Mayhew v. Burwell
772 F.3d 80
1st Cir.2014Background
- Maine has participated in Medicaid since 1966; since 1991 it voluntarily covered low-income 18–20 year olds (treated as "children" for Medicaid purposes) through its MaineCare program.
- After accepting ARRA stimulus funds in 2009 (which required maintaining eligibility through Dec. 31, 2010), Maine sought in 2012 to remove coverage for 19- and 20-year-olds to address a state budget deficit.
- The ACA contains a maintenance-of-effort (MOE) provision, 42 U.S.C. § 1396a(gg), freezing states’ Medicaid eligibility standards for children as of March 23, 2010, until Oct. 1, 2019.
- CMS disapproved Maine’s 2012 state-plan amendment eliminating coverage for 19- and 20-year-olds, finding it inconsistent with § 1396a(gg); Maine DHHS petitioned for review and raised constitutional challenges.
- Maine DHHS argued § 1396a(gg) is unconstitutional under the Spending Clause (coercion / Pennhurst anti‑retroactivity) and violates the equal‑sovereignty principle of Shelby County; the court reviewed these de novo.
Issues
| Issue | Plaintiff's Argument (Maine DHHS) | Defendant's Argument (U.S./Intervenor) | Held |
|---|---|---|---|
| Spending‑Clause coercion: Does § 1396a(gg) unconstitutionally coerce states under NFIB? | § 1396a(gg) effectively coerces states because Medicaid is too large for states to refuse; parallels the Medicaid expansion struck in NFIB. | MOE is a routine conditional spending alteration (not a new program); it is a shift in degree, not kind, and falls within Congress’s spending power. | The MOE is constitutional: NFIB’s plurality permits incremental Medicaid conditions; § 1396a(gg) is not a coercive, new‑program penalty. |
| Pennhurst / anti‑retroactivity: Did § 1396a(gg) impermissibly impose retroactive post‑acceptance conditions? | Maine relied on ARRA’s shorter MOE and was "surprised" by ACA’s longer freeze; Congress retroactively changed the deal. | Medicaid statute reserves Congress’s power to amend; states had notice Congress could alter Medicaid conditions; § 1396a(gg) simply froze existing standards. | No Pennhurst violation: the change is within Congress’s reserved amendment power and states had adequate notice. |
| Equal sovereignty (Shelby County): Does § 1396a(gg) unlawfully single out or disparately treat Maine in a way violating equal sovereignty? | The MOE prevents Maine from changing rules that other states may still change, amounting to disparate treatment. | MOE applies uniformly to all states (freeze as of Mar. 23, 2010) and does not intrude into a quintessentially sensitive area like elections; any disparity is tied to legitimate federal objectives. | Shelby County does not apply; no equal‑sovereignty violation—MOE is uniform, temporary, and sufficiently related to protecting children during transition. |
| Remedy / scope: Should CMS’s disapproval be set aside? | CMS erred by enforcing an unconstitutional statute. | CMS lawfully disapproved the state‑plan amendment as inconsistent with § 1396a(gg). | Petition denied: CMS’s disapproval affirmed; § 1396a(gg) constitutional as applied to Maine. |
Key Cases Cited
- Nat’l Fed. of Indep. Bus. v. Sebelius, 567 U.S. 519 (2012) (addressed limits of Spending Clause coercion in Medicaid expansion)
- Shelby County v. Holder, 570 U.S. 529 (2013) (equal‑sovereignty principle; coverage formula must fit current conditions for intrusive federal measures)
- Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1 (1981) (Spending Clause conditions must be unambiguous and not retroactive surprise)
- South Dakota v. Dole, 483 U.S. 203 (1987) (Spending Clause permissible conditional grants analysis; coercion vs. encouragement)
- Coyle v. Smith, 221 U.S. 559 (1911) (states’ equal sovereignty; limits on Congress imposing conditions that impair core state powers)