Q & A on the Supreme Court’s Frew v Hawkins Decision

Executive Summary

This Q&A discusses the importance of the 2004 Frew v. Hawkins case.

Q: What is the significance of the recent Frew v. Hawkins decision issued by the U.S. Supreme Court? 
A: In a unanimous decision, the U.S. Supreme Court found the consent decree entered into in a Medicaid case by the state of Texas was enforceable by the federal court. According to the court, enforcement of the consent decree did not violate the Eleventh Amendment. 
Background
Frew v. Hawkins, 540 U.S. ___, No. 02-628 (Jan. 14, 2003), began in 1993 when mothers of children eligible for Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services filed suit against two state agencies and some agency officials. The plaintiffs sought injunctive relief against the Texas Department of Health and the Texas Health and Human Services Commission as well as the Commissioners of both agencies, the Texas State Medicaid Director and certain staff members at the Department of Health, all in Governor George W. Bush=s administration. According to the plaintiffs, the Texas Medicaid program 1) failed to satisfy federal requirements that eligible children receive health, dental, vision and hearing screens, 2) provided inadequate notice of available services to recipients, 3) failed to meet annual participation goals, 4) lacked proper case management procedures and 5) did not provide uniform services throughout the state. The state agencies sought to dismiss the claims against them on Eleventh Amendment sovereign immunity grounds. The U.S. District Court dismissed the claims against the state agencies; however, state officials remained in the suit and the Court certified a class of more than one million children who were entitled to EPSDT services. After intense negotiations, the parties entered into a consent decree which outlined a comprehensive plan for implementing the federal EPSDT statute. 
Two years after the consent decree was entered, the plaintiffs filed a motion to enforce the decree in U.S. District Court. They claimed that state officials failed to comply with various parts of the consent decree. State officials denied the allegations and responded that the consent decree was unenforceable under sovereign immunity principles of the Eleventh Amendment.

Following an evidentiary hearing, the District Court held that certain provisions of the consent decree had been violated and rejected the Eleventh Amendment arguments. 
State officials appealed and the Court of Appeals for the Fifth Circuit reversed the lower court's decision. The Appeals Court found that the Eleventh Amendment barred enforcement of the decree. Unless the violation of the consent decree was also a statutory violation of the Medicaid Act that imposed a clear and binding obligation on the State, the consent decree could not be enforced by the federal court. According to the Fifth Circuit, the EPSDT program in Texas was fine as long as it complied with the general mandates of federal law. Without an established violation of federal law, the District Court lacked jurisdiction to remedy violations of the consent decree. 
Supreme Court's Decision
To resolve a conflict between the Fifth Circuit and other circuits which held that the Eleventh Amendment did not bar enforcement of consent decrees in similar circumstances, the U.S. Supreme Court granted certiorari. In a unanimous decision, the Court overturned the Fifth Circuit. It held that federal court enforcement of the consent decree did not violate the Eleventh Amendment. The opinion was written by Justice Anthony Kennedy. 
Petitioners asserted that the consent decree could be enforced without violating the Eleventh Amendment for two reasons: 1) the State of Texas waived its Eleventh Amendment immunity in the course of litigation, and 2) enforcement was permitted under the principles of Ex parte Young. Ex parte Young, 209 U.S. 123 (1908), provided an exception to Eleventh Amendment sovereign immunity, allowing federal courts to enjoin state actors from engaging in ongoing violations of federal law. Because the Court found that the consent decree was enforceable under Ex parte Young, it did not address the argument regarding waiver. 
According to the Court, Frew involved the intersection of the Eleventh Amendment and the rules governing consent decrees. While the Eleventh Amendment shielded states from law suits brought by individuals without their consent, suits for prospective injunctive relief against state officials who violate federal law were permitted. The issue to be resolved was whether violations of consent decrees constituted violations of federal law for the purposes of the Ex parte Young exception. 
The Court acknowledged that consent decrees must be directed at protecting federal interests. In Firefighters v. Cleveland, 478 U.S. 502, 525 (1986), the court found that a consent decree Amust spring from, and serve to resolve, a dispute within a court=s subject matter jurisdiction; must come within the general scope of the case made by the pleadings; and must further the objectives of the law upon which the complaint was based.@ Texas state officials did not claim that the entry of the consent decree violated the Eleventh Amendment, but rather that the Amendment narrowed the circumstances in which federal consent decrees involving state officials could be enforced.

The Respondents further argued that consent decrees involving state representatives threatened to broaden the narrow exception to Eleventh Amendment immunity because they could bind state governments to greater commitments than required by federal law. To avoid this, Respondents contended, federal courts should only be allowed to enforce a consent decree arising from an Ex parte Young suit if the court found a violation of federal law at the enforcement stage. They based this theory on the Court=s 1984 decision in Pennhurst State School and Hospital v. Halderman, 465 U.S. 89 (1984), in which the Supreme Court held that Ex parte Young did not apply to suits brought against state officials for violating state law. The Court was not persuaded, distinguishing Pennhurst on the basis that the consent decree in question sought to implement a federal statute, not state law, as in Pennhurst. 

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