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Bruns v. Mayhew

United States Court of Appeals, First Circuit

April 28, 2014

HANS BRUNS and KADRA HASSAN, on behalf of themselves and other similarly situated individuals, Plaintiffs, Appellants,
MARY MAYHEW, Commissioner, Maine Department of Health and Human Services, Defendant, Appellee

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Jennifer A. Archer, with whom Kelly Remmel & Zimmerman, Jack Comart, Maine Equal Justice Partners, Zachary L. Heiden and ACLU of Maine Foundation were on brief, for appellants.

Justin B. Barnard, Assistant Attorney General, with whom Janet T. Mills, Attorney General, and Doris A. Harnett, Assistant Attorney General, were on brief, for appellee.

Before Howard, Stahl and Thompson, Circuit Judges.


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HOWARD, Circuit Judge

After Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (" PRWORA" ), narrowing the eligibility of non-citizens for Medicaid and other federal benefits, the state of Maine responded in 1997 by extending state-funded medical assistance benefits to certain legal aliens rendered ineligible for Medicaid. In 2011, the Maine Legislature terminated these benefits. The appellants allege that this termination of their benefits violated their rights under the Equal Protection Clause of the Fourteenth Amendment, and presently appeal from the district court's denial of their motion for a preliminary injunction. Finding no constitutional violation, we affirm the district court's denial of a preliminary injunction and remand for dismissal.


Medicaid is a cooperative federal-state program created in 1965 as an amendment to the Social Security Act in order to help states provide publicly-funded medical assistance to certain needy citizens. See Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S.Ct. 2566, 2581, 183 L.Ed.2d 450 (2012). A state's participation in the Medicaid program is voluntary, but once a state chooses to participate it must comply with federal statutory and regulatory requirements in order to receive federal matching funds. See 42 U.S.C. § § 1396-1, 1396a, 1396b, 1396c; id. at 2581; id. at 2601, 2604 (Roberts, C.J., joined by Breyer and Kagan, JJ.); Frew ex rel. Frew v. Hawkins, 540 U.S. 431, 433, 124 S.Ct. 899, 157 L.Ed.2d 855 (2004). The eligibility requirements for Medicaid coverage are governed by federal law. Under the Medicaid Act, participating states must provide full Medicaid services under the approved state plan to certain groups of individuals who meet the eligibility criteria, including " categorically needy" groups. See 42 U.S.C. § § 1396a(a)(10)(A)(I), 1396d(a); Lewis v. Thompson, 252 F.3d 567, 570 (2d Cir. 2001). For years, federal Medicaid extended medical assistance to eligible individuals without regard to citizenship status or durational residency. By act of Congress, however, the alien eligibility requirements for publicly-funded benefits, including Medicaid, changed dramatically in 1996. See 8 U.S.C. § § 1601-1646.

In enacting PRWORA, Pub. L. No. 104-193, 110 Stat. 2105 (1996) (also known as the " Welfare Reform Act" ), Congress restricted the ability of aliens to access federal public welfare benefits, including Medicaid. See 8 U.S.C. § § 1611, 1612, 1621, 1622. PRWORA divided non-citizens into categories of " qualified" and " non-qualified" aliens, see id. § § 1611, 1641(b), and further restricted eligibility for federal welfare benefits by imposing a five-year United States residency requirement for most qualified aliens, see id. § 1613. Although PRWORA authorized states to expand the category of qualified aliens eligible for federal benefits, it prohibited the states from extending federal benefits to most aliens residing in the

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United States for less than five years. See id. § 1612(b).[1]

PRWORA left the states more discretion in the dispensation of state public benefits, authorizing the states " to determine the eligibility for any State public benefits of an alien who is a qualified alien," including qualified aliens residing less than five years in the United States. Id. § 1622(a). The Maine Legislature accordingly responded to PRWORA by enacting Public Law 1997, chapter 530, section A-16 (the " 1997 State Legislation," codified at Me. Rev. Stat. tit. 22, § 3762(3)(B)(2), as amended), which empowered the state Department of Health and Human Services (" DHHS" ) to provide medical assistance benefits to PRWORA-ineligible aliens residing in Maine. Although these benefits were purely state-funded, this program was jointly administered with the federal-state cooperative Medicaid program for eligible citizens and qualified aliens, and both the state-funded program and the state Medicaid program became known as " MaineCare." In June 2011, however, the Maine Legislature passed Public Law 2011, chapter 380, section KK-4 (the " 2011 State Legislation" ), a budgetary measure that terminated state-funded non-emergency medical assistance benefits for PRWORA-ineligible aliens residing less than five years in the United States, essentially repealing the 1997 State Legislation. In September 2011, DHHS sent form termination notices to approximately 500 non-citizens, informing them that their MaineCare benefits were being terminated and that they would remain eligible only for emergency care benefits.

The appellants Hans Bruns and Kadra Hassan represent a class of PRWORA-ineligible aliens residing in Maine and rendered ineligible for non-emergency medical assistance benefits as a result of the 2011 State Legislation. Bruns filed this class action complaint against Mary Mayhew in her official capacity as the Commissioner of DHHS in April 2012, and moved for a preliminary injunction against enforcement of the 2011 State Legislation. In the complaint, Bruns alleged that the state violated the Equal Protection Clause of the Fourteenth Amendment by continuing to provide MaineCare benefits to United States citizens while denying those benefits to similarly situated non-citizens due solely to their alienage.

The Commissioner opposed the motion for a preliminary injunction, and also filed a motion to dismiss the complaint. In November 2012, the district court denied without prejudice the Commissioner's motion to dismiss. Although the relevant legislative history and statutory provisions strongly suggested that the appellants were not similarly situated to United States citizens and eligible aliens receiving Medicaid and thus that they were not treated unequally by the state of Maine, the district court concluded that this determination ultimately came too close to a factual finding and was therefore inappropriate to resolve on a motion to dismiss.

In March 2013, the district court denied the appellants' motion for a preliminary injunction. The court found that the state had effectively operated two separate medical assistance programs and that the appellants, as PRWORA-ineligible aliens receiving separately-funded benefits from a state program, were not similarly situated to recipients of federal Medicaid. Accordingly, the court concluded that the appellants were unlikely to succeed on the

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merits of their equal protection claim. Secondarily, the court also concluded that the appellants had not established a potential for irreparable harm. This appeal followed.


" We review the denial of a preliminary injunction under a deferential standard, reversing only upon finding a mistake of law, a clear error in fact-finding, or other abuse of discretion." Nat'l Org. for Marriage v. Daluz, 654 F.3d 115, 117 (1st Cir. 2011). To obtain a preliminary injunction, a plaintiff " must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest." Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 20, 129 S.Ct. 365, 172 L.Ed.2d 249 (2008). We have recognized the first two factors, likelihood of success and of irreparable harm, as " the most important" in the calculus. González-Droz v. González-Colón, 573 F.3d 75, 79 (1st Cir. 2009). The appellants argue that the district court erred in concluding that they had demonstrated neither a likelihood of success on ...

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