928 F. Supp. 2d 258
D. Me.2013Background
- This case concerns Maine’s MaineCare plan amendment reducing income disregards for QMB/SLMB/QI groups, approved Jan 7, 2013 by CMS.
- Plaintiffs are disabled adults facing loss or reduction of MaineCare benefits effective March 1, 2013.
- Plaintiffs argue the approval violates the ACA maintenance of effort (MOE) provision as applied to their income level (133% FPL).
- CMS approval followed Maine’s statutory trigger allowing a waiver/notification of MOE; Maine certified budget deficit for FY2013.
- Plaintiffs seek a temporary restraining order to vacate CMS approval pending merits; court schedules expedited consideration.
- Court denies TRO, citing complex MOE statute, uncertainty on likelihood of success, irreparable harm, and timing constraints; future relief possible after full record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether MOE allows Maine to restrict eligibility for nonpregnant, nondisabled adults | Plaintiffs: MOE prohibits such restrictions | Sebelius: MOE applies based on group eligibility, not individual disability status | No TRO; merits uncertain; MOE interpretation contested |
| Whether income means countable income with state disregards | Plaintiffs: income = countable income incl. disregards | Defendant: income = actual gross income pre-disregards | Issue unresolved on full record; not enough to grant TRO |
| Whether irreparable harm from loss of MaineCare is likely | Affidavits show imminent harm | Record insufficient to show immediate irreparable harm | Harm not proven likely in immediate future to justify TRO |
| Whether balance of equities/public interest favor TRO | Relief serves health and independence; federal law enforcement | Costs to Maine and state finances; public interest uncertain | Public-interest and equities neutral given lack of decisive record |
Key Cases Cited
- Winter v. NRDC, 555 U.S. 7 (U.S. 2008) (four-factor test for preliminary relief; urgency considerations)
- Fortuño, 699 F.3d 1 (1st Cir. 2012) (strong likelihood of success required for preliminary relief; deference to agency interpretations)
- Petit, 647 F. Supp. 1312 (D. Me. 1986) (wrongful denial of benefits may cause irreparable harm; distinguishable facts)
- Mass. Ass’n of Older Americans v. Sharp, 700 F.2d 749 (1st Cir. 1983) (termination of benefits causing care denial constitutes irreparable injury)