its terms. Pp. 441-442.

300 F.3d 530, reversed.

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In this case we consider whether the Eleventh Amendment bars enforcement of a federal consent decree entered into by state officials.


Medicaid is a cooperative federal-state program that provides federal funding for state medical services to the poor. See Wilder v. Virginia Hospital Assn., 496 U.S. 498, 502 (1990). State participation is voluntary, but once a State elects to join the program, it must administer a state plan that meets federal requirements. One requirement is that every participating State must have an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. See 79 Stat. 343, as amended, 42 U.S.C. §§ 1396a(a)43, 1396d(r). EPSDT programs provide health care services to

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children to reduce lifelong vulnerability to illness or disease. The EPSDT provisions of the Medicaid statute require participating States to provide various medical services to eligible children, and to provide notice of the services. See ibid.

The petitioners here are mothers of children eligible for EPSDT services in Texas. In 1993, they filed a civil action pursuant to Rev.Stat. § 1979, 42 U.S.C. § 1983, seeking injunctive relief against the Texas Department of Health and the Texas Health and Human Services Commission, as well as various officials at these agencies charged with implementing the Texas EPSDT program. The named officials included the Commissioners of the two agencies, the Texas State Medicaid Director, and certain employees at the Texas Department of Health. The individuals were sued in their official capacities and were represented throughout the litigation by the office of the Texas Attorney General.

The petitioners alleged that the Texas program did not satisfy the requirements of federal law. They asserted that the Texas program did not ensure eligible children would receive health, dental, vision, and hearing screens; failed to meet annual participation goals; and gave eligible recipients inadequate notice of available services. The petitioners also claimed the program lacked proper case management and corrective procedures and did not provide uniform services throughout Texas.

After the suit was filed, the two Texas state agencies named in the suit moved to dismiss the claims against them on Eleventh Amendment grounds. The petitioners did not object, and in 1994 the District Court dismissed the state agencies as parties. The state officials remained in the suit, and the District Court certified a class consisting of children in Texas entitled to EPSDT services, a class of more than 1 million persons. Following extensive settlement negotiations, the petitioners and the state officials agreed to resolve the suit by entering into a consent decree. The District

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Court conducted a fairness hearing, approved the consent decree, and entered it in 1996.

Judicial enforcement of the 1996 consent decree is the subject of the present dispute. The decree is a detailed document about 80 pages long that orders a comprehensive plan for implementing the federal statute. In contrast with the brief and general mandate in the statute itself, the consent decree requires the state officials to implement many specific procedures. An example illustrates the nature of the difference. The EPSDT statute requires States to "provid[e] or arrang[e] for the provision of . . . screening services in all cases where they are requested," and also to arrange for "corrective treatment" in such cases. 42 U.S.C. §§ 1396a(a)(43)(B), (C). The consent decree implements the provision in part by directing the Texas Department of Health to staff and maintain toll-free telephone numbers for eligible recipients who seek assistance in scheduling and arranging appointments. Consent Decree ¶¶241-242, Lodging of Petitioners 63-64. According to the decree, the advisors at the toll-free numbers must furnish the name, address, and telephone numbers of one or more health care providers in the appropriate specialty in a convenient location, and they also must assist with transportation arrangements to and from appointments. Id., ¶¶243-245, Lodging of Petitioners 64. The advisers must inform recipients enrolled in managed care health plans that they are free to choose a primary care physician upon enrollment. Id., ¶244, Lodging of Petitioners 64.

Two years after the consent decree was entered, the petitioners filed a motion to enforce it in the District Court. The state officials, it was alleged, had not complied with the decree in various respects. The officials denied the allegations and maintained that the Eleventh Amendment rendered the decree unenforceable even if they were in noncompliance. After an evidentiary hearing, the District Court issued a detailed opinion concluding that certain provisions

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of the consent decree had been violated. Frew v. Gilbert, 109 F.Supp.2d 579 (ED Tex. 2000). The...

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