Good 5th Cir. Consent Decree Decision

The Court of Appeals for the Fifth Circuit issued another decision yesterday in a Texas Medicaid case regarding whether a consent decree is enforceable in federal court.

The Court of Appeals for the Fifth Circuit issued another decision yesterday in a Texas Medicaid case regarding whether a consent decree is enforceable in federal court. Frazar v. Ladd, 2006 WL 106 (5th Cir. 2006). The case concerns a detailed consent decree regarding the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for children. Unlike its first decision, yesterday’s Fifth Circuit decision upholds the enforceability of the consent decree.

In its first decision in this case, the Fifth Circuit refused to enforce the consent decree. It ruled that the state’s violations of the consent decree did not give rise to individual rights enforceable under section 1983 and that the state did not unequivocally waiver its Eleventh Amendment immunity with respect to enforcement of a consent decree. Frazar v. Gilbert, 300 F.3d 530 (5th Cir. 2002).

That decision was unanimously reversed by the Supreme Court. Frew v. Hawkins, 540 U.S. 431 (2004). The Court stated: "Federal courts are not reduced to approving consent decrees and hoping for compliance. Once entered, a consent decree may be enforced."

However, the state of Texas, in its recent appeal, latched on to another statement by the Supreme Court:

"[P]rinciples of federalism require that state officials with front-line responsibility for administering the program be given latitude and substantial discretion. The federal court must exercise its equitable powers to ensure that when the objects of the decree have been attained, responsibility for discharging the State’s obligations is returned promptly to the State and its officials."

In its latest appeal, the state argued that in Frew, the Supreme Court changed the standards regarding modification of a consent decree to place more weight upon "democratic accountability and federalism concerns." The state argued that they were complying with EPSDT law and therefore the consent decree should be terminated.

The Fifth Circuit strongly disagreed with the state’s position. The court held that the state must comply with the terms of the consent decree, which are more detailed than the federal statute. The court noted that the consent decree "speaks to the broader goals of enhancing recipients’ access to health care and improving the use of health care services by EPSDT recipients." Since the state had not complied with the consent decree’s requirements for medical checkups, dental services, outreach, and case management, the Fifth Circuit refused to terminate the decree.