Standard of Review Motion for Reconsideration Florida Jurisdiction

Original file, if bachelor:

AG HEADNOTE

Medicaid payment violations - Eleventh Amendment
The Eleventh Amendment bars a court gild directing Florida to brand retroactive payments to correct violations of federal Medicaid reimbursement rules, the 11th U.S. Circuit Courtroom of Appeals ruled.
The appeals courtroom said a lower court should determine whether Medicaid providers' other requests for relief had become moot past the time the lower court issued a judgment in their favor. At effect was whether the state had complied with the Boren Amendment, which established federal standards governing state plans for reimbursing Medicaid providers. Several Medicaid providers sued the state in 1991 over declared violations of the Boren Amendment, but a final order against the land was not issued until last year — and the Boren Amendment was repealed in 1997. The state argued that because it enacted a new rate plan that complied with the Boren Subpoena'southward successor, the providers' entitlement to prospective relief is moot. The 11th Excursion said the Eleventh Subpoena precludes "retrospective relief affecting the state treasury," and left it to the lower court to determine what prospective relief might be permissible.
"We do not attain these results without misgivings. The problems raised in this case by the Plaintiffs are extremely serious and vitally of import to the large group of developmentally-disabled persons who rely on the fair and proper administration of the State'southward Medicaid program," the 11th Circuit said. "(W)e acknowledge Plaintiffs' business that some of the long lapse betwixt the kickoff of this case and the entry of judgment (as a issue of which the basis for the case — the Boren Amendment — was repealed) may be attributed to Defendants' repeated requests for continuances. Still, we must notice the commands of the Eleventh Amendment and binding Supreme Court precedent, which forbid precisely the kind of retrospective relief awarded past the district court. In light of these circumstances, and given the time and resource that this litigation has already entailed, nosotros encourage the Defendants to seek a just resolution of the Plaintiffs' reimbursement claims."

IN THE Us COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT

________________________

No. 99-12507
________________________

D. C. Docket No. 89-00984-CV-KMM

FLORIDA Association OF REHABILITATION
FACILITIES, INC., UNITED CEREBRAL PALSY
Association OF MIAMI, INC., et al.,

Plaintiffs-Appellees,

versus

Country OF FLORIDA DEPARTMENT OF Wellness
AND REHABILITATIVE SERVICES,
GREGORY COLER, et al.,

Defendants-Appellants.

________________________

Appeal from the U.s.a. District Courtroom
for the Southern Commune of Florida
_________________________

(September 1, 2000)

Before TJOFLAT, MARCUS, and CUDAHY, Excursion Judges.

MARCUS, Circuit Guess:

This appeal involves difficult questions of mootness also every bit the Eleventh Amendment. Plaintiffs, providers of Medicaid services to developmentally-disabled persons, sued various Country of Florida officials seeking injunctive and declaratory relief for alleged violations of the Boren Amendment, which established federal standards governing state plans for reimbursing Medicaid providers. In September 1991 the district court entered a preliminary injunction essentially directing the Defendants to comply with the Boren Subpoena. Non until April 1999, even so, did the district court enter its final guild concluding that Defendants had violated the Boren Amendment and directing Defendants to right their reimbursement plan prospectively as well every bit retrospectively to 1991. In the meantime, Congress repealed the Boren Amendment in 1997, and Defendants debate that before entry of judgment they had already enacted a new rate programme in accordance with the requirements of the Boren Subpoena's successor.
Defendants debate on appeal that these developments render some or all of Plaintiffs' claims moot, and that in any issue the relief ordered by the district court is barred by the Eleventh Amendment to the extent information technology effectively requires the Land to pay money to redress pre-judgment violations. Because the Eleventh Subpoena bars retrospective relief affecting the state treasury in this case, we vacate the district court'south judgment to that extent. We remand for determination of whether Plaintiffs' entitlement to prospective relief had become moot by the time of judgment.

I.

Although the facts of this case are relatively straightforward, its procedural history is anything just. Plaintiffs include the Florida Association of Rehabilitation Facilities, Inc. and several operators of intermediate care facilities for the developmentally disabled ("ICF/DDs"). Plaintiffs provide essential developmental and wellness care services to low income persons in numerous ICF/DDs throughout the State of Florida. A number of Plaintiffs operate and provide care in ICF/DDs located on country owned by the State -- so-called "cluster" facilities. The care provided in the cluster facilities is the aforementioned as that provided in the private facilities.
Plaintiffs began this lawsuit in 1989, asserting that Defendants --various Florida officials responsible for formulating and administering the State's ICF/DD Medicaid Program -- violated federal law by failing to reimburse Plaintiffs for reasonable costs incurred as a result of providing intendance and handling to Florida's developmentally disabled citizens residing in ICF/DDs. The suit alleged equally well that Defendants violated federal police past reimbursing sure cluster providers inadequately through stock-still-rate contracts.
Plaintiffs' claims arose under the federal Medicaid program, established by Title IX of the Social Security Human action, 42 UsaC. � 1396, et seq . This plan is a cooperative federal-land effort to furnish with public assistance people who are unable to meet the cost of necessary medical services. Different major federal entitlement programs such every bit Social Security, Supplemental Security Income, and Medicare, Medicaid is not a federally-administered program with a compatible set up of statutorily-defined benefits; rather, it is a state-administered plan where the costs of services are allocated between the federal regime and the states. No state is obligated to participate in the Medicaid program. If a state opts to participate in the Medicaid program, however, it must do and so in a way that complies with federal statutory and regulatory requirements. See 42 UsaC. � 1396n. Within the full general framework of federal police force, states that cull to participate in the Medicaid program (thus qualifying for federal financial aid covering the medical assistance costs of eligible individuals) are granted wide latitude in defining the scope of covered services as well equally many other key characteristics of their programs. Florida, similar all other states, participates in the Medicaid plan.
At the time this suit was filed in 1989, and until Oct i, 1997, the Boren Amendment applied to the reimbursement claims at upshot. The Boren Subpoena to the Medicaid Deed, formerly codified at 42 U.S.C. � 1396(a)(xiii)(A), authorized a "land programme to provide . . . for payment . . . of the hospital services . . . through the utilise of rates . . . which the State finds, and makes assurances satisfactory to the Secretary, are reasonable and adequate . . .." Thus, the Amendment required that states pay ICF/DD providers under rates "reasonable and adequate to run into the costs which must be incurred by efficiently and economically operated facilities in gild to provide care and services in conformity with applicable State and federal laws, regulations and quality and safety standards." Id. The purpose of the Boren Amendment was "to give states greater flexibility in calculating reasonable costs and in containing the continuing escalation of those costs." Children's Hospital and Health Ctr. v. Belshe , 188 F.3d 1090, 1093-94 (ninth Cir. 1999) (citation and internal quotation marks omitted), cert. denied , 120 S. Ct. 2197 (2000).
As the 9th Excursion has summarized:

[T]he Boren Amendment authorizes states to develop their own Medicaid reimbursement standards and methodologies for payment of infirmary services, but subjects those standards and methodologies to three full general federal requirements. Start, states must take into account hospitals serving a disproportionate share of depression-income patients. Second, states must make findings that the rates are reasonable and acceptable to meet the necessary costs of an efficiently operated hospital. And third, states must assure Medicaid patients reasonable admission to inpatient hospital care.

Id. (citations and internal quotation marks omitted). Although the Boren Subpoena was intended to grant states greater freedom "in establishing the methodology for their reimbursement rates, the amendment was 'not intended to encourage capricious reductions in payment that would adversely affect the quality of care.'" Tallahassee Mem'fifty Reg'l Med. Ctr. five. Cook , 109 F.3d 693, 704 (11th Cir. 1997) (citing Due south. Rep. No. 139, 97th Cong., 1st Sess., at 478, reprinted in 1981 U.S.C.C.A.N. 396, 744).
On September xiii 1991, the commune court entered a preliminary injunction in Plaintiffs' favor, finding specifically that Defendants, in violation of the Boren Amendment, were not adequately reimbursing Plaintiffs for the costs of providing ICF/DD care. The district court constitute that Defendants' use of stock-still-rate contracts for payment of cluster providers (i.eastward., private providers of ICF/DD care in country-owned facilities) also violated the Medicaid Act. The district court enjoined Defendants from reimbursing providers at inadequate rates, making that ruling retroactive to September 4, 1991 (the date of the preliminary injunction hearing). The court also enjoined Defendants from reimbursing cluster providers "in a manner other than equally provided in a Rate Plan" at the "full Medicaid rate." The courtroom further ordered that Defendants file by Oct 4, 1991 a rate plan complying with the noun standards of the Boren Amendment. Defendants filed a rate plan by the required appointment and did not appeal the preliminary injunction.
Defendants insist that Plaintiffs never filed any objection to the new rate programme or the rates paid under it. As best nosotros tin can tell from the record, Defendants are correct. Although Plaintiffs filed multiple motions for contempt or sanctions, only ii of those motions implicated the preliminary injunction order, and none squarely challenged either the lawfulness of the programme or the specific rates. Plaintiffs argue that Defendants were always on notice of their objections to the plan and to the State'southward postal service-injunction reimbursement practices.
While the case remained pending before the district court (due in office to repeated continuances sought past Defendants), the Boren Subpoena was repealed effective Oct i, 1997. See Balanced Budget Act of 1997, Pub. Fifty. 105-33, � 4711(a)(i), 111 Stat. 251, 507-08 (1997). Congress amended the Medicaid Act to "eliminate the Boren Amendment and establish instead a [public] notice and comment provision." Belshe , 188 F.3d at 1093 (citation and internal quotation marks omitted). The new provision repeals the substantive limitations of, and the methodology set forth in, the Boren Subpoena, substituting a "public process" for determining rates.
The successor statute requires that a state program for medical aid:

(13) provide –

(A) for a public process for determination of rates of payment under the plan for infirmary services . . . under which --

(i) proposed rates, the methodologies under-lying the institution of such rates, and justifications for the proposed are published,

(ii) providers, beneficiaries and their representatives, and other concerned State residents are given a reasonable opportunity for review and comment on the proposed rates, methodologies, and justifications,

(three) final rates, the methodologies underlying the institution of such rates, and justifications for such final rates are published, and

(4) in the case of hospitals, such rates accept into account . . . the situation of hospitals which serve a disproportionate number of depression-income patients with special needs.

42 U.s.C. � 1396a(a)(13)(A). The legislation explicitly states that the repeal has just prospective effect and that Boren Amendment charge per unit standards go along to apply to payment for items and services provided on or earlier October 1, 1997. Pub. Fifty. 105-33, � 4711(d) ("This section shall take issue on the appointment of the enactment of this Human activity and the amendments fabricated by subsections (a) and (c) shall apply to payment for items and services furnished on or after October 1, 1997."). Notably, the legislation is silent as to what standards, if any, govern the menses between Oct 1, 1997 and a country's adoption of a new post-Boren charge per unit plan under the successor statute's find-and-annotate procedure.
Soon after the Boren Subpoena was repealed, in August 1997, Defendants moved for summary judgment on Plaintiffs' claims and also to vacate the preliminary injunction. The district court granted the motility in part, and asked the parties for advice as to which issues remained to be litigated. Both parties agreed that three bug remained:

1. Whether the method of contractual payment of cluster providers met whatever federal law requirement to pay them according to a rate plan.

2. What were the minimum requirements for land plans after repeal of the Boren Amendment.

3. Whether cluster providers were currently being paid pursuant to a rate program that complied with applicable law.

In May 1998, the district court conducted a three-day bench trial on these issues. Defendants moved in limine to bar introduction of evidence of their prior non-compliance with the Boren Subpoena and to limit the scope of the trial to their present compliance with federal law. The district court denied the motion only granted Defendants a standing objection to the introduction of evidence of by non-compliance with Boren standards.
On April 11, 1999, the district court entered final judgment in favor of Plaintiffs, stating its findings of fact and conclusions of law in a separate society. Florida Ass'n of Rehab. Facilities, Inc. v. State of Florida Bureau for Wellness Intendance Admin. , 47 F. Supp. second 1352 (S.D. Fla. 1999). The courtroom ruled "that Plaintiffs have established that the ICF/DD Rate Programme fails to adequately recoup Plaintiffs as information technology is non 'reasonable and adequate to meet the costs . . . of efficiently and economically operated facilities,' in violation of the Boren Amendment and 42 U.S.C. � 1983." Id. at 1360. The court noted that "[t]he Boren Amendment was in effect in 1989 when this lawsuit was filed, and was in effect through October i, 1997." Id. at 1357. Significantly, the court also concluded that even though the Boren Amendment had been repealed effective October 1, 1997, "[t]he standards governing reimbursement set forth in the Boren Subpoena continue to apply to this case as the State of Florida has not however promulgated any rules or regulations, or enacted whatever legislation, replacing the Boren Subpoena and continues to reimburse ICF/DD providers under the Rate Plan." Id.
The courtroom determined that "[t]he Rate Plan in force in the State of Florida setting along the terms, conditions and methodology for reimbursement of the costs incurred by ICF/DD providers is inadequate and is inherently flawed." Id. According to the court:

[T]he Rate Plan formulated and implemented past Defendants fails to substantively comply with the Boren Subpoena. Defendants have failed to assuredly rebut or abnegate evidence introduced by the Plaintiffs establishing that while they operate efficiently and economically, and indeed are required to plant this by submitting cost reports to the Land, they are not reimbursed in a manner that is "reasonable and adequate" to permit them to provide care to Florida'due south developmentally disabled population in compliance with federal laws and regulations. . . . Defendants take likewise violated the Medicaid Deed because of their failure and refusal to reimburse cluster providers pursuant to the Rate Program. The Medicaid Human action provides that the federally required State Programme must provide for payment of ICF/MR medical services "through the utilize of rates" set forth in the Plan. . . . Neither the regulations nor the Medicaid Human activity contains whatever limitation pursuant to a Charge per unit Plan based on ownership of ICF/DD facilities. Thus, cluster facilities are entitled to sufficient reimbursement. Defendants' continued refusal to pay cluster facilities pursuant to the Rate Plan, therefore, violates the Boren Amendment.

Id. at 1358-59.
The commune court then discussed its preliminary injunction, observing that "[o]northward September 13, 1991, . . . this Court entered a Preliminary Injunction . . . in favor of Plaintiffs on Counts I and 3 of their Complaint seeking, respectively, adequate and reasonable reimbursement nether the Charge per unit Plan in compliance with the Medicaid Act, and seeking payment pursuant to the same Charge per unit Program, on the same basis as ICF/DDs, to cluster providers." Id. at 1355. The court "adopt[ed] the findings and conclusions . . . in the Preliminary Injunction," id. , and found that the factors of irreparable harm, relative injury to the parties, and the public interest all continued to favor injunctive relief. Id. at 1359-60.
As a remedy, the commune courtroom ordered the following specific changes to the reimbursement plan retroactive to September 4, 1991 (the compliance date established retroactively in the September 13, 1991 preliminary injunction):

a. The prospective inflation index shall be the aforementioned every bit the historical (target) charge per unit which Defendants themselves selected, i.e., DRI times 1.786;

b. Iii year averaging of toll reports shall be used to summate charge per unit reductions based on decreases in costs;

c. The cap on rates for new facilities of half dozen beds or less shall be deleted;

d. Settlement of approaching rates for new providers shall utilize an average of the relevant rate periods;

e. For providers at small facilities, rates shall be set based on an boilerplate (or collectively) for all 6 bed ICF/DDs operated past that provider;

f. The Defendants shall develop a definable standard for an efficiently operated provider;

g. Increased costs related to increased needs of a

client due to changed medical, behavioral or therapeutic
needs shall exist a basis for an interim rate asking;

h. Price allocations between levels of care shall be revised (except where such a revision would reduce reimbursement already paid to a provider);

i. The Defendants shall rebase whenever actual costs exceed actual expenditures for fifty% or more than of providers in any rate catamenia as shown on KM Schedules of cost reports maintained by Defendants.

Id. at 1360-61, Conclusion � 2. The district court as well ordered that "Defendants shall comply with its published Charge per unit Plan including the immediate rebasing for the 1995 charge per unit setting period where it failed to rebase." Id. at 1361, Decision � 3. Moreover, ordered the Court, "Defendants are enjoined from violation of the Boren Amendment from September 13, 1991 until the State adopts regulations, procedures and standards governing the reimbursement of ICF/DD providers in place of the standards prepare forth in the Boren Amendment. Defendants shall amend the Rate Plan accordingly." Id. , Conclusion � 4.
On Apr 23, 1999, Defendants moved for reconsideration of the final social club. Defendants pointed out that in 1998, they had amended the country Medicaid charge per unit plan and taken it through the notice-and-comment procedure now required by the Boren Amendment's successor. The amendments had been approved effective Oct i, 1998. Defendants argued that this development mooted Plaintiffs' claims. Fastened to the motion was an affidavit from a state official who described the amendment process in detail and noted that at to the lowest degree one of the Plaintiffs (Sunrise Customs, Inc.) had unsuccessfully challenged the new plan in the administrative proceeding.
On July ix, 1999, the district court denied Defendants' motion, finding that Defendants had established no good reason for their failure to present the court evidence of these events prior to its final judgment, and that the new evidence would not warrant a modification of the final judgment anyway. This appeal followed.

II.

There is no dispute about the proper standard of review. We review a commune court'due south conclusions of police force de novo. See Doe v. Chiles , 136 F.3d 709, 713 (11th Cir. 1998). We review a district court'due south grant of injunctive relief for corruption of discretion. Meet id. (citing Sun America Corp. v. Lord's day Life Assur. Co. of Canada , 77 F.3d 1325, 1333 (11th Cir. 1996)). We also review the disposition of a motion for reconsideration under an abuse of discretion standard. See Region eight Forest Service Timber Purchasers Council 5. Alcock , 993 F.second 800, 806 (11th Cir. 1993).

III.

This case is made complicated past its unusual procedural posture. The commune court subsequently granting Plaintiffs a preliminary injunction in 1991did non comport a trial on the merits until 1998 and did not issue a final order of declaratory and injunctive relief until April 1999. As a outcome of this long lapse, the noun federal law underlying Plaintiffs' claims, the Boren Amendment, was repealed prior to trial. Defendants make two primary arguments, both of which are tied to the delay between preliminary injunction and final judgment. First, Defendants fence that the Boren Subpoena'southward repeal had mooted Plaintiffs' claims by the time of final judgment. Second, they assert that the relief awarded by the commune court violates the Eleventh Amendment to the extent that it requires payment of money from the state treasury for injuries suffered by Plaintiffs prior to the judgment. Defendants practise not appeal the merits of the district courtroom's factual findings or conclusions of police with respect to their violation of the Boren Amendment and federal Medicaid police force. We take up Defendants' mootness and Eleventh Amendment objections in that order.

A.

Article III of the Constitution limits the jurisdiction of the federal courts to the consideration of "Cases" and "Controversies." U.S. Const. fine art. III, � 2. "The doctrine of mootness is derived from this limitation because an action that is moot cannot be characterized as an active case or controversy." Adler five. Duval County Sch. Bd. , 112 F.3d 1475, 1477 (11th Cir. 1997) (citing Church of Scientology Flag Serv. Org. v. City of Clearwater , 777 F.2d 598, 604 (11th Cir. 1985)).
"[A] example is moot when the bug presented are no longer 'live' or the parties lack a legally cognizable interest in the upshot." Powell five. McCormack , 395 U.Due south. 486, 496, 89 S. Ct. 1944, 1951, 23 Fifty. Ed. second 491 (1969). Put another manner, "[a] case is moot when information technology no longer presents a live controversy with respect to which the courtroom can give meaningful relief." Ethredge v. Hail , 996 F.2nd 1173, 1175 (11th Cir. 1993) (citing United states v. Certain Real & Personal Holding , 943 F.2d 1292, 1296 (11th Cir. 1991)). When events subsequent to the commencement of a lawsuit create a state of affairs in which the courtroom can no longer give the plaintiff meaningful relief, the example is moot and must be dismissed. Encounter Jews for Jesus, Inc. 5. Hillsborough Canton Aviation Auth. , 162 F.3d 627, 629 (11th Cir. 1998) (citing Pacific Ins. Co. v. Full general Dev. Corp. , 28 F.3d 1093, 1096 (11th Cir. 1994)). Whatsoever determination on the merits of a moot case or event would be an impermissible advisory opinion. See, e.m., Hall five. Beals , 396 U.Southward. 45, 48, 90 S. Ct. 200, 201-02, 24 L. Ed. 2d 214 (1969) (per curiam).
Plaintiffs filed conform primarily to secure reimbursement at the "reasonable and adequate" rates required by the Boren Subpoena. Defendants fence that the repeal of the Boren Amendment now renders Plaintiffs' suit moot. They argue that Congress intended its repeal to prevent just this kind of accommodate against a country for declared inadequate reimbursement procedures. Defendants point to several portions of legislative history to argue that Congress's repeal of the Amendment was intended to eliminate the noun rate-setting requirements of the Amendment (and the ample litigation bellboy to those requirements) and supplant them with a strictly procedural "detect and comment" method for setting reimbursement rates. Defendants therefore assert that the repeal of the Amendment effectively concluded the substantive federal requirement on reimbursement rate-setting by states -- thereby mooting Plaintiffs' instance.
Nosotros disagree as to the period prior to the repeal; indeed, Defendants practise not seriously press this point. Congress'due south repeal of the Subpoena empowered states to replace their existing Boren-compliant rate plans with new rate plans not discipline to challenge based on the reasonableness and adequacy requirements of the Boren Amendment. Congress was explicit on how this alter was to occur; states were to promulgate a rate plan and subject it to the "notice and comment" administrative procedure. Such a new plan, however, would embrace just those services and items provided afterward Oct ane, 1997. Pub. 50. 105-33, � 4711(d). Congress made clear that the Boren Amendment even so applied to payment for items and services furnished before October 1, 1997. Come across id. Consequently, Plaintiffs' request for relief regarding services rendered prior to Oct one, 1997 had not go moot by the time the commune courtroom entered judgment in April 1999.
To the extent the district court ordered Defendants' compliance with Boren standards across the date of final judgment, the outcome is less articulate on this record. The dispositive question is whether Florida has indeed passed a valid rate programme in accordance with the requirements of the Boren Amendment's successor. After the district court entered final judgment, Defendants filed a motion for afterthought, asserting that as of October 1, 1998 (afterwards trial, only prior to entry of judgment) the State of Florida passed a new rate plan under the required "detect and annotate" procedures. On this basis, Defendants argued that the lawsuit had get moot by the time of entry of judgment, because it would be impossible to grant prospective relief regarding the State'south assistants of the Boren-era rate program when that plan had been superseded and the Boren Amendment's noun requirements rendered extraneous. The commune courtroom denied Defendants' motion, primarily on the basis that Defendants had produced no practiced reason for their failure to suggest the Court of the new program during the over six months that elapsed betwixt the effective appointment of the new programme and the entry of final judgment.
Normally nosotros review a ruling on a movement for afterthought nether a deferential abuse of discretion standard. See Alcock , 993 F.2d at 806. A court abuses its discretion, yet, when it misapplies the law. See, e.one thousand. , SunAmerica , 77 F.3d at 1333 (courtroom necessarily abuses its discretion if it "has practical an wrong legal standard"). When a motility for reconsideration raises a fundamental jurisdictional issue such every bit mootness, the court is obliged to consider the merits of the statement regardless of the motion's relative untimeliness. Come across, e.grand. , Tallahassee Mem'l Reg'50 Med. Ctr. v. Bowen , 815 F.2nd 1435, 1445 north. sixteen (11th Cir. 1987) ("[q]uestions of jurisdiction" such equally mootness "tin appropriately exist raised at any time in the litigation"); Carr v. Saucier , 582 F.2d 14, xv-16 (5th Cir. 1978) (per curiam) ("If a controversy becomes moot at any time during the trial or appellate process, the courtroom involved must dismiss the suit for want of jurisdiction. . . . Mootness arguments . . . can exist pressed by any party at any fourth dimension[.]"); see also Barilla v. Ervin , 886 F.2nd 1514, 1519 (9th Cir. 1989) (because a court "may not decide the merits of a moot case, regardless of whether it was mooted earlier or after the entry of judgment," a courtroom "cannot be divested of its obligation to consider the issue of mootness on the ground that the timing or mode in which a party has raised the event is somehow procedurally improper").
If indeed the State had properly enacted a new post-Boren rate program by the fourth dimension of entry of last judgment, and so a final guild providing prospective relief with respect to the Country'south Boren-era plan would serve no purpose and that portion of the case -- if not the entire case -- would be moot. Accordingly, while we share the Plaintiffs' and the district court's concern with Defendants' failure to raise this event promptly (a situation Defendants concede was "regrettable"), the district court withal was required to address Defendants' mootness statement, and if that argument had merit, to dismiss any claim for prospective relief on that ground.
That said, we are unwilling on this record to make up one's mind whether the new programme complies with the requirements of the mail-Boren statute. Defendants debate that in conjunction with their move for afterthought they submitted affidavits confirming that the Country has taken the new plan through the discover-and-annotate process and that the program fully complies with Boren'southward successor statute. Defendants also assert that Plaintiffs did not submit any affidavits of their own to dispute these claims. Given that Plaintiffs were responding to a motion for reconsideration, however, we attach little significance to their failure to submit counter-affidavits. Moreover, Plaintiffs suggest (although they do non state clearly) that the new plan may not be in compliance with the procedural requirements of the mail-Boren statute. Appellees' Brief at 24. In these circumstances, nosotros call back, the wisest course is to remand the case to the district court and then that it may determine in the first instance whether the new plan complied with the requirements of Boren's successor statute, and if so whether the lawsuit had become moot prior to the entry of judgment in April 1999. We therefore remand to the district court on this threshold jurisdictional issue.

B.

We turn next to whether the Eleventh Amendment precluded the district court from ordering, in essence, that the Defendants rectify improper past payments to providers such as Plaintiffs. The Eleventh Amendment to the United states of america Constitution provides: "The Judicial Power of the United States shall non be construed to extend to any suit in law or equity, commenced or prosecuted confronting i of the U.s. past Citizens of some other Country, or by Citizens or Subjects of any Foreign State." U.S. Const. ameliorate. Xi. The Amendment not but confined suits against a state by citizens of another state, but besides bars suits against a state initiated by that country'southward own citizens. Run across Edelman v. Jordan , 415 U.S. 651, 663, 94 S. Ct. 1347, 1355, 39 Fifty. Ed. 2d 662 (1974).
Under the doctrine of Ex parte Young , 209 U.S. 123, 28 S. Ct. 441, 52 L. Ed. 714 (1908), at that place is a long and well-recognized exception to this dominion for suits against land officers seeking prospective equitable relief to end continuing violations of federal law. Run across Pinnacle Med. Assocs., P.C. v. Pryor , 180 F.3d 1326, 1336-37 (11th Cir. 1999) (citing Idaho v. Coeur d'Alene Tribe , 521 U.S. 261, 269, 117 S. Ct. 2028, 2034, 138 L. Ed. 2nd 438 (1997) ("We do not . . . question the continuing validity of the Ex parte Young doctrine.")), cert. denied , 120 S. Ct. 1287, 146 L. Ed. 2d 233 (2000). The availability of this doctrine turns, in the beginning identify, on whether the plaintiff seeks retrospective or prospective relief.
Ex parte Young has been applied in cases where a violation of federal law by a country official is ongoing as opposed to cases in which federal law has been violated at 1 time or over a flow of fourth dimension in the by. Thus, Ex parte Immature applies to cases in which the relief against the state official directly ends the violation of federal law, as opposed to cases in which that relief is intended indirectly to encourage compliance with federal law through deterrence or simply to recoup the victim. "'Remedies designed to end a continuing violation of federal law are necessary to vindicate the federal interest in assuring the supremacy of that constabulary. Merely compensatory or deterrence interests are bereft to overcome the dictates of the Eleventh Amendment.'" Summit Med. Assocs. , 180 F.3d at 1337 (quoting Papasan v. Allain , 478 U.South. 265, 277-78, 106 Southward. Ct. 2932, 2940, 92 Fifty. Ed.ii d 209 (1986)). Therefore, the Eleventh Amendment does non more often than not prohibit suits against land officials in federal court seeking but prospective injunctive or declaratory relief, but bars suits seeking retrospective relief such every bit restitution or damages. Come across Light-green five. Mansour , 474 U.Due south. 64, 68, 106 Southward. Ct. 423, 426, 88 Fifty. Ed. 2d 371 (1985); Sandoval v. Hagan , 197 F.3d 484, 492 (11th Cir. 1999) ("[Individual suits that seek prospective relief for ongoing violations of federal police . . . may be levied against state officials."). If the prospective relief sought is "measured in terms of a budgetary loss resulting from a past alienation of a legal duty," it is the functional equivalent of coin amercement and Ex parte Immature does not employ. Edelman , 415 U.South. at 669, 94 S. Ct. at 1347.
Plaintiffs' suit originally fell within the Ex parte Young exception. Their adapt was directed against land officials in their official capacities and asked for prospective injunctive relief to halt continuing violations of federal law. Plaintiffs are not barred by the Eleventh Amendment from seeking enforcement, in a federal court, of a federal statute which country agents have violated. Defendants, in fact, exercise not argue that Plaintiffs' suit was barred from the outset. Instead, they make a more focused argument that much of the relief ordered past the district court is retrospective rather than prospective. They assert that, to the extent the commune courtroom directed them to make changes to the State's Boren-era reimbursement plan retroactive to September 4, 1991, it essentially required them to redress inequities in their by reimbursement payments from 1991 to the date of final judgment (April 1999), and potentially to reimburse Plaintiffs for those past deficiencies. We reluctantly agree.
To begin with, we annotation that the judgment clearly does contemplate the payment of land funds to redress prior inadequate reimbursements. Defendants observe that the final judgment does not expressly require them to pay whatever money or arrears in reimbursements. Technically speaking they are right. It is obvious, however, that the entire purpose and upshot of the judgment is to prescribe a gear up of standards upon which Defendants are to provide reimbursement for inadequate past and future payments, and that failure to provide such reimbursement would subject area them to sanctions past the federal district court, which expressly "retain[ed] jurisdiction to enforce [its] Gild." 47 F. Supp. 2d at 1361. Plaintiffs view the judgment in those terms. See Appellee's Brief at 39 (arguing that "the Eleventh Amendment does not preclude the payment of money which Defendants have withheld improperly"). If the gild were read every bit nothing more than an idle annunciation of Defendants' by obligations, without any intent or authorisation on the part of the commune court to enforce its ruling, then the order would be a nullity and plainly invalid on that basis alone. We decline to adopt such an unrealistic reading of the commune courtroom's order.
Because some of the relief ordered in the final judgment requires the State in effect to rectify improper past payments, nosotros see no style to distinguish the holding of Edelman which prohibits exactly this sort of retroactive accolade. Edelman itself illustrates the problem. There, a plaintiff sought declaratory and injunctive relief against two sometime directors of the Illinois Section of Public Aid, alleging that those state officials were administering the federal-state programs of Assistance to the Aged, Bullheaded, or Disabled (AABD) in a manner inconsistent with various federal regulations and the Fourteenth Subpoena to the Constitution. The plaintiff's complaint charged that the defendants were improperly authorizing grants to embark only with the month in which an application was approved and were not including prior eligibility months for which an applicant was entitled to aid nether federal law. The complaint also declared that the defendants were not processing the applications inside the applicable time requirements of the federal regulations.
The commune court granted a permanent injunction requiring compliance with the federal time limits for processing and paying AABD applicants. Information technology also ordered the defendants to pay retroactively benefits which would have been awarded if defendants had complied with federal police. The Seventh Circuit reversed, holding that this retroactive relief was barred by the Eleventh Amendment, and the Supreme Court agreed. In this now-famous ruling, the Court articulated the retrospective/prospective dichotomy for Eleventh Subpoena caselaw: prospective injunctive or declaratory relief can be awarded but retrospective relief cannot. The Supreme Courtroom explained:

[T]hat portion of the Commune Court's prescript which petitioner challenges on Eleventh Amendment grounds goes much further than any of the cases cited. Information technology requires payment of state funds, not as a necessary issue of compliance in the time to come with a substantive federal-question determination, but every bit a form of compensation to those whose applications were processed on the slower fourth dimension schedule at a time when petitioner was under no court-imposed obligation to conform to a different standard. While the Court of Appeals described this retroactive award of monetary relief as a form of 'equitable restitution,' it is in practical effect indistinguishable in many aspects from an honor of damages against the State. It volition to a virtual certainty be paid from state funds, and not from the pockets of the individual country officials who were the defendants in the activity. It is measured in terms of a monetary loss resulting from a past breach of a legal duty on the part of the defendant state officials.

415 U.Southward. at 668, 94 Southward. Ct. at 1358.
The district court judgment in this case effectively requires Defendants to redress inadequate past reimbursement payments past recalibrating the rates and paying Plaintiffs the departure out of the state treasury. But the Eleventh Amendment bars the laurels of retroactive relief for violations of federal police. The fact that harm is ongoing in the sense that Plaintiffs are continuing to suffer the furnishings of Defendants' prior failure to reimburse them adequately does not make the relief any less retrospective. Quite simply, the Eleventh Amendment's immunity is triggered when an announcement or injunction effectively calls for the payment of state funds as a form of compensation for by breaches of legal duties by state officials. See id. ; Pennhurst State School & Hosp. five. Halderman , 465 U.S. 89, 102-03, 104 Due south. Ct. 900, 909, 79 L. Ed. 2d 67 (1984). Such is the instance hither.
The district court tried to avoid this limitation by describing the relief decreed in its terminal order as simply enforcing the 1991 preliminary injunction; thus, reasoned the court, the relief was not retrospective and did not run afoul of the Eleventh Amendment. Nosotros are unpersuaded. To begin with, the district courtroom's reasoning cannot be squared with the command of the Eleventh Amendment as it has been interpreted in Edelman as well as other decisions of the Supreme Court and this Court. Moreover, even assuming that the commune courtroom'south reasoning could exist squared with binding precedent, the 1991 preliminary injunction was not enforceable on its ain terms and thus could non serve as the basis for the district court's retroactive relief. Finally, the district courtroom's judgment imposed reimbursement obligations starkly different from and more detailed than those contemplated past the preliminary injunction. For each of these independent reasons, which nosotros accost in sequence below, the retrospective relief ordered past the district court violates the Eleventh Subpoena.
Beginning, we are aware of no federal court that has upheld against Eleventh Amendment scrutiny a terminal judgment requiring a land to pay money for illegal conduct which pre-dates the judgment on the theory that the conduct violated an earlier preliminary injunction and therefore the remedy was prospective. The requirements imposed past the district court in its April 11, 1999 final judgment with respect to reimbursement for services rendered prior to that engagement are undeniably retrospective, and cannot exist justified as simply "relating back" to the appointment of the preliminary injunction. If Plaintiffs or the district court felt that Defendants had violated the preliminary injunction, the remedy would accept been to comport a show cause hearing and, if appropriate, to pursue civil contempt requiring Defendants to pay rates or provide reimbursement in accordance with the injunction. But the district court could not, at to the lowest degree in the peculiar circumstances of this case, avert the constraints of the Eleventh Subpoena by relying on Defendants' past violations of the preliminary injunction to justify imposing plainly retroactive relief in its final judgment. See Kostok v. Thomas , 105 F.3d 65, 69 (2d Cir. 1997) ("Any claim for retroactive monetary relief, under whatsoever proper noun, is barred . . .. When state funds are awarded to compensate for by wrongs past state officials, the Eleventh Amendment bars the payment equally retrospective." (citing Edelman and Green )).
2d, even if we assume that such a "relation back" theory could exist used to avoid the constraints of the Eleventh Subpoena in some cases, here in that location are more central issues with the district courtroom's reasoning. The underlying preliminary injunction lacked the precision and specificity necessary for it to exist enforceable prospectively from the date of its entry in 1991, permit alone to serve as the linchpin of the district court's "relation back" theory eight years later. Fed. R. Civ. P. 65(d) requires that a preliminary injunction be "specific in its terms" and "describe in reasonable detail . . . the deed or acts sought to be restrained." The district court's preliminary injunction did not see these criteria; on the opposite, information technology accomplished petty more than than enjoining Defendants from violating the law. It stated that Defendants were enjoined from "inadequately reimbursing providers of care in the ICF/[DD] program," and from "paying providers for services at ICF/[DD] cluster facilities in a way other than as provided for in a charge per unit plan" that "pay[due south] to each provider of ICF/[DD] services at cluster facilities the total Medicaid rate for that facility" and affords "each provider at cluster facilities all rights and protections accompanying a rate plan governing ICF/[DD] facilities." The injunction order specifically declined to change the State's existing programme by imposing new rates, but rather permitted Defendants themselves to file a new plan "which complies with the substantive requirements of" the Medicaid Act.
This Excursion has held repeatedly that "obey the law" injunctions are unenforceable. Encounter, due east.m. , Burton v. Metropolis of Belle Glade , 178 F.3d 1175, 1200 (11th Cir. 1999) (holding that injunction which prohibited municipality from discriminating on the basis of race in its annexation decisions "would practice no more than than instruct the City to 'obey the constabulary,'" and therefore was invalid); Payne v. Travenol Labs., Inc. , 565 F.2d 895, 899 (fifth Cir. 1978) (invalidating injunction that prohibited defendant from violating Championship 7 in its employment decisions). The specificity requirement of Rule 65(d) is no mere technicality; "[the] command of specificity is a reflection of the seriousness of the consequences which may flow from a violation of an injunctive gild." Payne , 565 F.2d at 897. An injunction must exist framed so that those enjoined know exactly what conduct the court has prohibited and what steps they must take to adapt their conduct to the law. Meet Meyer v. Brown & Root Constr. Co. , 661 F.2d 369, 373 (5th Cir. 1981) (citing International Longshoremen's Assoc. v. Philadelphia Marine Trade Assoc. , 389 U.Due south. 64, 76, 88 S. Ct. 201, 208, 19 L. Ed. 2d 236 (1967)). The preliminary injunction in this case differs niggling from an "obey the law" order because information technology fails to place with adequate particular and precision how Defendants are to perform such disquisitional obligations equally "[]adequately reimbursing providers of care" and "compl[ying] with the substantive requirements of" the Medicaid Act.
Tertiary, even if the preliminary injunction were valid and enforceable, the injunctive relief awarded by the district court's concluding lodge of April 11, 1999 was not the same as that ordered by the preliminary injunction. On the reverse, the terminal order imposed more expansive, and far more detailed, obligations on Defendants for the mail service-September 1991 flow than those imposed prospectively in the preliminary injunction. The preliminary injunction, every bit noted in a higher place, essentially enjoined the Defendants from violating the police force and directed them to submit a new charge per unit plan that complied with the law. The final judgment went much further, ordering 10 specific alterations to the rate programme, including requirements that Defendants employ "[t]hree year averaging of cost reports . . . to calculate rate reductions," delete "[t]he cap on rates for new facilities with 6 beds or less," set rates for providers at pocket-size facilities based on "an boilerplate (or collectively) for all six bed ICF/DDs operated by that provider," and "rebase whenever actual costs exceed actual expenditures for 50% or more of providers in any rate period as shown on KM Schedules of cost reports maintained past Defendants." Regardless of whether a "relation dorsum" theory comports with electric current Eleventh Subpoena doctrine, the final judgment manifestly cannot relate back to an birthday dissimilar and far less precise injunction.
In short, the relief ordered by the district court's final injunction did non get validly prospective simply because it was intended to redress past violations of the before preliminary injunction.
For its conclusion the commune court relied primarily on Rye Psychiatric Infirmary Center, Inc. 5. Surles , 777 F. Supp. 1142 (Southward.D.North.Y. 1991). The court too cited Libby v. Marshall , 653 F. Supp. 359 (D. Mass. 1986) and Bennett v. White , 865 F.2d 1395 (3d Cir. 1989). Plaintiffs likewise rely on these opinions, besides equally an unpublished ruling, Kansas Health Intendance Association, Inc. v. Kansas Department of Social and Rehabilitation Services , No. 93-4045-RDR (D. Kan. May 31, 2000). None of these decisions is binding precedent in this Excursion and none alters our conclusion.
In Rye , the court issued a partial summary judgment ruling finding that the defendants were providing inadequate reimbursement to the plaintiff Medicaid provider. The plaintiff later sought a show cause lodge compelling the defendants to use the proper formula to reimburse it for services rendered subsequent to the summary judgment ruling too as for the four years preceding that ruling. The court began its analysis of the show crusade request by highlighting the longstanding principles we utilize here. 777 F. Supp. at 1146 ("Simply put, the eleventh amendment bars the accolade of retroactive relief for violations of federal law which would require the payment of funds from a state treasury. . . . [T]he amendment'due south immunity is triggered when relief amounts to the payment of state funds as a form of bounty for past breaches of legal duties by country officials."). The court held that granting relief for the four years preceding the summary judgment ruling would be prohibited. Id. at 1147-51. Yet, it concluded, without elaboration, that "[t]he portion of plaintiff's action relating to inadequate reimbursement payments and improper rate methodologies occurring since [the ruling] represents injuries arising afterwards the court issued its conclusion. Relief for these injuries is clearly prospective in nature." Id. at 1147.
Rye does not help the Plaintiffs in this example. In Rye , the relief granted by the commune courtroom for the postal service-summary judgment period arguably may be viewed as prospective because the relief covered a period later on a final ruling on the claim of the plaintiff'due south claim had been rendered. Moreover, the relief was granted pursuant to a show cause application. Here, past contrast, the relief ordered by the district courtroom for the September 1991-Apr 1999 period cannot exist viewed as enforcing a prior club finally deciding the claim of Plaintiffs' merits. At best, it enforced a non-terminal determination of Plaintiffs' merits made in connection with the preliminary injunction lodge. Additionally, the commune court was not considering a evidence cause or contempt application, which would accept been the proper vehicle for Plaintiffs to seek relief for any declared violation of the preliminary injunction. The factual differences betwixt Rye and this case are significant. In any event, to the extent Rye may be read to endorse the reasoning applied by the district court in this case, it is odds with Eleventh Amendment doctrine applied past the Supreme Court.
In Libby , the district court found that the Eleventh Subpoena did not prohibit it from entering an injunction requiring state officials to spend state funds to better prison house weather condition in order to comply with a prior preliminary injunction imposing a cap on the jail's population. The court described the boosted relief equally ancillary to a "substantive prospective injunction" and necessary to ensure future compliance with the prior injunction. 653 F. Supp. at 363. Libby concerns a well-recognized exception to the Eleventh Subpoena for ancillary budgetary relief. That exception is inapposite, even so, because the 1991 preliminary injunction, besides existence unenforceable, did non simply seek to regulate Defendants' time to come comport without necessarily requiring the expenditure of funds. On the contrary, this preliminary injunction obviously contemplated the expenditure of funds by the State in accord with required Boren Amendment rates. The relief awarded by this final judgment with respect to events pre-dating the judgment cannot remotely be described as an "coincident" remedy necessary to ensure future compliance with the terms of the preliminary injunction.
The Third Circuit's stance in Bennett 5. White is inapposite too. Bennett involved a challenge to a state's administration of a child support benefits program under the auspices of the Social Security Human activity. The district courtroom plant, amidst other things, that the defendants had improperly withheld sure payments due to the plaintiffs. The district court declined, however, to order defendants to make those payments. Plaintiffs challenged that ruling on appeal, asserting that " Edelman five. Hashemite kingdom of jordan should be construed as inapplicable to their suit because they are not seeking the recovery of entitlements to government benefits funded by general revenues, merely only the recovery of their own property." 865 F.2d at 1407. The Third Excursion rejected the argument, stating that Edelman "prevents a federal courtroom from requiring state officers to disgorge from the state treasury fifty-fifty unlawfully converted belongings, at least so long as the state pays for the disgorgement." Id. at 1408. The court suggested in dicta an exception to this principle in instances where payments from the land treasury would be offset by payments into the treasury by the federal government. Id.
Such an exception has not been recognized by this Circuit, and cannot readily be squared with the Supreme Court'due south Eleventh Subpoena jurisprudence. But even assuming that information technology has any validity, it does not assistance the Plaintiffs hither. Although Plaintiffs speculate that the Land of Florida may "financially do good from modifications ordered in the Final Judgment through additional federal funding," Plaintiffs' Supplemental Brief at 2, there is no tape evidence for this proposition, and in whatever result it is of no legal consequence under the Supreme Court and this Courtroom's binding precedent, which focus on whether the "judgment . . . would implicate the state treasury," non whether as a bottom line matter the state treasury would be any worse off. Shands Teaching Hospital and Clinics Inc. five. Beech Street Corp. , 208 F.3d 1308, 1311 (11th Cir. 2000) (emphasis added). And although in Bennett the Third Circuit declined to opposite the district courtroom'south decision to lodge back payments for improperly withheld funds in a limited prepare of cases, the defendants had conceded that issue and thus no Eleventh Amendment scrutiny was applied. Bennett does not justify the consequence here.
Simply put, in this case, every bit in Edelman , the relief would corporeality to direct state reimbursement for past unlawful comport. Although the retrospective relief only extends back to the preliminary injunction, considering the injunction was entered about eight years prior to final judgment, it would evidently amount to an award for past due benefits in contravention of Edelman . The proper recourse for Plaintiffs would have been to obtain a antipathy guild after Defendants failed to comply with the district court's preliminary injunction. The relief awarded in the final judgment is essentially a surrogate for such a civil contempt award. Accordingly, we cannot characterize Defendants' reimbursement of past due payments every bit annihilation but impermissibly retroactive. The district courtroom lacked jurisdiction to order that Defendants recalibrate the rates for the September 1991-April 1999 menstruation and pay Plaintiffs whatsoever arrears, because such relief obviously would require the payment of money from the country treasury to redress past unlawful carry toward the Plaintiffs.
To the extent the district court order contemplates the payment of state funds to remedy unlawful carry prior to the appointment of the final judgment, the judgment is prohibited past the Eleventh Amendment, and nosotros are constrained to vacate information technology. This includes all of the changes to the reimbursement plan required "retroactive to September iv, 1991" by paragraph 2 of the district court's Determination. See 47 F. Supp. second at 1360. This also includes the requirement in paragraph three of the Conclusion that Defendants behave an "immediate rebasing for the 1995 charge per unit setting period where it failed to rebase," and the portion of paragraph 4 which enjoins the Defendants from violating the Boren Subpoena from September 13, 1991 to the appointment of judgment. Id. at 1361.
We practice not rule at this fourth dimension on whether the prospective relief ordered by the district court also is barred by the Eleventh Amendment. Although a federal court is prohibited by the Eleventh Amendment from ordering a country to provide retrospective relief, there are very limited circumstances where a court may enter an club implicating the state treasury if such payments will be aught more than ancillary to compliance with a enforceable prospective injunction prohibiting future unlawful behave by country officials. See, e.g. , Milliken v. Bradley , 433 U.S. 267, 289, 97 S. Ct. 2749, 2762, 53 L. Ed. 2d 745 (1977); DeKalb County Sch. Dist. v. Schrenko , 109 F.3d 680, 690-91 (11th Cir. 1997) (per curiam) (noting Eleventh Amendment exception that "permits federal courts to enjoin state officials to accommodate their conduct to the requirements of federal police, even if in that location is an ancillary impact on the country treasury," but finding that injunction at upshot was barred by the Eleventh Subpoena because the obligation to make future payments was not merely coincident). How this exception survives more recent pronouncements of Eleventh Amendment doctrine, and whether some portions of the district courtroom'south guild may feasibly come inside this exception, are potentially difficult questions that need not be answered if on remand the district court determines that any question of prospective relief had already become moot by the fourth dimension it entered terminal judgment. See supra at 22.
We practice not reach these results without misgivings. The issues raised in this case by the Plaintiffs are extremely serious and vitally important to the large group of developmentally-disabled persons who rely on the fair and proper administration of the Country'south Medicaid program. Every bit we have noted, Defendants practise not dispute the commune court'south findings of fact or conclusions of police force, which item at length Defendants' violations of the Boren Amendment and federal law. Moreover, nosotros acknowledge Plaintiffs' business organisation that some of the long lapse between the showtime of this case and the entry of judgment (as a result of which the basis for the case --the Boren Amendment -- was repealed) may be attributed to Defendants' repeated requests for continuances. Still, we must notice the commands of the Eleventh Amendment and binding Supreme Courtroom precedent, which forbid precisely the kind of retrospective relief awarded by the district court.
In calorie-free of these circumstances, and given the time and resources that this litigation has already entailed, we encourage the Defendants to seek a just resolution of the Plaintiffs' reimbursement claims. We also stress that, whatsoever the relief (if any) available in federal court, our conclusion does non foreclose the Plaintiffs from seeking relief that still may be available to them in the Florida state courts, where the paramount jurisdictional concerns addressed in this opinion do non apply.
VACATED IN PART AND REMANDED IN PART.

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