Bruns v. Mayhew, 1st Cir. (2014)

7/26/2019 Bruns v. Mayhew, 1st Cir. (2014)

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United States Court of AppealsFor the First Circuit

No. 13- 1456

HANS BRUNS and KADRA HASSAN, on behal f of t hemsel vesand ot her si mi l ar l y si t uat ed i ndi vi dual s,

Pl ai nt i f f s , Appel l ant s ,

v.

MARY MAYHEW, Commi ssi oner ,

Mai ne Depar t ment of Heal t h and Human Ser vi ces,

Def endant , Appel l ee.

APPEAL FROM THE UNI TED STATES DI STRI CT COURT

FOR THE DI STRI CT OF MAI NE

[ Hon. J ohn A. Woodcock, J r . , U. S. Di st r i ct J udge]

Bef or e

Howar d, St ahl and Thompson,Ci r cui t J udges.

J enni f er A. Ar cher , wi t h whom Kel l y Remmel & Zi mmer man, J ackComart , Mai ne Equal J ust i ce Part ners, Zachary L. Hei den and ACLU ofMai ne Foundat i on wer e on br i ef , f or appel l ant s.

J ust i n B. Bar nar d, Assi st ant At t or ney Gener al , wi t h whomJ anetT. Mi l l s, At t or ney Gener al , and Dor i s A. Har net t , Assi st antAt t or ney Gener al , wer e on br i ef , f or appel l ee.

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HOWARD, Circuit Judge. Af t er Congr ess passed t he

Per sonal Responsi bi l i t y and Wor k Oppor t uni t y Reconci l i at i on Act of

1996 ( "PRWORA") , nar r owi ng t he el i gi bi l i t y of nonci t i zens f or

Medi cai d and ot her f eder al benef i t s, t he st at e of Mai ne responded

i n 1997 by extendi ng st at e- f unded medi cal assi st ance benef i t s t o

cer t ai n l egal al i ens r ender ed i nel i gi bl e f or Medi cai d. I n 2011,

t he Mai ne Legi sl at ur e t er mi nat ed t hese benef i t s. The appel l ant s

al l ege t hat t hi s t er mi nat i on of t hei r benef i t s vi ol at ed t hei r

r i ght s under t he Equal Pr ot ect i on Cl ause of t he Four t eent h

Amendment , and pr esent l y appeal f r omt he di st r i ct cour t ' s deni al of

t hei r mot i on f or a pr el i mi nar y i nj unct i on. Fi ndi ng no

consti t ut i onal vi ol at i on, we af f i r mt he di str i ct cour t ' s deni al of

a pr el i mi nar y i nj unct i on and remand f or di smi ssal .

I.

Medi cai d i s a cooper at i ve f eder al - st at e pr ogr am cr eat ed

i n 1965 as an amendment t o t he Soci al Secur i t y Act i n order t o hel p

st at es pr ovi de publ i cl y- f unded medi cal assi st ance to cer t ai n needy

ci t i zens. See Nat ' l Fed' n of I ndep. Bus. v. Sebel i us, 132 S. Ct .

2566, 2581 ( 2012) . A st at e' s par t i ci pat i on i n t he Medi cai d pr ogr am

i s vol unt ar y, but once a st at e chooses t o par t i ci pat e i t must

compl y wi t h f eder al st at ut or y and regul at or y r equi r ement s i n or der

t o r ecei ve f eder al mat chi ng f unds. See 42 U. S. C. 1396- 1, 1396a,

1396b, 1396c; i d. at 2581; i d. at 2601, 2604 ( Rober t s, C. J . , j oi ned

by Br eyer and Kagan, J J . ) ; Fr ew ex rel . Frew v. Hawki ns, 540 U. S.

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431, 433 ( 2004) . The el i gi bi l i t y r equi r ement s f or Medi cai d

coverage are governed by f ederal l aw. Under t he Medi cai d Act ,

par t i ci pat i ng st at es must pr ovi de f ul l Medi cai d ser vi ces under t he

appr oved st at e pl an t o cer t ai n gr oups of i ndi vi dual s who meet t he

el i gi bi l i t y cri t er i a, i ncl udi ng "cat egor i cal l y needy" gr oups. See

42 U. S. C. 1396a( a) ( 10) ( A) ( I ) , 1396d( a) ; Lewi s v. Thompson, 252

F. 3d 567, 570 ( 2d Ci r . 2001) . For year s, f eder al Medi cai d extended

medi cal assi st ance t o el i gi bl e i ndi vi dual s wi t hout r egar d t o

ci t i zenshi p st at us or dur at i onal r esi dency. By act of Congr ess,

however , t he al i en el i gi bi l i t y requi r ement s f or publ i cl y- f unded

benef i t s, i ncl udi ng Medi cai d, changed dr amat i cal l y i n 1996. See 8

U. S. C. 1601- 1646.

I n enact i ng PRWORA, Pub. L. No. 104- 193, 110 St at . 2105

( 1996) ( al so known as t he "Wel f ar e Ref or m Act " ) , Congr ess

r est r i ct ed t he abi l i t y of al i ens t o access f eder al publ i c wel f ar e

benef i t s, i ncl udi ng Medi cai d. See 8 U. S. C. 1611, 1612, 1621,

1622. PRWORA di vi ded nonci t i zens i nt o cat egor i es of "qual i f i ed"

and "non- qual i f i ed" al i ens, see i d. 1611, 1641( b) , and f ur t her

r est r i cted el i gi bi l i t y f or f eder al wel f ar e benef i t s by i mposi ng a

f i ve- year Uni t ed St at es r esi dency r equi r ement f or most qual i f i ed

al i ens, see i d. 1613. Al t hough PRWORA aut hor i zed st at es t o

expand t he cat egor y of qual i f i ed al i ens el i gi bl e f or f eder al

benef i t s, i t pr ohi bi t ed t he st at es f r omext endi ng f eder al benef i t s

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t o most al i ens r esi di ng i n t he Uni t ed St at es f or l ess t han f i ve

year s. See i d. 1612( b) . 1

PRWORA l ef t t he st at es mor e di scr et i on i n t he

di spensat i on of st at e publ i c benef i t s, aut hor i zi ng t he st at es " t o

det er mi ne t he el i gi bi l i t y f or any St at e publ i c benef i t s of an al i en

who i s a qual i f i ed al i en, " i ncl udi ng qual i f i ed al i ens r esi di ng l ess

t han f i ve year s i n t he Uni t ed St at es. I d. 1622( a) . The Mai ne

Legi sl atur e accordi ngl y responded t o PRWORA by enact i ng Publ i c Law

1997, chapt er 530, sect i on A- 16 ( t he "1997 St at e Legi sl at i on, "

codi f i ed at Me. Rev. St at . t i t . 22, 3762( 3) ( B) ( 2) , as amended) ,

whi ch empower ed t he st at e Depar t ment of Heal t h and Human Ser vi ces

( "DHHS") t o pr ovi de medi cal assi st ance benef i t s t o PRWORA-

i nel i gi bl e al i ens resi di ng i n Mai ne. Al t hough t hese benef i t s wer e

pur el y st at e- f unded, t hi s pr ogr amwas j oi nt l y admi ni st er ed wi t h t he

f eder al - st at e cooper at i ve Medi cai d pr ogr am f or el i gi bl e ci t i zens

and qual i f i ed al i ens, and bot h t he st at e- f unded pr ogr am and t he

st ate Medi cai d pr ogr ambecame known as "Mai neCare. " I n J une 2011,

however , t he Mai ne Legi sl atur e passed Publ i c Law 2011, chapt er 380,

sect i on KK- 4 ( t he "2011 St at e Legi sl at i on") , a budget ar y measur e

t hat t ermi nated st ate- f unded non- emergency medi cal assi st ance

benef i t s f or PRWORA- i nel i gi bl e al i ens r esi di ng l ess t han f i ve year s

i n t he Uni t ed St at es, essent i al l y r epeal i ng t he 1997 St at e

1We r ef er t hr oughout t hi s opi ni on t o al i ens absol ut el y bar r edf r om f eder al benef i t s by PRWORA' s f i ve- year r esi dency r equi r ement( such as t he appel l ant s her e) as " PRWORA- i nel i gi bl e al i ens. "

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Legi sl at i on. I n Sept ember 2011, DHHS sent f or mt er mi nat i on not i ces

t o appr oxi mat el y 500 nonci t i zens, i nf or mi ng t hem t hat t hei r

Mai neCare benef i t s were bei ng t ermi nated and t hat t hey woul d r emai n

el i gi bl e onl y f or emer gency car e benef i t s.

The appel l ant s Hans Br uns and Kadr a Hassan r epr esent a

cl ass of PRWORA- i nel i gi bl e al i ens r esi di ng i n Mai ne and r ender ed

i nel i gi bl e f or non- emer gency medi cal assi st ance benef i t s as a

r esul t of t he 2011 St at e Legi sl at i on. Br uns f i l ed t hi s cl ass

act i on compl ai nt agai nst Mar y Mayhew i n her of f i ci al capaci t y as

t he Commi ss i oner of DHHS i n Apr i l 2012, and moved f or a pr el i mi nary

i nj unct i on agai nst enf or cement of t he 2011 St at e Legi sl at i on. I n

t he compl ai nt , Br uns al l eged t hat t he st at e vi ol at ed t he Equal

Protect i on Cl ause of t he Four t eent h Amendment by cont i nui ng t o

pr ovi de Mai neCar e benef i t s t o Uni t ed St at es ci t i zens whi l e denyi ng

t hose benef i t s t o si mi l ar l y si t uat ed nonci t i zens due sol el y t o

t hei r al i enage.

The Commi ssi oner opposed t he mot i on f or a prel i mi nar y

i nj unct i on, and al so f i l ed a mot i on t o di smi ss t he compl ai nt . I n

November 2012, t he di st r i ct cour t deni ed wi t hout pr ej udi ce the

Commi ss i oner ' s mot i on t o di smi ss. Al t hough t he r el evant

l egi sl at i ve hi st or y and st at ut or y pr ovi si ons st r ongl y suggest ed

t hat t he appel l ant s wer e not si mi l ar l y si t uat ed t o Uni t ed St at es

ci t i zens and el i gi bl e al i ens r ecei vi ng Medi cai d and t hus t hat t hey

wer e not t r eat ed unequal l y by t he stat e of Mai ne, t he di st r i ct

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cour t concl uded t hat t hi s det er mi nat i on ul t i mat el y came t oo cl ose

t o a f act ual f i ndi ng and was t her ef or e i nappr opr i at e t o r esol ve on

a mot i on t o di smi ss.

I n Mar ch 2013, t he di st r i ct cour t deni ed t he appel l ant s'

mot i on f or a pr el i mi nar y i nj unct i on. The cour t f ound t hat t he

st at e had ef f ect i vel y oper at ed t wo separ at e medi cal assi st ance

pr ogr ams and t hat t he appel l ant s, as PRWORA- i nel i gi bl e al i ens

r ecei vi ng separ at el y- f unded benef i t s f r oma st at e pr ogr am, wer e not

si mi l ar l y si t uat ed t o r eci pi ent s of f eder al Medi cai d. Accor di ngl y,

t he cour t concl uded t hat t he appel l ant s wer e unl i kel y t o succeed on

t he mer i t s of t hei r equal pr ot ect i on cl ai m. Secondar i l y, t he cour t

al so concl uded t hat t he appel l ant s had not est abl i shed a pot ent i al

f or i r r epar abl e har m. Thi s appeal f ol l owed.

II.

"We revi ew t he deni al of a pr el i mi nar y i nj unct i on under

a def er ent i al st andar d, r ever si ng onl y upon f i ndi ng a mi st ake of

l aw, a cl ear er r or i n f act - f i ndi ng, or ot her abuse of di scret i on. "

Nat ' l Or g. f or Mar r i age v. Dal uz, 654 F. 3d 115, 117 ( 1st Ci r .

2011) . To obt ai n a pr el i mi nar y i nj unct i on, a pl ai nt i f f " must

est abl i sh t hat he i s l i kel y t o succeed on t he mer i t s, t hat he i s

l i kel y t o suf f er i r r epar abl e har m i n t he absence of pr el i mi nar y

r el i ef , t hat t he bal ance of equi t i es t i ps i n hi s f avor , and t hat an

i nj unct i on i s i n t he publ i c i nt er est . " Wi nt er v. Nat ur al Res. Def .

Counci l , I nc. , 555 U. S. 7, 20 ( 2008) . We have r ecogni zed t he f i r st

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t wo f act or s, l i kel i hood of success and of i r r epar abl e har m, as "t he

most i mpor t ant " i n t he cal cul us. Gonzl ez- Dr oz v. Gonzl ez- Col n,

573 F. 3d 75, 79 ( 1st Ci r . 2009) . The appel l ant s ar gue t hat t he

di st r i ct cour t er r ed i n concl udi ng t hat t hey had demonst r at ed

nei t her a l i kel i hood of success on t he mer i t s of t hei r equal

pr ot ect i on chal l enge nor a l i kel i hood of i r r epar abl e har mabsent a

pr el i mi nar y i nj unct i on. Because we hol d t hat t he appel l ant s cannot

succeed on t he mer i t s of t hei r cl ai m, we need not consi der t he

l i kel i hood of i r r epar abl e har m.

The appel l ant s ar gue t hat t he t er mi nat i on of t hei r st at e-

f unded medi cal benef i t s under t he 2011 Legi sl at i on r epr esent ed

sel ect i ve al i enage- based t r eat ment by t he st at e of Mai ne. I n t he

appel l ant s' est i mat i on, t he st at e' s act i on di scr i mi nat ed agai nst a

suspect cl ass and t her ef or e war r ant s st r i ct scrut i ny, r equi r i ng t he

st at e to demonst r at e that t he al i enage cl assi f i cat i on advances a

compel l i ng st at e i nt er est by the l east r est r i ct i ve means avai l abl e.

The Commi ssi oner advances no ar gument t hat t he 2011 St at e

Legi sl at i on woul d sur vi ve st r i ct scrut i ny. I nst ead, t he crux of

t he Commi ssi oner ' s def ense, and of t he di st r i ct cour t ' s r ul i ng, i s

t hat Mai ne di d not di scr i mi nat e agai nst al i ens and i n f avor of

ci t i zens at al l . The Commi ssi oner suggest s that t he onl y al i enage-

based di st i nct i on i mpl i cat ed i n t hi s case was t he one dr awn by

Congr ess i n PRWORA, a di st i nct i on subj ect onl y t o def er ent i al

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r at i onal basi s r evi ew i n l i ght of t he f eder al gover nment ' s br oad

aut hor i t y over i mmi gr at i on and nat ur al i zat i on.

Thi s case t hus i nter t wi nes a cor e quest i on of equal

pr ot ect i on j ur i spr udence, concer ni ng t he pr oper scope of compar i son

i n det er mi ni ng whet her a pl ai nt i f f i s si mi l ar l y si t uat ed t o anot her

gr oup or ent i t y t r eat ed mor e f avor abl y under t he l aw, wi t h not i ons

of f eder al i smconcer ni ng t he r espect i ve r ol es of f eder al and st at e

gover nment s i n i mmi gr at i on pol i cy and Medi cai d al i ke. Bef or e

t ur ni ng t o the mer i t s of t hi s case, we ther ef or e pause t o l i mn some

over ar chi ng equal pr ot ect i on pr i nci pl es i n t he cont ext of al i enage.

A. Equal Protection Framework

I n or der t o est abl i sh an equal pr ot ect i on vi ol at i on, a

pl ai nt i f f must show st at e- i mposed di spar ate t r eat ment compar ed wi t h

ot her s si mi l ar l y si t uat ed "' i n al l r el evant r espects. ' " Bar r i ngt on

Cove Ltd. P' shi p v. R. I . Hous. & Mor t g. Fi n. Cor p. , 246 F. 3d 1, 8

( 1st Ci r . 2001) ( quot i ng Dar t mout h Revi ew v. Dar t mout h Col l . , 889

F. 2d 13, 19 ( 1st Ci r . 1989) , over r ul ed on ot her gr ounds by

Educadores Puert orr i queos en Acci n v. Hernndez, 367 F. 3d 61 (1st

Ci r . 2004) ) . I n det er mi ni ng whet her t wo gr oups ar e si mi l ar l y

si t uat ed, we have i dent i f i ed t he somewhat i mpr eci se test as

"whet her a pr udent per son, l ooki ng obj ect i vel y . . . woul d t hi nk

t hem r oughl y equi val ent . " Dart mout h Revi ew, 889 F. 2d at 19. Put

di f f er ent l y, " t he pr oponent of t he equal pr ot ect i on vi ol at i on must

show t hat t he par t i es wi t h whom he seeks t o be compar ed have

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engaged i n t he same act i vi t y vi s- - vi s t he gover nment ent i t y

wi t hout such di st i ngui shi ng or mi t i gat i ng ci r cumst ances as woul d

r ender t he compar i son i nut i l e. " Cor di - Al l en v. Conl on, 494 F. 3d

245, 251 ( 1st Ci r . 2007) .

Al i enage, l i ke r ace and nat i onal i t y, const i t ut es a

suspect cl assi f i cat i on under t he Four t eent h Amendment . See Gr aham

v. Ri char dson, 403 U. S. 365, 372 ( 1971) ( i nval i dat i ng st at e- i mposed

al i enage- based cl assi f i cat i ons) . Because "[ a] l i ens as a cl ass ar e

a pr i me exampl e of a ' di scr et e and i nsul ar ' mi nor i t y, " a st at e' s

al i enage- based cl assi f i cat i ons i nher ent l y r ai se concer ns of

i nvi di ous di scr i mi nat i on and ar e t her ef or e gener al l y subj ect t o

st r i ct j udi ci al scr ut i ny. I d. ( quot i ng Uni t ed St at es v. Car ol ene

Prods. Co. , 304 U. S. 144, 152- 53 n. 4 ( 1938) ) . Though st at es

t r adi t i onal l y enj oy br oad power t o regul at e economi cs and soci al

wel f ar e, even t he ot her wi se "val i d i nt er est i n pr eser vi ng t he

f i scal i nt egr i t y of [ st at e] pr ogr ams" i s gener al l y i nsuf f i ci ent

gr ounds f or a st ate- i mposed bur den on al i enage to sur vi ve an equal

pr ot ect i on chal l enge. I d. at 374- 75.

The cal cul us i s mar kedl y di f f er ent f or congr ess i onal act s

di st i ngui shi ng on t he basi s of al i enage, eval uat ed under t he Due

Process Cl ause of t he Fi f t h Amendment . See Mathews v. D az, 426

U. S. 67, 80- 85 ( 1976) ( hol di ng t hat congr essi onal al i enage- based

r est r i ct i ons on f eder al Medi car e benef i t s di d not vi ol at e due

pr ocess) . Unl i ke ot her suspect cl assi f i cat i ons such as r ace and

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nat i onal i t y, congr essi onal di spar at e t r eat ment of al i ens i s

pr esumed t o rest on nat i onal i mmi gr at i on pol i cy rat her t han

i nvi di ous di scr i mi nat i on. See i d. at 79- 80. Because Congr ess act s

wi t h pl enar y aut hor i t y when i t l egi sl at es t he r i ght s and benef i t s

t o be af f or ded al i ens pr esent i n t hi s count r y, such congr essi onal

act s ar e appr opr i at el y af f or ded r at i onal basi s j udi ci al r evi ew.

See i d. at 80- 85. St at es do not shar e i n t hi s pl enar y f eder al

power , t hough t hey obvi ousl y ar e i mpact ed by i t s exer ci se. See

Pl yl er v. Doe, 457 U. S. 202, 225 ( 1982) ; Hampton v. Mow Sun Wong,

426 U. S. 88, 95 ( 1976) ( "Congr ess and t he Pr esi dent have br oad

power over i mmi gr at i on and natur al i zat i on whi ch t he St ates do not

possess. " ) . The Supr eme Cour t has, however , st at ed t hat " i f t he

Feder al Gover nment has by uni f or mr ul e pr escr i bed what i t bel i eves

t o be appr opr i at e st andar ds f or t he t r eat ment of an al i en subcl ass,

t he St at es may, of cour se, f ol l ow t he f eder al di r ect i on. " Pl yl er ,

457 U. S. at 219 n. 19.

Because Medi cai d, unl i ke Medi car e, i s not sol el y f unded

and admi ni st er ed by the f eder al gover nment , t hi s case does not f al l

neat l y wi t hi n t he hol di ng of Mat hews. On t he ot her hand, t he

al i enage- based di st i nct i on i n t hi s case does not or i gi nat e pur el y

f r om st at e l egi sl at i on, unl i ke t he r est r i cti ons st r uck down i n

Gr aham. I nst ead, t hi s case pr esent s a Gor di an knot of f eder al and

st at e l egi sl at i on ef f ect i ng an adver se i mpact on r esi dent al i ens:

a f eder al - st at e cooper at i ve pr ogr am( Medi cai d) , t he el i gi bi l i t y f or

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whi ch was subsequent l y l i mi t ed on t he basi s of al i enage by f eder al

l egi sl at i on ( PRWORA) , t o whi ch t he st at e of Mai ne responded by

f i r st cr eat i ng, and t hen t er mi nat i ng, suppl ement al st at e- f unded

medi cal assi st ance benef i t s f or PRWORA- i nel i gi bl e al i ens onl y. We

now exami ne t hi s st at e l egi sl at i on i n mor e det ai l i n or der t o

pr oper l y eval uat e t he equal pr ot ect i on cl ai m bef or e us.

B. MaineCare

I n concl udi ng t hat t he appel l ant s wer e unl i kel y t o

succeed on t he mer i t s of t hei r equal pr ot ect i on cl ai m, t he di st r i ct

cour t expl ai ned t hat "because there were t wo separate pr ogr ams [ i n

Mai ne] di st r i but i ng medi cal benef i t s t o Medi cai d- i nel i gi bl e

qual i f i ed al i ens and ci t i zens . . . [ and] ci t i zens wer e st at ut or i l y

unabl e t o r ecei ve heal t h benef i t s under t he same st at e- sponsored

pr ogr am, t he Pl ai nt i f f s ar e unabl e [ t o] show [ t hat ] t hey wer e

si mi l ar l y si t uat ed wi t h ci t i zens f or equal pr ot ect i on pur poses. "

Br uns v. Mayhew, 931 F. Supp. 2d 260, 273 ( D. Me. 2013) . I t

ar r i ved at t hi s concl usi on af t er a t hor ough anal ysi s of t he

"[ c] ont our s of t he [ d] i sput ed [ p] r ogr ams, " not i ng i nt er al i a t hat

" [ t ] he st at ut or i l y mandat ed separ at e f undi ng st r uct ur es f or

Mai neCar e, whi ch r ecei ves f eder al and st at e f unds, and t he al i ens-

onl y pr ogr am, whi ch r ecei ved onl y st ate f unds post - PRWORA, i s t he

f i r st i ndi cat or of [ t he pr ogr ams' ] i ndependence"; t hat t hese

separ at e f undi ng st r uct ur es "al so si gni f y t hat t he pr ogr ams wer e

separatel y cont r ol l ed by the government s t hat f unded t hem"; and

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t hat "t he hi st or y of t he benef i t pr ogr ams, speci f i cal l y t he f eder al

gover nment ' s expr ess r el i nqui shment of i t s f or mer obl i gat i on t o

pr ovi de benef i t s f or qual i f i ed al i ens subj ect t o t he r esi dency

r equi r ement and t he St at e' s deci si on t o assume that obl i gat i on onl y

under scor es t hei r aut onomy. " I d. at 272- 73.

The appel l ant s aver t hat " [ t ] he Di st r i ct Cour t er r ed as

a mat t er of f act and l aw when i t concl uded t hat t here was no cl ass

of ci t i zens who wer e si mi l ar l y si t uat ed t o t he Pl ai nt i f f s, " because

( i n t hei r vi ew) Mai ne oper at ed a "uni t ar y medi cal assi st ance

benef i t s pr ogr am" f or ci t i zens and al i ens al i ke. To eval uat e t hi s

cont ent i on, we begi n wher e t he di st r i ct cour t di d - - by exami ni ng

t he l egal cont our s t hr ough whi ch such publ i cl y- f unded benef i t s have

been pr ovi ded t o Mai ne r esi dent s.

As we have expl ai ned above, PRWORA sei smi cal l y shi f t ed

t he l andscape of Medi cai d f undi ng i n 1996. Despi t e t he cooper at i ve

f eder al - st at e nat ur e of Medi cai d benef i t s, PRWORA cl assi f i es

Medi cai d as a "f eder al pr ogr am" f r om whi ch many subcl asses of

al i ens are excl uded, i ncl udi ng l egal r esi dent s who have not yet

r esi ded i n t hi s count r y f or f i ve year s. Par t i ci pat i ng st at es ar e

st at ut or i l y obl i gat ed t o al t er Medi cai d benef i t s avai l abl e t o t hei r

r esi dent s i n or der t o remai n compl i ant wi t h evol vi ng f eder al l aw.

Nevert hel ess, i n enact i ng PRWORA Congr ess aut hor i zed t he st ates t o

pr ovi de pur el y st at e- f unded wel f ar e benef i t s t o l egal al i ens, and

i n 1997, t he st at e of Mai ne enact ed l egi sl at i on t o amel i or at e t he

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ef f ect s of PRWORA f or l egal al i ens who woul d have remai ned el i gi bl e

f or Medi cai d benef i t s but f or PRWORA. Mai ne t her ef or e di spensed

bot h t he Medi cai d medi cal assi st ance f unds f or el i gi bl e r esi dent s

and t he st ate suppl ement al medi cal assi st ance f unds f or PRWORA-

i nel i gi bl e al i en r esi dent s under t he auspi ces of Mai neCar e. I n

2011, t he st at e l egi sl at ur e r epeal ed t he 1997 St at e Legi sl at i on' s

gr ant of st at e suppl ement al medi cal assi st ance benef i t s f or PRWORA-

i nel i gi bl e al i ens. At pr esent , publ i cl y- f unded medi cal assi st ance

r emai ns avai l abl e t o el i gi bl e Mai ne r esi dent s t hr ough f eder al - st at e

Medi cai d f undi ng st i l l known l ocal l y as Mai neCar e.

Wi t h t hi s cont ext est abl i shed, we t ur n t o t he appel l ant s'

f i r st cont ent i on t hat t he di st r i ct cour t er r ed i n const r ui ng t he

1997 St at e Legi sl at i on as establ i shi ng a new st at e pr ogr amdi st i nct

f r om Medi cai d. The 1997 St at e Legi sl at i on mandat ed t hat " f unds

must be expended"

[ t ] o pr ovi de f i nanci al and medi cal assi st ancet o cer t ai n nonci t i zens l egal l y admi t t ed t o t heUni t ed St at es. Reci pi ent s of assi st ance undert hi s subpar agr aph ar e l i mi t ed t o t hecat egor i es of nonci t i zens who woul d beel i gi bl e f or t he TANF or Medi cai d pr ogr ams butf or t hei r st at us as al i ens under PRWORA.El i gi bi l i t y f or t he TANF and Medi cai d pr ogr amsf or t hese cat egor i es of nonci t i zens must bedet er mi ned usi ng t he cr i t er i a appl i cabl e toot her r eci pi ent s of assi st ance f r om t hese

programs.

Me. Pub. L. 1997, ch. 530, A- 16 ( codi f i ed at Me. Rev. St at . t i t .

22, 3762( 3) ( B) ( 2) , as amended) . I n t he appel l ant s'

i nt er pr et at i on, t he l ast sent ence bespeaks a si ngl e medi cal

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assi st ance pr ogr ampr ovi ded by t he stat e of Mai ne f or ci t i zens and

al i ens al i ke. Par si ng i t s l anguage cl osel y, t hey suggest t hat had

t he l egi sl at ur e i nt ended t o cr eat e a separ at e and di st i nct pr ogr am

f or i nel i gi bl e al i ens, "i t woul d have r ef er enced ot her r eci pi ent s

of ' t hose pr ogr ams, ' r at her t han ' t hese pr ogr ams. ' "

The appel l ant s, however , gl oss over t he i mmedi at el y

pr ecedi ng sent ence, whi ch expr essl y l i mi t s st at e assi st ance t o " t he

cat egor i es of nonci t i zens who woul d be el i gi bl e f or t he TANF or

Medi cai d pr ogr ams but f or t hei r st atus as al i ens under PRWORA. "

Thi s sent ence cl ear l y evi nces t he l egi sl at ure' s awar eness t hat t hi s

subcl ass of al i ens was i nel i gi bl e f or f eder al l y- sponsor ed Medi cai d

due t o " t hei r st atus as al i ens under PRWORA. " We t heref ore agr ee

wi t h t he Commi ssi oner ' s suggest i on t hat "a sensi bl e r eadi ng of t he

f i nal sent ence" shows onl y t hat t he l egi sl at ur e i nt ended t o ut i l i ze

"t he same el i gi bi l i t y st andar ds ( save ci t i zenshi p r equi r ement s) "

f or PRWORA- i nel i gi bl e al i ens appl yi ng f or st at e assi st ance as wer e

ut i l i zed f or Medi cai d appl i cant s.

The appel l ant s al so al l ege t hat , i n pract i ce, Mai ne

oper at ed a si ngl e st at e heal t hcar e pr ogr am, Mai neCar e, whi ch di d

not di st i ngui sh bet ween el i gi bl e ci t i zens and al i ens on t he one

hand and PRWORA- i nel i gi bl e al i ens on t he ot her . The appel l ant s

emphasi ze, i nt er al i a, t hat t he st at e r ef er r ed t o al l publ i c

medi cal assi st ance benef i t s as "Mai neCare" and i nf ormed PRWORA-

i nel i gi bl e al i ens i n 2011 t hat t hei r "Mai neCar e" benef i t s wer e

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bei ng changed; t hat t he st at e appl i ed t he same el i gi bi l i t y cr i t er i a

and used t he same appl i cat i on f or m f or al l Mai neCar e appl i cant s;

t hat ci t i zens and nonci t i zens r ecei ved t he same "f ul l benef i t s";

and t hat t he st at e occasi onal l y submi t t ed i t s expendi t ur es on

PRWORA- i nel i gi bl e al i ens t o the f eder al gover nment , whi ch l at er

sought r ei mbur sement f r omt he st ate. The Commi ss i oner acknowl edges

t hat t he appel l ant s' mat er i al s " col l ect i vel y suggest t hat t he Mai ne

Depart ment of Heal t h and Human Servi ces di d not di st i ngui sh, both

out war dl y and i n cer t ai n aspect s of i t s i nt er nal admi ni st r at i on,

bet ween t he Medi cai d benef i t pr ovi ded t o ci t i zens and el i gi bl e

al i ens and t he st at e- cr eat ed benef i t t hat was pr ovi ded t o Medi cai d-

i nel i gi bl e al i ens. " Never t hel ess, t he Commi ssi oner mai nt ai ns t hat

publ i c per cept i on and common admi ni st r at i on do not r ender t he

f eder al - st at e Medi cai d benef i t s and t he st at e al i ens- onl y benef i t s

l egal l y i ndi st i nct f or equal pr ot ect i on pur poses.

We agr ee wi t h t he Commi ss i oner . The veneer of a si ngl e

Mai neCar e pr ogr ammer el y obscur ed t he l egal r eal i t y t hat , f r om1997

t o 2011, Mai neCar e r eci pi ent s r ecei ved benef i t s f r om t wo di st i nct

pr ogr ams: one f unded j oi nt l y by the f ederal and st ate government s,

wi t h t he f eder al gover nment r et ai ni ng ul t i mat e aut hor i t y over ,

i nt er al i a, el i gi bi l i t y cr i t er i a; and t he ot her f ul l y f unded and

cont r ol l ed by t he st at e gover nment . I t was t he f eder al gover nment

t hat det er mi ned t he appel l ant s' i nel i gi bi l i t y f or Medi cai d benef i t s

by enact i ng PRWORA, t o whi ch the st at e responded by ext endi ng

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equi val ent st at e- f unded medi cal assi st ance benef i t s t o t he

appel l ant s f or a t i me.

The Ni nth Ci r cui t ' s anal ysi s i n Pi ment el v. Dr eyf us, 670

F. 3d 1096 ( 9t h Ci r . 2012) , r ej ect i ng a compar abl e equal pr ot ect i on

chal l enge t o t he ter mi nat i on of a st at e f ood assi st ance pr ogr amf or

PRWORA- i nel i gi bl e al i ens onl y, i s par t i cul ar l y i nst r uct i ve her e.

Li ke Mai neCar e, Washi ngt on' s "Basi c Food Progr am" j oi nt l y pr ovi ded

st at e- f unded f ood assi st ance t o PRWORA- i nel i gi bl e al i ens and

f eder al Suppl ement al Nut r i t i on Assi st ance Pr ogr am( "SNAP" ) benef i t s

t o ci t i zens and el i gi bl e al i ens. The agency empl oyed a si ngl e

appl i cat i on f orm and i dent i cal el i gi bi l i t y cr i t er i a f or al l ai d

r eci pi ent s, and t he ai d r eci pi ent s t hemsel ves wer e not i nf or med of

t he sour ce of t hei r benef i t s. I d. at 1101- 02. The st at e was al so

aut hor i zed t o i ssue f eder al SNAP benef i t s t o i nel i gi bl e al i ens so

l ong as i t t hen r ei mbur sed t he f eder al gover nment f or t he val ue of

t he benef i t and associ at ed admi ni st r at i ve cost s. I d. at 1100- 01.

The Ni nth Ci r cui t never t hel ess hel d t hat " [ t ] he appear ance of a

si ngl e pr ogr am does not over come thi s f act : t he two pr ogr ams ar e,

i n r eal i t y, t wo separ at el y admi ni st er ed pr ogr ams f unded by two

di st i nct sover ei gns, " l eavi ng t he pl ai nt i f f s di ssi mi l ar l y s i t uat ed

t o SNAP r eci pi ent s. I d. at 1107. The cour t el abor at ed:

A car ef ul consi der at i on of t he cont our s of t heSNAP pr ogr am, i ncl udi ng the st atut ory scheme,sour ce of f undi ng, ext ent of st at ei nvol vement , and hi st or y, demonst r at es t hatSNAP i s a f eder al pr ogr am whi ch t he st at emer el y assi st s i n admi ni st er i ng, r at her t han a

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st at e pr ogr am whi ch r ecei ves f eder alassi st ance, and t hat i t s benef i ci ar i es ar edi f f er ent l y si t uat ed f r om, and cannot becompar ed t o, [ t he named pl ai nt i f f ] .

I d. at 1108; see al so Hong Pham v. St ar kowski , 16 A. 3d 635, 654- 55

( Conn. 2011) ( exami ni ng t he cont our s of Medi cai d and f i ndi ng

pl ai nt i f f s, PRWORA- i nel i gi bl e al i ens f or mer l y r ecei vi ng

suppl ement al st at e medi cal assi st ance benef i t s, di ssi mi l ar l y

si t uat ed t o Medi cai d r eci pi ent s "[ i ] n l i ght of t he scope of f eder al

cont r ol over t he f eder al Medi cai d pr ogr am and t he extent t o whi ch

t he f ederal government f unds t hat pr ogr am") .

Cont r ar y t o t he appel l ant s' suggest i on t hat Mai ne

oper at ed a si ngl e st at e medi cal assi st ance pr ogr am f or al l st at e

r esi dent s, we t her ef or e agr ee wi t h t he di st r i ct cour t ' s concl usi on

t hat Mai neCare compr i sed t wo separ at e medi cal assi st ance pr ogr ams:

f eder al - st at e cooper at i ve Medi cai d and a st at e suppl ement al pr ogr am

f or PRWORA- i nel i gi bl e al i ens onl y. When i t repeal ed t he

suppl ement al al i ens- onl y pr ogr am, t he st at e of Mai ne di d not

depr i ve t he appel l ant s of a benef i t t hat i t cont i nued t o pr ovi de t o

ci t i zens - - or t o anyone el se, f or t hat mat t er . Consequent l y, t he

appel l ant s cannot poi nt t o any si mi l ar l y si t uat ed i ndi vi dual s who

r emai n "engaged i n t he same act i vi t y vi s- - vi s t he government

ent i t y. " Cor di - Al l en, 494 F. 3d at 251 ( emphasi s added) ; see al so

Hong Pham, 16 A. 3d at 650 ( " [ T] he equal pr otect i on cl ause does not

r equi r e t he st at e t o t r eat i ndi vi dual s i n a manner si mi l ar t o how

ot her s are t r eat ed i n a di f f er ent pr ogr am gover ned by a di f f er ent

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gover nment . " ) ; Pi ment el , 670 F. 3d at 1107; Soski n v. Rei ner t son,

353 F. 3d 1242, 1255- 56 (10t h Ci r . 2004) ; Khr apunski y v. Doar , 909

N. E. 2d 70, 76- 77 ( N. Y. 2009) . 2

The f act t hat Mai ne vol unt ar i l y par t i ci pat ed i n Medi cai d

does not al t er our anal ysi s. By t he appel l ant s' l ogi c, Mai ne' s

cont i nued vol unt ar y par t i ci pat i on i n Medi cai d and compl i ance wi t h

PRWORA vi ol at ed t he Equal Pr ot ect i on Cl ause, r equi r i ng t he st at e to

ei t her wi t hdr aw f r omMedi cai d al t oget her or t o cr eat e an equi val ent

st at e- f unded medi cal assi st ance benef i t f or PRWORA- i nel i gi bl e

al i ens. Of cour se, Mai ne di d t he l at t er f or a t i me; accor di ng t o

t he appel l ant s, t he st at e' s t er mi nat i on of t hose equi val ent st at e-

f unded benef i t s pl aced i t i n vi ol at i on of t he Equal Pr ot ect i on

2I n l i ght of t hi s di st i nct i on bet ween f eder al and st at eact i on, we f i nd t he appel l ant s' cases unper suasi ve. Al i essa exr el . Fayad v. Novel l o, 754 N. E. 2d 1085 ( N. Y. 2001) , addr essed a

st at e' s di scret i onar y i mposi t i on of al i enage- based cri t er i a f orpur el y st at e- f unded benef i t s, r ender i ng t he pl ai nt i f f al i enssi mi l ar l y s i t uat ed t o ci t i zens st i l l r ecei vi ng t hese benef i t s .( The New Yor k Cour t of Appeal s i t sel f l at er under scor ed t hi sdi st i nct i on i n Khr apunski y, 909 N. E. 2d at 76- 77. ) Al t hough Ehr l i chv. Per ez, 908 A. 2d 1220 ( Md. 2006) , i nval i dat ed t he t er mi nat i on ofa st at e- f unded benef i t s pr ogr amf or PRWORA- i nel i gi bl e al i ens onl y,t he Mar yl and cour t r el i ed heavi l y on Al i essa wi t hout addr essi ngt hi s di st i nct i on. As f or Unt haksi nkun v. Por t er , No. 11- 588, 2011WL 4502050 (W. D. Wash. Sept . 28, 2011) , Fi nch v. Commonweal t hHeal t h I nsur ance Connect or Aut hor i t y ( Fi nch I I ) , 959 N. E. 2d 970( Mass. 2012) , and Fi nch v. Commonweal t h Heal t h I nsur ance Connect or

Aut hor i t y ( Fi nch I ) , 946 N. E. 2d 1262 ( Mass. 2011) , t hese casesi nvol ved Medi cai d "demonst r at i on pr ogr ams" r at her t han f eder al -st at e cooper at i ve Medi cai d pr ogr ams per se. See Fi nch I I , 959N. E. 2d at 974, 981 ( expl ai ni ng that Massachuset t s' Commonweal t hCar e pr ogr am, al t hough f eder al l y- subsi di zed, was " St at e- i ni t i at ed, ""ent i r el y St at e- r un, " "ent i r el y under St at e cont r ol , and not boundby uni f or m Feder al r ul es") .

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Cl ause, j ust as i t woul d have been had i t never extended t hose

benef i t s i n t he f i r st pl ace.

The Equal Pr ot ect i on Cl ause does not pl ace t he st at e i n

such a Procr ust ean bed. The f act t hat Congr ess di scr i mi nat ed on

t he basi s of al i enage i n enact i ng PRWORA does not al so est abl i sh

al i enage- based di scr i mi nat i on by Mai ne mer el y because of i t s

cont i nued Medi cai d par t i ci pat i on and r equi r ed compl i ance wi t h

PRWORA. Whi l e t he f ederal government determi nes cer t ai n basel i ne

el i gi bi l i t y r equi r ement s and sel ect s par t i cul ar cl asses of

cat egor i cal l y needy per sons who ar e el i gi bl e t o r ecei ve Medi cai d

benef i t s, a st at e, by choosi ng t o par t i ci pat e i n Medi cai d,

gener al l y adopt s t he gr oupi ng of f eder al el i gi bi l i t y requi r ement s

as a whol e. Li ke t he Hong Pham cour t , we t her ef or e concl ude t hat

i f Mai ne can be sai d t o have "di scr i mi nat ed" at al l , i t onl y di d so

on t he basi s of f eder al Medi cai d el i gi bi l i t y, a beni gn

cl assi f i cat i on subj ect t o mer e r at i onal basi s revi ew. See i d. at

659; cf . Soski n, 353 F. 3d at 1255- 56.

Li ke ot her cour t s f aci ng si mi l ar post - PRWORA equal

pr ot ect i on cl ai ms, we t her ef ore concl ude t hat t he st at e was under

no const i t ut i onal obl i gat i on t o " f i l l t he gap" cr eat ed by PRWORA by

ext endi ng equi val ent st at e- f unded benef i t s t o f eder al l y- i nel i gi bl e

al i ens. See Korab v. Fi nk, No. 11- 15132, 2014 WL 1302614, at *2,

*9 ( 9t h Ci r . Apr . 1, 2014) ; Pi ment el , 670 F. 3d at 1109; Hong Pham,

16 A. 3d at 661; Khr apunski y, 909 N. E. 2d at 77; cf . Sudomi r v.

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McMahon, 767 F. 2d 1456, 1465- 66 ( 9th Ci r . 1985) . Because Mai ne was

not obl i gat ed t o ext end equi val ent st at e- f unded benef i t s t o t he

appel l ant s i n t he f i r st pl ace, i t f ol l ows t hat t he t er mi nat i on of

t hose benef i t s does not vi ol at e t he Equal Pr ot ect i on Cl ause. See

Pi ment el , 670 F. 3d at 1109- 10; Hong Pham, 16 A. 3d at 661.

As a l ast st and, t he appel l ant s r el y on Gr aham' s

pr ocl amat i on t hat Congr ess "does not have t he power t o aut hor i ze

t he i ndi vi dual St at es t o vi ol at e t he Equal Pr ot ect i on Cl ause. " 403

U. S. at 382. Mor e speci f i cal l y, t hey cont end t hat "[ t ] he

Commi ssi oner cannot seek shel t er f or her equal pr ot ect i on vi ol at i on

i n Congress' s enact ment of PRWORA" because PRWORA di d not "cr eate

a nat i onal uni f or m i mmi gr at i on pol i cy wi t h r espect t o access t o

medi cal car e, " and i nst ead l ef t " t he deci si on of whet her t o pr ovi de

medi cal assi st ance f or medi cal l y i ndi gent nonci t i zens who have

been i n t he count r y l ess t han f i ve year s t o t he i ndi vi dual st at es. "

However , as we have expl ai ned above, t he appel l ant s' argument r est s

on t he assumpt i on t hat a st at e' s mer e par t i ci pat i on i n Medi cai d,

subj ect t o PRWORA' s mandat or y el i gi bi l i t y r est r i ct i ons, r epr esent s

al i enage- based di scr i mi nat i on. Because we concl ude t hat t he

st at e dr ew no di st i nct i ons on t he basi s of al i enage, Gr aham' s

pr oscr i pt i on does not appl y her e, and we ther ef or e need not r each

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t he quest i on of whet her Mai ne act ed i n accor dance wi t h uni f or m

f eder al pol i cy. 3

I n shor t , t he di spar at e t r eat ment chal l enged by t he

appel l ant s i s not at t r i but abl e t o l egi sl at i on enact ed by t he st at e

of Mai ne. I nst ead, t he appel l ant s ar e exper i enci ng t he i mpact of

a congr essi onal deci si on - - PRWORA' s mandat or y f i ve- year r esi dency

r equi r ement - - r estr i ct i ng t hei r el i gi bi l i t y f or publ i c wel f ar e

benef i t s, i ncl udi ng f eder al - st at e cooper at i ve pr ogr ams such as

Medi cai d. As a r esul t , t her e i s no cl ass of si mi l ar l y si t uat ed

ci t i zens wi t h whom t he appel l ant s can be compar ed vi s- - vi s t he

st at e of Mai ne. We t her ef or e concl ude t hat t he appel l ant s' equal

pr ot ect i on cl ai m f ai l s on t he mer i t s and t hat t he di st r i ct cour t

pr oper l y deni ed t he appel l ant s' r equest f or a pr el i mi nar y

i nj uncti on.

C. Dismissal

One f i nal t ask r emai ns. The Commi ss i oner r equest s that

we r emand and or der t he di st r i ct cour t t o di smi ss t hi s case

out r i ght . The r equest i s a sound one. We may r emand a case f or

di smi ssal af t er r evi ewi ng a di st r i ct cour t ' s pr el i mi nar y i nj uncti on

3Even assumi ng arguendo that Mai ne di scr i mi nated on t he basi sof al i enage i n decl i ni ng t o extend st at e- f unded benef i t s t o PRWORA-

i nel i gi bl e al i ens, we quest i on whet her t he st at e' s act i on woul d i nf act r un af oul of Gr aham. We need not deci de t he quest i on t oday,but we note t hat bot h the Ni nt h and Tent h Ci r cui t s have hel d thatPRWORA r epr esent s a uni f or m f eder al pol i cy such t hat a st at e' sexer ci se of i t s di scr et i on under 8 U. S. C. 1612( b) and 1622( a)gar ner s onl y r at i onal basi s r evi ew under Pl yl er . See Kor ab, 2014WL 1302614, at *8; Soski n, 353 F. 3d at 1255.

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or der , see Fi r st Med. Heal t h Pl an, I nc. v. Vega- Ramos, 479 F. 3d 46,

50- 51 ( 1st Ci r . 2007) , and we do so here.

I n or der t o sur vi ve a mot i on t o di smi ss, a compl ai nt

"must pr ovi de f ai r not i ce t o t he def endant s and st at e a f aci al l y

pl ausi bl e l egal cl ai m. " Ocasi o- Her nndez v. For t uo- Bur set , 640

F. 3d 1, 12 ( 1st Ci r . 2011) . "Non- concl usor y f act ual al l egat i ons i n

t he compl ai nt must [ ] be t r eat ed as t r ue, even i f seemi ngl y

i ncredi bl e, " i d. , but a cour t i s "' not bound t o accept as t r ue a

l egal concl usi on couched as a f act ual al l egat i on, ' " Bel l At l . Cor p.

v. Twombl y, 550 U. S. 544, 555 (2007) ( quot i ng Papasan v. Al l ai n,

478 U. S. 265, 286 ( 1986) ) .

I n i t s order denyi ng wi t hout pr ej udi ce t he Commi ssi oner ' s

mot i on t o di smi ss f or f ai l ur e t o st at e a cl ai m, t he di st r i ct cour t

was deci dedl y skept i cal as t o t he mer i t s of t he appel l ant s' equal

pr ot ect i on cl ai m, and al l owed t he case t o go f or war d "despi t e some

mi sgi vi ngs. " Br uns v. Mayhew, No. 12- 131, 2012 WL 5874812, at *13

( D. Me. Nov. 20, 2012) . Never t hel ess, t he di st r i ct cour t f el t

const r ai ned by t he def er ent i al pl eadi ng st andar d and f ound " t he

l i ne bet ween f act ual al l egat i on and l egal concl usi on [ ] t oo mur ky

f or a cl ean and deci si ve r esol ut i on, " because i n i t s opi ni on t he

quest i on of whether Mai ne operated separate medi cal benef i t s

pr ogr ams appear ed t o be "a f act ual i ssue. " I d. at *9, *13.

I n opposi ng di smi ssal , t he appel l ant s agr ee wi t h t he

di st r i ct cour t ' s r easoni ng and al so poi nt t o t he Ni nt h Ci r cui t ' s

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anal ysi s i n Pi ment el , whi ch l ooked t o the "t he st at ut or y scheme,

sour ce of f undi ng, extent of st at e i nvol vement , and hi st or y" t o

det er mi ne whet her r eci pi ent s of st at e- f unded f ood assi st ance wer e

si mi l ar l y si t uat ed t o f eder al SNAP r eci pi ent s. 670 F. 3d at 1108.

The appel l ant s er r , however , i n f r ami ng Pi ment el ' s anal ysi s as a

" f act ual i nqui r y. " The Pi ment el cour t f ocused al most excl usi vel y

on t he l egal cont our s of t he f eder al and st at e f ood assi st ance

pr ogr ams, and not at al l on t he pl ai nt i f f s' f actual al l egat i ons

r egardi ng t he admi ni st r at i on and appear ance of t he pr ogr ams.

I ndeed, t he cour t expl i ci t l y st at ed, "The st at ut or y scheme

est abl i shes t hat t he SNAP pr ogr am i s f eder al . " I d. ( emphasi s

added) .

Li kewi se, bot h t he appel l ant s' under l yi ng compl ai nt and

our own anal ysi s i n t hi s case ar e gr ounded i n l aw r at her t han f act .

The appel l ant s set f or t h Mai ne' s pur por t edl y unconst i t ut i onal

l egi sl at i ve acti ons i n a secti on of t hei r compl ai nt t i t l ed

"St at ut or y Framewor k, " separ at e f r om t he "Fact ual Al l egat i ons"

sect i on descr i bi ng t he i ndi vi dual appel l ant s' medi cal condi t i ons

and deni al of benef i t s. That sect i on i s r i f e wi t h l egal

concl usi ons, st at i ng i nt er al i a t hat "PRWORA di d not pr escr i be a

uni f or m r ul e f or t he t r eat ment of al i ens"; t hat "[ a] l t hough

Mai neCar e benef i t s f or [ PRWORA- i nel i gi bl e] nonci t i zens wer e

excl usi vel y st at e- f unded whi l e Uni t ed St at es ci t i zen benef i t s wer e

j oi nt l y f unded by t he f eder al and st at e gover nments, t hi s di d not

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cr eat e an i ndependent st at e Medi cai d pr ogr am f or l awf ul per manent

r esi dent s i n Mai ne" ; and t hat t he 2011 Legi sl at i on "den[ i ed] non-

ci t i zens l awf ul l y resi di ng i n Mai ne f ul l Mai neCar e cover age whi l e

al l owi ng si mi l ar l y si t uat ed Uni t ed St at es ci t i zens t o r et ai n t hose

same Mai neCare benef i t s. "

I n f i ndi ng no equal pr ot ect i on vi ol at i on i n t hi s case, we

have t aken as t r ue t he appel l ant s' al l egat i ons t hat Mai ne' s st at e-

f unded suppl ement al medi cal assi st ance benef i t s f or PRWORA-

i nel i gi bl e al i ens wer e j oi nt l y admi ni st er ed wi t h, and out war dl y

i ndi st i ngui shabl e f r om, t he Medi cai d benef i t s enj oyed by ci t i zens

and el i gi bl e al i ens. We r ej ect onl y t hei r l egal concl usi ons, whi ch

we are under no obl i gat i on t o accept . See Twombl y, 550 U. S. at

555.

The appel l ant s al t er nat i vel y suggest t hat even i f st r i ct

scrut i ny i s unwar r ant ed, di smi ssal i s never t hel ess i nappr opr i at e

because t hey ar e ent i t l ed t o di scover y on t he quest i on of whet her

Mai ne' s act i ons woul d vi ol at e t he Equal Pr ot ect i on Cl ause under

mor e def er ent i al r evi ew. Mor e speci f i cal l y, t hey suggest t hat

di scover y may uncover evi dence of a di scr i mi natory ani mus agai nst

al i ens, i nval i dat i ng t he st at e' s act i on even under r at i onal basi s

r evi ew. Thi s ar gument i s doubl y f l awed. Fi r st , as we have

expl ai ned above, as a mat t er of l aw, Mai ne di d not di scr i mi nat e on

t he basi s of al i enage at al l . Second, and mor e f undament al l y, t he

appel l ant s' under l yi ng compl ai nt does not al l ege di scr i mi nat or y

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ani mus on the par t of t he st at e, nor does i t anywher e suggest t hat

Mai ne' s act i ons vi ol at ed t he Equal Prot ect i on Cl ause even under

r at i onal basi s r evi ew. The appel l ant s t her ef or e cannot sal vage

t hei r compl ai nt now by i nvoki ng such a cl ai m f or t he f i r st t i me.

See Al i cea v. Machete Musi c, No. 12- 1548, 2014 WL 888909, at *6

( 1st Ci r . Mar . 7, 2014) ( "The pl ai nt i f f s' f ai l ur e t o adequat el y

r ai se thi s ar gument bel ow dooms i t on appeal . " ) ; I ver son v. Ci t y of

Bost on, 452 F. 3d 94, 102 ( 1st Ci r . 2006) ( " [ T] heor i es not squar el y

and t i mel y rai sed i n t he t r i al cour t cannot be pur sued f or t he

f i r st t i me on appeal . ") .

III.

For t he f or egoi ng r easons, t he appel l ant s have f ai l ed t o

st at e a cl ai m under t he Equal Pr ot ect i on Cl ause. We t her ef or e

affirm t he di st r i ct cour t ' s deni al of a pr el i mi nar y i nj unct i on and

remand wi t h i nst r uct i ons t hat t he appel l ant s' compl ai nt be

di smi ssed.

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Documents

Bruns v. Mayhew, 1st Cir. (2014)