NHeLP files amicus brief on behalf of American Academy of Pediatrics, et al, in Florida v. Health & Human Services in the 11th Circuit

Amici are national and Florida-based health care provider and consumer organizations that have worked with the Medicaid program over its 46-year history. While each Amicus has particular interests in the Medicaid program, they collectively bring to the Court an in-depth understanding of how the Medicaid Act has been amended and/or implemented over time. The parties have consented to the filing of this Brief.

Founded in 1930, the American Academy of Pediatrics (AAP) is a national, non-profit organization dedicated to furthering the interests of children?s health and the pediatric specialty. The majority of people who are covered by Medicaid are children, and pediatricians interact with Medicaid more than any other leading physicians? society. Established in 1872, the American Public Health Association (APHA) aims to protect families and communities from preventable, serious health threats and strives to assure that community-based health promotion and disease prevention activities and preventive health services are universally accessible. APHA represents a broad array of health professionals and others who care about the health of their communities, many of whose residents are uninsured or depend on Medicaid for their health care. The National Association of Community Health Centers (NACHC) is the membership organization for federally qualified health centers (FQHCs). There are more than 1200 FQHCs with more than 7000 sites serving 23 million patients nationwide. Approximately 35% of health center patients are Medicaid recipients; approximately 40% are uninsured. NACHC estimates that the Medicaid expansions contained in ACA will result in health centers serving approximately 18.4 million Medicaid recipients by 2015. The Florida Pediatric Society/Florida Chapter of the American Academy of Pediatrics (FPS) is a non-profit professional organization of pediatricians and pediatric specialists. In the most recent Federal fiscal year, more that 1.6 million children were enrolled in Florida?s Medicaid program. A substantial proportion of FPS?s approximately 2100 members are enrolled as Medicaid providers in Florida and provide primary care and specialty services to children enrolled in Florida?s Medicaid program.

Families USA is the national organization for health care consumers. For the past 28 years, Families USA has led various coalition efforts designed to expand health coverage for low-income families, including the National Medicaid Coalition that it chairs. Florida Community Health Action Information Network (CHAIN) is a statewide consumer health care advocacy organization. Priorities of Florida CHAIN include ensuring that Medicaid beneficiaries are protected against barriers to access and working to obtain coverage for Florida?s estimated 4.1 million uninsured. Florida Legal Services, Inc. (FLS) is a statewide nonprofit law firm founded in 1973 to expand the availability of legal assistance to the poor. As a state support center for over 40 legal aid/legal services offices throughout Florida, FLS works with low income Floridians who are in desperate need of health care services. Florida has the third highest rate of uninsurance in the U.S.

The National Partnership for Women and Families is a nonprofit, nonpartisan organization that uses public education and advocacy to promote access to quality, affordable health care, work and family policies, and fairness in the workplace. Medicaid is a particularly vital source of health care for women of reproductive age (15-44).

United Cerebral Palsy (UCP) is one of the oldest and largest national health organizations dedicated to improving the lives of people with disabilities, many of whom receive services pursuant to the Medicaid program. Founded in 1949, the organization advances the independence, productivity and full citizenship of people with disabilities through a nationwide network of approximately 100 affiliates across the country. The National Alliance on Mental Illness (NAMI) is the nation?s largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness. Founded in 1979, NAMI has over 1100 state and local affiliates that engage in research, education, support, and advocacy. The National Disability Rights Network (NDRN) is the non-profit membership association of protection and advocacy (P&A) agencies that are located in all 50 States, the District of Columbia, Puerto Rico, and the U.S. Territories. For 30 years, P&As have worked with children and adults with disabilities who depend on Medicaid-funded services and supports to enable them to live in the community rather than in institutions. Disability Rights Florida, formerly the Advocacy Center for Persons with Disabilities, is the designated P&A for the State of Florida. In 2009, Florida Disability Rights assisted approximately 7,500 Floridians, with the largest group of requests for assistance in the area of securing access to health care supports and services. The Judge David L. Bazelon Center for Mental Health Law is a national public interest organization founded in 1972 to advocate for the rights of individuals with mental disabilities.

No party?s counsel authored this brief in whole or in part. No party or party?s counsel contributed money to fund preparation or submission of this brief. No person, other than amici and amici?s counsel, contributed money intended to fund preparation or submission of this brief.

Whether the district court properly held that the Medicaid provisions of the Patient Protection and Affordable Care Act (ACA) do not impermissibly coerce the Plaintiff States or commandeer their Medicaid programs.

Count Four of the Second Amended Complaint challenged provisions of the Patient Protection and Affordable Care Act (ACA) that expand Medicaid to childless, non-disabled adults whose incomes are below 133% of the federal poverty level. Second Am. Compl. at ¶¶ 83-86. Part of the State Plaintiffs? ?coercion and commandeering? claim was that the ACA works such a transformation in Medicaid that the States have no choice but to spend money and provide services in ways that are ?radically changed? from what was required by the Medicaid Act on the day before the ACA was enacted. Mem. in Supp. of Pls? Mot. for Summ. J. (Plfs. Mem.) at 25. According to the Plaintiffs, the Act converts Medicaid into a ?federally-imposed universal healthcare regime? that they have no choice but to accept. One can expect the States to reiterate their coercion and commandeering assertions before this Court.

The Court need not reach the merits of Plaintiffs? complaints about how the ACA changes Medicaid. It can join the five Circuits and the district court below?all of which have held that a ?coercion? claim does not lie against a Spending Clause cooperative-federalism program when, as here, a State has the legal right to withdraw from the program.1 If, however, the Court does decide to address the nature of the changes that the ACA makes in Medicaid, it will find that the Plaintiffs? coercion and commandeering claims find no support in the history and structure of the Medicaid Act, as originally enacted or as Congress and the States have changed it over time.