Salazar v. Dist. of Columbia

United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued September 25, 2017 Decided July 20, 2018

No. 16-7065

OSCAR SALAZAR, BY HIS PARENTS AND NEXT FRIENDS, ADELA

AND OSCAR SALAZAR, ET AL.,

APPELLEES

v.

DISTRICT OF COLUMBIA, ET AL.,

APPELLANTS

CHARTERED HEALTH PLAN,

APPELLEE

Consolidated with 16-7085, 16-7100

Appeals from the United States District Court

for the District of Columbia

(No. 1:93-cv-00452)

Richard S. Love, Senior Assistant Attorney General,

Office of the Attorney General for the District of Columbia,

argued the cause for appellants. With him on the briefs were

Karl A. Racine, Attorney General, Todd S. Kim, Solicitor

General at the time the briefs were filed, and Loren L. AliKhan,

Deputy Solicitor General at the time the briefs were filed.

2

Kathleen L. Millian argued the cause for plaintiffs-

appellees. With her on the briefs were Martha Jane Perkins,

Zenia Sanchez Fuentes, and Lynn E. Cunningham.

Jonathan H. Levy, Allen Snyder, and Daniel Bruner were

on the brief for amici curiae Legal Aid Society of the District

of Columbia, et al. in support of appellees.

Before: HENDERSON and MILLETT, Circuit Judges, and

GINSBURG, Senior Circuit Judge.

Opinion for the Court filed by Circuit Judge MILLETT.

MILLETT, Circuit Judge: This case involves an injunction

garbed in the clothing of a consent decree modification.

While district courts generally have discretion under Federal

Rule of Civil Procedure 60(b)(5) to adjust the terms of an

existing consent decree in light of changed circumstances, the

issuance of a new injunction must meet the strict preconditions

for such exceptional relief set out in Federal Rule of Civil

Procedure 65. Because the district court’s order in this case

provided brand new relief based on brand new facts alleging

violations of a new law without the requisite findings for an

injunction, it crossed the line from permissibly modifying into

impermissibly enjoining. For that reason, we reverse the

district court’s order, vacate the new injunctive relief, and

remand for proceedings consistent with this opinion.

I

A

By way of background, under long-established practice,

federal courts may enter, as final judicial orders, consent

decrees that reflect the agreement of the parties to forward-

3

going injunctive relief, as long as the consent decree arises

from and resolves a dispute “within the court’s subject-matter

jurisdiction[.]” Frew v. Hawkins, 540 U.S. 431, 437 (2004).

Once a consent decree has been entered, Federal Rule of Civil

Procedure 60(b) empowers the court to modify its terms to the

same extent as any other final judgment. See United States v.

Western Elec. Co., 46 F.3d 1198, 1205 (D.C. Cir. 1995) (citing

System Fed’n No. 91 v. Wright, 364 U.S. 642, 651 (1961)); see

also Plaut v. Spendthrift Farm, Inc., 514 U.S. 211, 233–234

(1995) (“Rule 60(b) * * * merely reflects and confirms the

courts’ own inherent and discretionary power, firmly

established in English practice long before the foundation of

our Republic, to set aside a judgment whose enforcement

would work inequity.”) (internal quotations and citations

omitted).

As relevant here, Rule 60(b) permits modification or relief

from a judgment when: (i) it “has been satisfied, released or

discharged;” (ii) “it is based on an earlier judgment that has

been reversed or vacated;” (iii) “applying it prospectively is no

longer equitable,” FED. R. CIV. P. 60(b)(5); or (iv) there is “any

other reason that justifies relief,” FED. R. CIV. P. 60(b)(6).

When a party seeks relief under Rule 60(b), that party

bears the threshold burden of proving that a “significant

change” in legal or factual circumstances “warrants revision of

the decree.” Rufo v. Inmates of Suffolk Cty. Jail, 502 U.S. 367,

383 (1992). For a change in the law to be significant, it must

“make legal what the decree was designed to prevent,” or

otherwise effect a material change in the governing legal

regime. Id. at 388. A change in the facts qualifies as

significant if it makes compliance with the decree

“substantially more onerous,” “unworkable because of

unforeseen obstacles,” or “detrimental to the public interest.”

Id. at 384.

4

B

Title XIX of the Social Security Act, 42 U.S.C. § 1396, et

seq.—commonly known as Medicaid—is a federal subsidy

program that underwrites participating States’ provision of

medical services to “families with dependent children and [to]

aged, blind, or disabled individuals, whose income and

resources are insufficient to meet the costs of necessary

medical services.” Armstrong v. Exceptional Child Ctr., Inc.,

135 S. Ct. 1378, 1382 (2015) (quoting 42 U.S.C. § 1396-1).

Participating States receive federal funds that are subject to

congressionally mandated controls and directives. See id.

With exceptions not relevant here, both federal and local

law have long required the District of Columbia to make

Medicaid eligibility determinations within 45 days of an

application for benefits, 42 C.F.R. § 435.912(c)(3); D.C. Code

§ 4–205.26, and to provide Medicaid recipients timely notice

of any proposed termination, discontinuation, or suspension of

eligibility, see, e.g., 42 C.F.R. §§ 435.919(a), 431.200 (1993).

As a general rule, the District must annually “recertify”—that

is, renew—the eligibility of its Medicaid recipients to maintain

their benefits. Compare 42 C.F.R. § 435.916 (2016)

(prescribing “renewal” of Medicaid eligibility), with Salazar v.

District of Columbia, 954 F. Supp. 278, 292–294 (D.D.C.

1996) (“Liability Order”) (referring to the legacy eligibility

redetermination process as “recertification”).

Historically, the District conducted the application and

recertification processes by paper and mail. That system

required beneficiaries to take the affirmative step of mailing in

the required paperwork to continue their benefit eligibility.

See Liability Order, 954 F. Supp. at 282–283, 292.

5

In 2010, the Patient Protection and Affordable Care Act,

Pub. L. 111-148, 124 Stat. 119 et seq. (“Affordable Care Act”),

wrought several changes in the District’s eligibility and

recertification processes. Under the Affordable Care Act, the

majority of Medicaid applicants and recipients have their

eligibility determined by the amount of modified adjusted gross

income that they report on their federal income taxes. The Act

thus uses household tax information to assess income,

household composition, and family size. See 42 C.F.R.

§§ 435.901–435.911, 435.916.

For such tax-based eligibility determinations, the District

had to replace its old paper recertification system with a new

passive renewal model. The passive renewal program first

attempts to automatically renew eligibility based on available

electronic federal and local tax records. See 42 C.F.R.

§ 435.916(a). If the data necessary for passive renewal are

unavailable, then the District must ask the Medicaid recipient

to provide the missing information before renewing Medicaid

eligibility. Id. § 435.916(a)(3).

The District began to implement its passive renewal

system in late 2012 by building a new, automated eligibility

system called the DC Access System. When the DC Access

System is fully realized, the District plans to retire its legacy

application and recertification system. However, the

transition from the old system to the new DC Access System

has been halting, due to “technology challenges, contracting

issues, and funding.” J.A. 827. The plodding transition

between systems proved problematic for many individuals’

Medicaid application and renewal process. J.A. 1298.

6

C

1

In 1993, long before the Affordable Care Act emerged on

the scene, Plaintiffs—a broad group of Medicaid applicants

and recipients—filed a class action against the District of

Columbia principally alleging that the District’s administration

of its Medicaid program violated the Medicaid statute, its

implementing regulations, District of Columbia law, and the

United States Constitution.

The putative class action proved actually to be an

amalgamation of several subclasses, and within each subclass

the Medicaid applicants and recipients asserted a distinct and

“particular set of claims.” Salazar v. District of Columbia,

106 F. Supp. 3d 114, 115 (D.D.C. 2015). In 1994, the district

court certified a class consisting of five Subclasses. The first

two Subclasses, which involved Medicaid-eligible newborns

and certain hospitalized applicants, settled before trial and are

not at issue here. Of the remaining three, Subclass III

consisted of individuals who alleged delayed processing of

their initial Medicaid applications. Subclass IV consisted of

individuals who alleged that the District failed to comply with

pre-Affordable Care Act requirements to provide adequate

advance notice of the termination or suspension of Medicaid

eligibility. Liability Order, 954 F. Supp. at 326–328. And

Subclass V consisted of individuals alleging that the District

failed to give notice of or to provide the early and periodic

screening, diagnostic, and treatment services required for

Medicaid-qualified children (“Early Childhood Services”)

required by 42 U.S.C. § 1396a(a)(43) (1996).

After a bench trial in 1996, the District was found liable to

Subclasses III, IV, and V for numerous violations of the law.

7

See Liability Order, 954 F. Supp. at 280–281, 324–333. For

the Medicaid applicants composing Subclass III, the district

court found that the District failed to meet the 45-day deadline

for processing Medicaid applications for over half of all

pending applications. Id. at 325–326. The District’s delay

left more than a hundred sick and impoverished children and

adults without medical treatment each month. Id. at 325.

As for the individuals in Subclass IV facing suspension or

termination of their benefits, the court held that a pattern of

critical failures in the District’s Medicaid recertification

process violated the due process rights of the Subclass

members and also ran afoul of various statutes and regulations.

Liability Order, 954 F. Supp. at 326–327.

Finally, for the children and their parents that composed

Subclass V, the court ruled that the District was violating its

Early Childhood Services obligations by failing (i) to

adequately notify eligible families about Early Childhood

Services, (ii) to ensure that children eligible for such services

receive complete screening services and necessary follow-up

diagnoses and treatments, and (iii) to provide scheduling and

transportation assistance to Early Childhood Services

recipients. Liability Order, 954 F. Supp. at 328–333.

2

The District appealed. In 1999, while that appeal was still

pending, the parties reached a settlement agreement, which the

district court approved as the governing Consent Decree in this

case. The Consent Decree divided the District’s obligations

by sections that very roughly mapped onto the remaining

Subclasses, albeit (alas) with non-corresponding roman

numerals.

8

Sections II and IV of the Consent Decree (which, to escape

all the roman numerals, we will refer to as the “Eligibility

Provisions”) addressed Subclass III’s grievances concerning

the District’s slow handling of initial Medicaid applications.

It generally required the District to determine Medicaid

eligibility within 45 days of an application’s submission.

Section III of the Consent Decree (the “Renewal

Provisions”) addressed the District’s failure to provide the

legally required notice to Subclass IV members of the need to

renew their Medicaid eligibility, and it mapped out a detailed

schedule for the District to follow in processing recertification

forms and providing advance notice to beneficiaries of the

District’s eligibility determinations.

Finally, Sections V and VI (the “Early Childhood

Provisions”) remedied the District’s failures to provide notice

of and to deliver Early Childhood Services to the Subclass V

members by requiring the District to adopt a variety of

measures designed to improve access to and the provision of

Early Childhood Services. Section V of the Consent Decree

applies only to “Medicaid recipients”—that is, persons already

enrolled in the Medicaid program. Section VI of the Consent

Decree required the District to “effectively inform all pregnant

women, parents, child custodians, and teenagers” whom the

District had “found eligible for Medicaid benefits” of the

availability of Early Childhood Services. J.A. 286 ¶ 54.

Each Consent Decree section prescribed specific criteria

for measuring when the District had satisfied the terms of the

Consent Decree and could exit from its governance, generally

framed in terms of demonstrated levels of compliance over a

9

specified period of time. 1 The Consent Decree would

automatically terminate in its entirety “at the same time” the

last remaining section of the Consent Decree was satisfied and

coverage ended. J.A. 296.

The district court “retain[ed] jurisdiction of this matter to

make any necessary orders enforcing or construing this Order.”

J.A. 296 ¶ 79. The Decree also provided that either party

could, at any time, move the court to modify the Consent

Decree if a “change of law” materially affected the District’s

continuing obligations under the Consent Decree. J.A. 293

¶ 70. The district court’s review of any request for

modification was to be controlled by the “general body of

federal law governing motions to modify orders in contested

matters pursuant to Rule 60(b) of the Federal Rules of Civil

Procedure[.]” J.A. 294 ¶ 72.

1

See, e.g., J.A. 254 ¶ 8, 294 ¶ 74 (establishing that the District

would satisfy the Eligibility Provisions’ application processing

obligations by timely processing at least 95% of all initial

applications averaged over any four consecutive months for three

years); J.A. 261 ¶ 17, 262 ¶ 19, 294–295 ¶ 75 (the Renewal

Provisions’ recertification compliance would be satisfied upon the

District’s processing of at least 95% of all recertifications for “non-

Public Assistance, non-foster care, Medicaid recipients” averaged

over any four consecutive months for three years); J.A. 295 ¶ 76

(District could end court oversight of the Early Childhood

Provisions’ eligibility renewal processes by showing its systems

“accurately confirmed the eligibility status of 98% of all requests for

eligibility verification for twenty-two (22) of twenty-four (24)

consecutive months and accurately confirmed the eligibility status of

at least 95% of all requests for each of the other two (2) months * * *

and have accurately confirmed the eligibility status of at least 98%

of all requests for” one month that Plaintiffs were designated to

randomly select).

10

3

Over the next fourteen years, several provisions of the

Consent Decree terminated. In 2009, the parties agreed that

the District had come into compliance with the standards

governing the timely processing of initial Medicaid

applications for the Plaintiffs in Subclass III. As a result, the

district court “vacated” the Eligibility Provisions (Sections II

and IV) of the Consent Decree. Salazar v. District of

Columbia, No. 93-452, MINUTE ORDER (D.D.C. Feb. 24, 2009)

(“2009 Vacatur Order”). The district court also specifically

ordered that its “supervision over” the Eligibility Provisions of

the Consent Decree “is ended.” Id. (adopting the language of

the proposed order).

The Renewal Provisions for Subclass IV were the next to

go. The District requested termination of the Renewal

Provisions following enactment of the Affordable Care Act

because that law materially changed the law governing the

renewal of beneficiaries’ Medicaid eligibility. Specifically,

the Act required the District (and States) to implement a

passive renewal system that started with the individual’s

federal tax filing and generally required no affirmative action

by the beneficiary. See 42 U.S.C. § 1396a(e)(14); 42 C.F.R.

§ 435.916(a)(2).

In October 2013, the district court granted the District’s

motion. The court explained that the Affordable Care Act

“created a ‘significant change in circumstances’”—indeed,

“almost a seismic change” in the governing law—“that justifies

termination of the [Renewal P]rovisions of Section III[.]”

Salazar v. District of Columbia, 991 F. Supp. 2d 34, 37 (D.D.C.

2013) (“2013 Termination Order”) (citing FED. R. CIV. P.

60(b)(5)). “There is simply no comparison,” the court

continued, “between the statutory framework that existed at the

11

time th[e] Court made its factual findings in 1996 and what

implementation of the [Affordable Care Act] envisions.” Id.

The two legal regimes are “apples and oranges.” Id.

In particular, the Affordable Care Act’s “brand new

recertification procedure” was “in direct conflict with the

renewal process set forth in” the Renewal Provisions of the

Consent Decree, and rendered the steps required of the District

under the notice requirements of the Consent Decree

“inaccurate, confusing, and unnecessary.” 2013 Termination

Order, 991 F. Supp. 2d at 37. Even the Plaintiffs “concede[d]

that the [Renewal P]rovisions * * * are either in conflict with

the [Affordable Care Act] or are outdated and * * * no longer

relevant.” Id. at 38. The court accordingly entered an order

providing that the District was “relieved from complying with”

the Renewal Provisions. Id. at 39. The Plaintiffs did not

appeal that decision.

After the 2009 Vacatur Order and the 2013 Termination

Order, no provisions of the Consent Decree relating to

Medicaid eligibility determinations or renewals remained in

effect. The only portions of the Consent Decree that were still

operative on the District were the Early Childhood Provisions,

which governed issuing notice about and the delivery of Early

Childhood Services for already Medicaid-eligible children and

their family members in Subclass V. Over the next two years,

the parties continued to litigate various issues concerning those

portions of the Consent Decree, as well as ancillary

reimbursement issues.

D

In December 2015, the Plaintiffs filed a motion for a

preliminary injunction to require the District to (i)

provisionally approve all Medicaid applications that had been

12

pending for more than 45 days, until the District made a final

determination, and (ii) continue the eligibility of all Medicaid

recipients due to be renewed, until the District was able to

demonstrate that its technology and business processing

systems function in an adequate and timely manner. The

motion alleged widespread failures by the District to process

Medicaid applications and renewals under the Affordable Care

Act, as well as significant technological problems that resulted

in the improper termination of Medicaid benefits.

While the preliminary injunction motion was being

briefed, the District resolved “all of the thousands of

remaining” Medicaid processing errors. Salazar v. District of

Columbia, 177 F. Supp. 3d 418, 440 (D.D.C. 2016) (“2016

Order”).

Roughly one week after briefing on the preliminary

injunction concluded, the Plaintiffs filed a motion under

Federal Rules of Civil Procedure 60(b)(5) and (b)(6) to

“modify” the Consent Decree to achieve precisely the same

relief as the pending motion for a preliminary injunction, with

the small difference that the Rule 60(b) motion also asked for

monthly reporting by the District. Salazar, No. 93-452, PLS.’

MOTION FOR MODIFICATION OF THE SETTLEMENT ORDER, ECF

No. 2093 at 1 (Feb. 9, 2016); see 2016 Order, 177 F. Supp. 3d

at 423 (noting that the two motions “request precisely the same

relief”).

On April 4, 2016, the district court granted the Plaintiffs’

motion to modify the Consent Decree and then denied the

motion for a preliminary injunction as moot. 2016 Order, 177

F. Supp. 3d at 423–424. The court recognized that its decision

provided the Plaintiffs “additional injunctive relief, based on

the new [post-Affordable Care Act] factual circumstances.”

Id. at 441 (internal quotation omitted) (emphases in original).

13

The court also acknowledged that, because of its past

modifications, “no provisions of the [Consent Decree] relating

to Medicaid application processing or benefits renewal

remained in effect,” and that the “only portions” of the Consent

Decree still “in force” applied to “programmatic elements of

the District’s Medicaid program * * * related to the delivery of

[Early Childhood Services].” Id. at 426. The district court

nonetheless decided that “common sense” dictated that “issues

affecting initial applications and renewals are clearly related

to” the remaining Subclass seeking Early Childhood Services

because “a child cannot obtain [these services] when he or she

lacks Medicaid eligibility.” Id. at 442–443 (internal quotation

omitted).

On that basis, the district court ordered the District (i) to

provisionally approve all Medicaid applications pending more

than 45 days, and (ii) to continue for ninety days the eligibility

of Medicaid recipients who were up for renewal. See 2016

Order, 177 F. Supp. 3d at 443–445. In neither case did the

district court confine its relief to children or families with

children. The court also ordered that these remedies “remain

in place” indefinitely, “until [the District] demonstrate[d] to the

[c]ourt” that the District’s technology systems were

“functioning as required to ensure and protect the rights of

Medicaid recipients and applicants[.]” Id. at 442 n.16

(internal quotation omitted). In so ruling, the court

acknowledged the District’s “substantial progress * * * in

addressing the problems caused by changes in its

administration of the Medicaid program to comply with the

[Affordable Care Act].” Id. at 423; see also id. at 430, 435.

Still, the court decided it was appropriate to impose structural

injunctive relief because the District had not “entirely

remediate[d]” all of the identified problems, id. at 430, and the

court had “no assurance” that eligibility determination issues

“w[ould] not arise again,” id. at 441.

14

The district court subsequently entertained several

motions concerning the 2016 Order. On May 17, 2016, the

court granted the District’s motion to stay the 2016 Order

pending appeal. Salazar, No. 93-452, ORDER GRANTING

MOTION TO STAY, ECF No. 2134 (D.D.C. May 17, 2016).

Two weeks later, the court denied the District’s motion to alter

or amend the 2016 Order because the stay was in place and the

District’s appeal of the 2016 Order was already pending in this

court. Id., ORDER DENYING MOTION TO AMEND, ECF No.

2141 (D.D.C. June 2, 2016). Finally, on July 12, 2016, the

district court granted in part Plaintiffs’ motion to narrow the

stay entered in May, causing portions of the 2016 Order to go

into immediate effect. Id., ORDER GRANTING IN PART

MOTION TO MODIFY STAY, ECF No. 2150 (D.D.C. July 12,

2016). The District appealed the district court’s April 4th,

June 2nd, and July 12th Orders separately, and we consolidated

the three appeals.

II

The district court exercised jurisdiction over the class

action under 28 U.S.C. § 1331, and we have jurisdiction over

the district court’s decision granting or modifying a consent

decree under 28 U.S.C. § 1292(a)(1).

We generally review orders on Rule 60(b) motions for an

abuse of discretion, Twelve John Does v. District of Columbia,

841 F.2d 1133, 1138 (D.C. Cir. 1988), unless the decision is

“rooted in an error of law,” id. at 1138, in which case our

review is de novo, see, e.g., Smith v. Mallick, 514 F.3d 48, 50

(D.C. Cir. 2008).

15

III

There is a critical difference between a district court’s

power to modify an ongoing consent decree and its authority to

impose a new injunction. By trying to force the square peg of

a new injunction into the round hole of modification, the

district court impermissibly crossed that line.

An injunction is an exceptional form of relief. Monsanto

Co. v. Geertson Seed Farms, 561 U.S. 139, 165–166 (2010).

Doubly so when the judicial branch undertakes to restructure

the operations of an executive branch of government and to

superintend its operations on an ongoing basis. See Horne v.

Flores, 557 U.S. 433, 449 (2009) (“Injunctions of this sort bind

state and local officials to the policy preferences of their

predecessors and may thereby ‘improperly deprive future

officials of their designated legislative and executive

powers.’”) (quoting Frew, 540 U.S. at 441); Rizzo v. Goode,

423 U.S. 362, 379 (1976) (“[In] a system of federal courts

representing the Nation, subsisting side by side with 50 state

judicial, legislative, and executive branches, appropriate

consideration must be given to principles of federalism in

determining the availability and scope of equitable relief.”).

Ordinarily, to obtain a running structural injunction, the

plaintiff bears the burden of proving both the facts that warrant

such intrusive relief and that (i) the plaintiff(s) suffered an

irreparable injury, (ii) traditional legal remedies cannot redress

the injury, (iii) the balance of hardships between the parties

justifies extraordinary relief, and (iv) the injunction is not

counter to the public interest. See, e.g., eBay Inc. v.

MercExchange, LLC, 547 U.S. 388, 391 (2006); Chaplaincy of

Full Gospel Churches v. England, 454 F.3d 290, 297 (D.C. Cir.

2006).

16

The standard for obtaining a consent decree is somewhat

less demanding, but that is because it depends centrally on the

parties’ mutually agreed resolution of a legal dispute. Local

93, Int’l Ass’n of Firefighters v. City of Cleveland, 478 U.S.

501, 521–522, 525 (1986). To have their agreement ratified

by a court as a consent decree, the decree’s terms must “spring

from, and serve to resolve, a dispute within the 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.” Frew, 540 U.S.

at 437.

When an injunction or consent decree has been entered as

a final judgment, the district court retains the authority under

Federal Rule of Civil Procedure 60(b) to provide “[r]elief from

[the] Judgment” if, as relevant here, “applying it prospectively

is no longer equitable,” or “any other reason * * * justifies

relief” from the injunctive order. FED. R. CIV. P. 60 (title) &

60(b)(5) & (6). Rule 60(b)’s standard is a “flexible” one.

Rufo, 502 U.S. at 393; see Horne, 557 U.S. at 450–451. Still,

because exercise of the court’s power under Rule 60(b) reopens

a final judgment, the party requesting modification bears the

burden of proving that “a significant change in

circumstances”—whether factual or legal—justifies revision of

the order. Rufo, 502 U.S. at 383; see id. at 384. Any

adjustment of the order must be “suitably tailored to the

changed circumstance[s],” id. at 383, 391, and a court “should

do no more” than is necessary to “resolve the problems created

by the change in circumstances,” id. at 391.

As Rule 60(b)’s title indicates, the overwhelming majority

of motions to modify the terms of a consent decree are filed by

the enjoined party seeking “relief from” the court’s judgment.

That is not to say that such Rule 60(b) motions can never be

filed by the plaintiff seeking to enforce the terms of the

17

injunction. We have previously recognized that a court’s

“broad[] and flexible” equitable powers, which Rule 60(b)

codifies, may allow a district court to “tighten [a] decree” as

well. Western Elec., 46 F.3d at 1202. That makes sense. A

district court must retain the authority to prevent evasion and

ensure effectuation of the order it entered. But any such

fortification of the injunction’s terms must be in service of the

consent decree’s original “intended result.” Id.

When a plaintiff seeks to enhance a consent decree’s

terms, courts must be careful to ensure that the new injunctive

terms give effect to and enforce the operative terms of the

original consent decree. Courts may not, under the guise of

modification, impose entirely new injunctive relief. That

practice would end run the demanding standards for obtaining

injunctive relief in the first instance, would deny the enjoined

party the contractual bargain it struck in agreeing to the consent

decree at the time of its entry, and would destroy the

predictability and stability that final judgments are meant to

provide. Frew, 540 U.S. at 437; United States v. Armour &

Co., 402 U.S. 673, 682 (1971) (“[T]he scope of a consent

decree must be discerned within its four corners, and not by

reference to what might satisfy the purposes of one of the

parties to it.”).

Undoubtedly in some cases, the line between the

permissible tautening of an injunction’s terms and the

impermissible imposition of a new injunction will be difficult

to discern. Not so here. This injunction comes as an

injunction.

First, the district court’s opinion admits as much. The

decision announced that it was imposing “additional injunctive

relief, based on the new factual circumstances,” 2016 Order,

177 F. Supp. 3d at 441 (emphases in original), arising from the

18

District’s asserted violations of a new law—the Affordable

Care Act—that did not even exist at the time the Consent

Decree was entered, see id. at 440. Nor was the district court’s

order aimed at enforcing a point of relevant overlap between

the longstanding Medicaid statute and the new Affordable Care

Act. As the district court previously found, the two renewal

schemes are “apples and oranges,” and “there is simply no

comparison between the statutory framework[s]” because the

Affordable Care Act worked “almost a seismic” change in the

District’s legal obligations. 2013 Termination Order, 991 F.

Supp. 2d at 37. Imposing a new structural injunction based on

new facts found to demonstrate a violation of a whole new

statute—none of which were adjudicated within the original

Consent Decree, let alone consensually agreed to by the

District—is out of Rule 60(b)’s bounds. See Pigford v.

Veneman, 292 F.3d 918, 927 (D.C. Cir. 2002) (“Whatever

tailoring method the district court ultimately adopts * * * it

must preserve the essence of the parties’ bargain[.]”) (internal

citation omitted).

In that same vein, it bears noting that the Plaintiffs

themselves originally sought a brand new preliminary

injunction to obtain the relief they wanted. It was not until

almost three months later, after their preliminary injunction

motion had been fully briefed, that the Plaintiffs decided to try

the Rule 60(b) route. As it turns out, their first instinct that

they were seeking a new injunction was the correct one.

Second, the district court’s order provided relief for

Subclasses of Plaintiffs and corresponding sections of the

Consent Decree that had already been vacated or terminated.

The new injunctive obligations sought to enforce compliance

with the Affordable Care Act’s provisions governing the initial

eligibility for and renewal of Medicaid eligibility. 2016

Order, 177 F. Supp. 3d at 443–444. But the Consent Decree’s

19

Subclasses for Medicaid eligibility (Subclasses II and IV) were

“[v]acate[d],” 2009 Vacatur Order, and the district court’s

supervision “ended,” No. 93-452, CONSENT MOTION TO

VACATE SECTIONS II AND IV, ECF No. 1443 at 6. Likewise,

in 2013, the district court “terminat[ed]” the Consent Decree’s

Medicaid Renewal Provisions, and “relieved” the District of

any forward-going compliance obligation under the Consent

Decree. 2013 Termination Order, 991 F. Supp. 2d at 39.

Whatever the scope of a district court’s modification authority

under Rule 60(b), it cannot resurrect vacated and terminated

provisions as a vehicle for imposing novel obligations under a

new law based on new facts.

The district court insisted that its order did not revive

closed aspects of the Consent Decree, but instead gave effect

to the “only [executory] portions” of the Consent Decree still

“in force”—the Early Childhood Provisions governing

notification for and the delivery of Early Childhood Services.

2016 Order, 177 F. Supp. 3d at 426. The court reasoned that

children must be eligible for Medicaid before they can receive

such services. True enough. But the Consent Decree never

contained an Early Childhood eligibility or renewal Subclass

or corresponding sections of the Consent Decree. The Early

Childhood Service Subclass, and the relevant provisions of the

Consent Decree, were expressly limited to Medicaid

recipients—that is, individuals who had already been

determined to be eligible for Medicaid benefits. J.A. 271–

272, 280. All issues concerning eligibility determination and

redetermination matters were governed by the terminated

Provisions. None of those Provisions continued in effect at

the time of the district court’s latest injunctive order.

The court’s order also applies unqualifiedly to all

Medicaid applicants and beneficiaries seeking renewal,

without regard to whether they are children or have children.

20

The order, in other words, based a remedy of classwide

structural reform on anecdotal evidence and individual

testimonies, only a subset of which implicated the children for

whose benefit the Early Child Services exist. Indeed, despite

a lengthy recitation of Affordable Care Act implementation

issues culled from a voluminous record, the district court cited

only four instances where the putative Medicaid recipients

even had eligible children. See 2016 Order, 177 F. Supp. 3d

at 427–437.

The district court’s new injunctive obligations, in short,

have no anchor in the remaining executory portions of the

Consent Decree and seek to provide benefits to many

individuals wholly outside the remaining operative Subclass.

Writing new injunctive obligations governing eligibility and

renewal into Consent Decree provisions that never addressed

those matters and extending the protections to individuals

never included within the corresponding Subclass would turn

the power to modify a consent decree into an injunctive blank

check. “Who would sign a consent decree if district courts

had free-ranging interpretive or enforcement authority

untethered from the decree’s negotiated terms?” Pigford, 292

F.3d at 925.

Third, and finally, this case vividly illustrates the hazards

of an uncabined conception of Rule 60(b) modification. The

district court imposed brand new injunctive commands on

governmental operations without any of the ordinary

protections for such exceptional relief. The district court

resolved factual disputes in the record against the District. See

2016 Order, 177 F. Supp. 3d at 430, 441–443. The court then

imposed the burden on the District to disprove the existence of

a problem in need of classwide structural relief. See id. at

441–442. The court, in fact, acknowledged that, at the time of

its new order, the District had made impressive progress in

21

improving its systems and that there were “zero individuals” in

the case-processing backlog. Id. at 428. The district court

nonetheless ruled that “individual errors combine to form

systemic problems.” Id. at 430.

Yet no such showing of a persisting structural breakdown

was made on this record. The court made no factual finding

of a pattern or high volume of eligibility or renewal delays.

Instead, the district court faulted the District for not “entirely

remediat[ing]” the problems arising from the transition to the

Affordable Care Act. Id. (emphasis added). But a local

government cannot be subjected to ongoing classwide

structural relief simply because a problem has not been 100%

eradicated. See Lewis v. Casey, 518 U.S. 343, 349 (1996)

(“[T]he court’s failure to identify anything more than isolated

instances of actual injury renders its finding of a systemic []

violation invalid.”).

Even crediting the district court’s finding of a handful of

individual processing errors by the District—disputed facts that

were resolved without a hearing or discovery—the district

court’s assertion that it could not “separate individual

mistakes” from “systemic” ones, 2016 Order, 177 F. Supp. 3d

at 437, admits the problem. Expansive, classwide structural

relief that judicially superintends local government operations

cannot issue based on a factual predicate consisting only of

one-off errors that have, at best, a marginal connection to the

only remaining executory portions of the Consent Decree.

The burden was on the Plaintiffs to prove the existence of a

continuing and widespread problem. By shoehorning the

Plaintiffs’ new injunction into a Rule 60(b) modification, the

district court evaded that proof problem, finding it sufficient to

enter a sweeping injunction just because it had “no assurance”

that already-solved problems “w[ould] not arise again.” Id. at

441. That gets Rule 60(b) exactly backwards. See Horne,

22

557 U.S. at 450 (“If a durable remedy has been implemented,

continued enforcement of the order is not only unnecessary, but

improper.”).

*****

The district court’s imposition of sweeping new injunctive

obligations to redress new factual problems arising under a new

law and providing relief under no longer operative provisions

of the Consent Decree cannot be forced into the mold of a Rule

60(b) modification. For the foregoing reasons, we reverse the

orders of the district court, vacate the modification, and remand

for further proceedings consistent with this opinion.

So ordered.