WPC $@QиKi,$I*0s͸3K<ABEceM.lH'*FeՊK`o@n\mvdA^֠ۛyI 3̏)+^{ZП .l!s0aahԱY]C״ɂI}Ӝu >]vd39p~AHsPt7ԺCDRA43̣sOk#4ꬄx u$kV>|s\Q4{# II|vr[" Ģ_%<܏EktA!cg|6ͧUߺ;,#h %) 0D/ 0(s 0inT UFa N ^ w 4   m E f a > K bU@  MqXs<<<<<<<<<< BUF8UF~HP LaserJet 5/5M - Standard,,,,0+X(#$  0  ($ (d:2ٛ$ !    =*s*XXdd=    0    ٛ$  =**XXdd=    3    _Onecommentatorsuggeststhat"Section1396aisgenerally  regardedtobethelongestsentenceintheEnglishlanguage."  BarryR.Furrowetal.,HealthLaw121,at2n.2(2ded.2000).<6X9`("Courier NewTTXXx6X@DQX@<6X9`(CourierTTXXw6X@QX@.Courier New Regularg-s s]-6Xy File3|xUTABLE Aq:\template\OPINIONS\SELYA.WPT  ٛ$  =**XXdd=    1    _Section1983providesinpertinentpart:  8  8`   Everypersonwho,undercolorofanystatute, \ ordinance,regulation,custom,orusage,of 2 anyState...subjects,orcausestobe X subjected,anycitizenoftheUnitedStatesor . otherpersonwithinthejurisdictionthereof   tothedeprivationofanyrights,privileges,   orimmunitiessecuredbytheConstitutionand `  laws,shallbeliabletothepartyinjuredin 6   anactionatlaw,suitinequity,orother  \  properproceedingforredress.... 2 ` x` x Ѐ42U.S.C.1983.- -(9 Z(Times New Roman   ٛ$  =**XXdd=    4    _Weassume,withoutdeciding,thatthedefendantsarecorrect  intheirassertionthatsection1396a(a)(3)offersremediesthat  arenarrowerthantheprospectiveinjunctivereliefavailableunder \ ExparteYoung.Itisunsettling,however,thatthedefendants 2 basethisassertioninlargemeasureontheregulationsthat X implementthestatute"42C.F.R.431.200250"ratherthanon . thestatutorytext.InbothSeminoleTribeandVerizon,theCourt   lookedonlyatthestatutorylanguage,notatanyaccompanying   regulations.Thatmaywellbesignificant,asregulatorylanguage `  isnotinvariablyareliableguidetocongressionalintent. g ٛ$  =**XXdd=    2    _Theamendmentreads:  8  8`   TheJudicialpoweroftheUnitedStatesshall \ notbeconstruedtoextendtoanysuitinlaw 2 orequity,commencedorprosecutedagainstone X oftheUnitedStatesbyCitizensofanother . State,orbyCitizensorSubjectsofany   ForeignState. ` x` x U.S.Const.amend.XI.Despiteitsphrasing,theamendment 6   consistentlyhasbeenreadtorenderastateimmunefromsuits  \  broughtinfederalcourtsbothbyitsowncitizensandbycitizens  2  ofotherstates.E.g.,EmployeesofDep'tofPub.Health&Welfare   v.Dep'tofPub.Health&Welfare,411U.S.279,280(1973);Fred   v.Roque,916F.2d37,38(1stCir.1990)(percuriam). i ٛ$  =**XXdd=    5    _Wenoteatthisjuncturethatthedefendants'readingof  SeminoleTribeisindirectconflictwiththeCourt'sstatement  therethat"wedonotholdthatCongresscannotauthorizefederal \  jurisdictionunderExparteYoungoveracauseofactionwitha  limitedremedialscheme."517U.S.at75n.17(emphasisin  original).  ٛ$  =**XXdd=    6    _Althoughthedefendantsseeksupportforsuchadeparturein  arecentdecisionofthiscourt,seeGreenlessv.Almond,277F.3d  601(1stCir.2002),thatcaseoffersthemnosuccor.There,we \ dismissedaprivateclaimundertheMedicaidstatuteonthebasis 2 ofstatutoryinterpretation.Id.at60809.Weexplicitly X refrainedfromrulingonthequestionofsovereignimmunity.Id. . at60607. d.Courier New Regular<4 9Z+.Courier New Regular !  _TRY,3'X3' Letter 3' Letter3'T ? * !     +!X+X+!UnitedStatesCourtofAppeals  #X'6X#BXX'6FortheFirstCircuit#X'6XBY##+XXXX'6#   A') ` dE<` A   No.021604   @ROSIED.,BYHERPARENTS,JOHNANDDEBRAD.,ETAL., K  @Plaintiffs,Appellees, ! q @tt)v.    @ JANEM.SWIFT,ACTINGGOVERNOR,ETAL., y  @Defendants,Appellants. O  A') ` dE<` A K  @ APPEALFROMTHEUNITEDSTATESDISTRICTCOURT 0 @0 0 FORTHEDISTRICTOFMASSACHUSETTS  @$ $ [Hon.MichaelA._Ponsor_,U.S.DistrictJudge] b A') ` dE< ` A ^ @'Before C   @@((Selya,CircuitJudge,  CoffinandB.Fletcher,*SeniorCircuitJudges. u A') ` dE< ` A !q       Deirdre_Roney_,AssistantAttorneyGeneral,withwhomThomasF. V Reilly,AttorneyGeneral,wasonbrief,forappellants. ,    StevenJ.Schwartz,withwhomCathyE._Costanzo_,Centerfor ! PublicRepresentation,JamesC.Burling,SaraJ._Shanahan_,JohnS. " _Rhee_,Haleand_Dorr_,_LLP_,Frank_Laski_,andMentalHealthLegal ^ # Advisorswereonbrief,forappellees. 4!$   StevenA._Hitov_andVictoria_Pulos_onbriefforNational  "Z% HealthLawProgram,NationalAlliancefortheMentallyIll, "0& NationalMentalHealth_Ass'n_,National_Ass'n_ԀofProtectionand #' AdvocacySystems,Mass.LawReformInstitute,WesternMass.Legal $( Services,andtheJudgeDavidL._Bazelon_ԀCenterforMentalHealth b% ) Law,amicicuriae. 8&!* *'ddd Xdd Xdd X(#(#,( dd ,( dd ,( dd +  ( $-( $  SI)n$. W@37566W@SNovember7,2002 )D%0  RHC*&1" W@37566 W@ R()n$2  (* !_______________ + '2 *Hon.BettyB.Fletcher,oftheNinthCircuit,sittingby ,'3 designation.  |-(4? _  8  XXdd8*,X` XX* ` SELYA,CircuitJudge. Inrecentyears,theSupremeCourt  hasredefinedthecalculusoffederalism,tiltingthescalesmore x andmoretowardstates'rights.Thisappealrepresentsanattempt $t bythenameddefendants"acomplementofMassachusettsofficials,   includingthegovernor,twocabinetofficers,andtheCommissioner |  oftheDivisionofMedicalAssistance"tocapitalizeuponthat ( x  trend.Asweexplainbelow,theyseektopushtheenvelopetoo $  far.    ` Webeginwithbasics.Inthisclassaction,the ,|  plaintiffsseekprospectiveinjunctiverelieftovindicatetheir ( viewthatthefederalMedicaidActrequiresMassachusettsto  providehomebasedmentalhealthservicestoMedicaideligible 0 children.Thedefendantsresisttheplaintiffs'interpretationof , theMedicaidAct.Asapreliminarymatter,however,theyclaim  thattheEleventhAmendmentbarstheprosecutionoftheplaintiffs' 4 actioninafederalcourt(and,thus,obviatesanyneedtoaddress 0 thesubstantivequestion).    ` Thedistrictcourtrejectedthedefendants'Eleventh 8!" Amendmentsortie,andthedefendantsthereuponfiledthis "4$ interlocutoryappeal.Weaffirmthedistrictcourt'sruling. $& WhilerecentSupremeCourtdecisionshavemadesomeinroadsonthe <&!( venerabledoctrineofExparteYoung,209U.S.123(1908),they '8#* havenotevisceratedthatdoctrine,andonlyverynarrowexceptions )$, infringeonthewellestablishedrighttoaskforprospective @+&. injunctivereliefagainststateofficialsinafederalforum.  Consequently,theEleventhAmendmentdoesnotprecludethe \ maintenanceofthisaction. X  I.BACKGROUND     ` CongresscreatedtheMedicaidprogram,42U.S.C.1396 |  1396v,in1965.Overtime,itaugmentedtheprogram'scoverageto ( x  provideearlyandperiodicscreening,diagnosisandtreatment $  (EPSDT)servicestoMedicaideligiblechildren.Seeid.   1396a(a)(10),1396a(a)(43),1396d(a)(4)(B),1396d(r)(5).Congress ,|  intendedthattheserevisionswouldgivechildrenaccessto ( preventivehealthcare(e.g.,vision,hearing,anddental  services),preempttheonsetofchildhoodillness,andidentify 0 childrenwithdisabilitiesinneedofearlyattention.See,e.g., , H.R.Rep.No.101247,at42114214(1989),reprintedin1989  U.S.C.C.A.N.1906,21212127;S.Rep.No.90744,atIIG(1967), 4 reprintedin1967U.S.C.C.A.N.2834,28692871.TheEPSDTreforms 0 enactedbyCongressin1989(aspartoftheOmnibusBudget   ReconciliationActof1989,Pub.L.No.101239,103Stat.2106) 8!" wereparticularlynoteworthyintwopertinentrespects.First, "4$ Congressobligatedparticipatingstatestoprovideacomprehensive $& packageofpreventiveservicesthatmetreasonablestandardsof <&!( medicalnecessity.42U.S.C.1396a(a)(43),1396d(r).Second, '8#* CongressexpandedEPSDTservicestoinclude"[s]uchothernecessary )$, healthcare,diagnosticservices,treatment,andothermeasures @+&. described[asmedicalassistance]tocorrectoramelioratedefects  andphysicalandmentalillnessesandconditionsdiscoveredbythe \ screeningservices,whetherornotsuchservicesarecoveredunder X theStateplan."Id.1396d(r)(5).Ineffect,theseamendments   requiredstatestoprovideMedicaidcoverageforanyservice `  "identifiedasmedicallynecessarythroughtheEPSDTprogram."135  \  Cong.Rec.S6899,6900(dailyed.June19,1989)(statementofSen.   Chafee). d   ` Thecasebeforeusarisesoutofadisputeoverthe `  Commonwealth'sobligationsundersections1396a(a)(43)and   1396d(r)(5).TheplaintiffsarenineMedicaideligiblechildren, h actingthroughtheirparentsorguardians,whoseektocompelthe d Commonwealthtofurnishthemwithhomebasedmentalhealth  services.Althoughtheirparticularailmentsvary,eachplaintiff l hasbeendiagnosedwithaseverepsychiatricorbehavioral h disorder.Thesedebilitatingconditionshaveledtoawidearray  ofunhappyresults,includingexpulsionsfromschools,cyclical p  transfersbetweentreatingfacilities,repeatedhospitalizations, !l" andyearsspentawayfromfamilymembersatcrisisstabilization "$ units. t$&  ` Intheplaintiffs'view,theMassachusettsMedicaid  &p!( program,aspresentlyadministered,reliesalmostexclusivelyon '#* institutionbasedpsychiatriccare.Theplaintiffsallegethat x)$, suchanarrowlyfocusedtreatmentregimecannotrehabilitate(and, $+t&. indeed,mayexacerbate)theirconditions;thathomebased  psychiatriccareismedicallynecessaryforeffectivetreatment; \ thattheCommonwealth,notwithstandingitsclearstatutory X obligationtoprovidesuchservices,hastakennoaction;andthat   itslethargyfliesinthefaceoftheEPSDTmandates. `   ` Torighttheseperceivedwrongs,theplaintiffsinvoked  \  42U.S.C.1983andbroughtsuitinfederaldistrictcourt. #  1      ׀They   claimtorepresentthousandsofMedicaideligiblechildren, d  residentinMassachusetts,whosufferfromsimilarlysevere `  behavioral,emotional,andpsychiatricdisordersandwhorequire   homebasedcare.Thegravamenoftheircomplaintisthatthe h Medicaidstatuteentitlesthemembersoftheputativeclassto,and d obligatestheCommonwealthtoprovide,intensivehomebasedmental  healthservices.Theyfurtherallegethatthedefendants' l persistentdenialofsuchmedicallynecessarytreatmenthascreated h a"mentalhealthcrisis"withinMassachusetts.Onthisbasis,they  askthedistrictcourttoorderthedefendantstoreformthe  MassachusettsMedicaidprogramtoincludethehomebasedmental \ healthcarethattheEPSDTprovisionsallegedlyrequire. X  ` Thedefendantsmovedtodismisstheactiononthree   grounds.First,theyclaimthattheCommonwealth'ssovereign `  immunity,enshrinedintheEleventhAmendmentoftheUnitedStates  \  Constitution,barsthesuit. #  2      ׀Second,theyassertthattheEPSDT   provisionsoftheMedicaidActdonotcreateprivaterights d  enforceableundersection1983.Third,theypositthatthe `  plaintiffs'complaintfailstostateanactionableclaim.The   plaintiffsopposedthismotionandthedistrictcourt,rulingore h sponte,deniedit. d  ` Thedefendantsrespondedbyfilingthisinterlocutory  appeal.TheappealisproperastotheEleventhAmendmentissue, l aspretrialordersgrantingordenyingEleventhAmendmentimmunity h areimmediatelyappealable.SeeP.R.Aqueduct&SewerAuth.v.  Metcalf&Eddy,Inc.,506U.S.139,141(1993).Weaffirmthe  districtcourt'srulingasitpertainstotheissueofEleventh \ Amendmentimmunity.Theotherfacetsoftheorderdenyingthe X motiontodismissarenotripeforreview,andweexpressno   opinionastothoseissues. `   II.ANALYSIS   \   ` Asageneralmatter,theEleventhAmendmentbarssuitsin $  federalcourtsagainstunconsentingstates(including"official   capacity"suitsagainststatehierarchs).DeLeonLopezv. ,|  CorporacionInsulardeSeguros,931F.2d116,121(1stCir.1991) ( (collectingcases).Thisproscriptionissubjecttoawell  recognizedexceptionmemorializedinExparteYoung,209U.S.at 0 15960.Theexceptionallowsfederalcourts,"notwithstandingthe , absenceofconsent,waiverorevidenceofcongressionalassertion  ofnationalhegemony,[to]enjoinstateofficialstoconformfuture 4 conducttotherequirementsoffederallaw."Lanev.FirstNat'l 0 Bank,871F.2d166,172n.5(1stCir.1989)(quotingRamirezv.   P.R.FireServ.,715F.2d694,697(1stCir.1983)). 8!"  ` Fornearlyacentury,thedoctrineofExparteYoung "4$ flourishedandsuitsagainststateofficialsseekingprospective $& injunctivereliefwerecommonplace.E.g.,Quernv.Jordan,440 <&!( U.S.332,34647(1979);Ramirez,715F.2dat697;Coalitionfor '8#* BasicHumanNeedsv.King,654F.2d838,842(1stCir.1981)(per )$, curiam).Lately,however,theSupremeCourthasfashionedan @+&. exceptiontotheexception,applicabletocertaincasesinwhich  "Congresshascreatedaremedialschemefortheenforcementofa \ particularfederalright."SeminoleTribev.Florida,517U.S.44, X 74(1996).Sincetheplaintiffsheresueonlyforprospective   injunctiverelief,anddosoundertheimprimaturofExparte `  Young,thiscaserequiresustoevaluate,forthefirsttime, the  \  extenttowhichSeminoleTribehasnarrowedtheExparteYoung   exception. d   ` Thelitigantssketchthesuggestedcontoursofthisnew `  limitationinverydifferentways.Theplaintiffs(andtheamici)   viewSeminoleTribeasararaavis,assertingthatitrelatesonly h tothosefewfederalstatutesthatcontaincomprehensiveremedial d schemes,andotherwiseleavesthedoctrineofExparteYoungalive  andwell.ThedefendantscontendthattheSeminoleTribe l constraintappliesmuchmorebroadly.Theytellusthat,under h SeminoleTribe,theinquiryintotheapplicabilityofExparte  Younginanygivencaseturnsuponacomparisonbetweenthe p  remediesconferredbythestatutegoverningthedisputeandthe !l" judicialremediesavailableunderExparteYoung;wheneverthe "$ statuteprovidesanodynesthataremorelimitedthanthoseallowed t$& underExparteYoung,acomplainant'sredressisrestrictedtothe  &p!( former(and,accordingly,ExparteYoungbecomesadeadletter). '#*  ` Forpurposesofanalysis,weturndirectlytothe x)$, defendants'argument.Thedefendantsbasetheirassessmentofthe $+t&. diminishedefficacyoftheExparteYoungexceptionontheir  readingoftworecentSupremeCourtcases.Theyasseveratethat, \ inSeminoleTribe,theCourtexaminedtheremedialprovisions X createdbytheIndianGamingRegulatoryAct(IGRA),25U.S.C.   27012721,andaskedwhetherthoseremediesweremorecircumscribed `  thanthereliefavailableunderExparteYoung.SeminoleTribe,  \  517U.S.at7475.Thedefendantsalsocontendthatina   subsequentcase,VerizonMd.,Inc.v.Pub.Serv.Comm'n,122S.Ct. d  1753,1761(2002),theCourtundertookasimilarinquirywith `  respecttotheTelecommunicationsActof1996,Pub.L.No.104104,   110Stat.56(codified,asamended,inscatteredsections,chiefly h in47U.S.C.151615). Buildingonthisfoundation,the d defendantsarguethatExparteYoungremainsascendantonlywhen  theapplicablestatuteauthorizesasetofremediesmorefar l reachingthanprospectiveinjunctiverelief. h  ` Clingingtothisapproach,thedefendantsvisualizethe  caseathandthroughtheprismofthe"fairhearing"requirementof p  theMedicaidstatute,42U.S.C.1396a(a)(3).Thatprovision, !l" nestledamongalonglistofrequirementsimposedonstateplans, #  3       "$ declaresterselythat"[a]Stateplanformedicalassistancemust t$& ...provideforgrantinganopportunityforafairhearingbefore  &p!( theStateagencytoanyindividualwhoseclaimformedical '#* assistanceundertheplanisdeniedorisnotacteduponwith  reasonablepromptness."Accordingtothedefendants,thislanguage \ suppliesaremedy(afairhearing)morelimitedthanthatavailable X underExparteYoung(prospectiveinjunctiverelief),and,thus,   precludestheuseofExparteYoungasaninstrumentforpiercing `  theshieldoftheCommonwealth'sEleventhAmendmentimmunity. #  4        \   ` Tobesure,recentSupremeCourtdecisionshaveredefined   EleventhAmendmentjurisprudenceinavarietyofways.E.g.,Alden d  v.Maine,527U.S.706,71215(1999);Fla.PrepaidPostsecondary `  Educ.ExpenseBd.v.Coll.Sav.Bank,527U.S.627,63536(1999);   Idahov.Coeurd'AleneTribe,521U.S.261,26770,28182(1997).  h Wehavetermedthismovementa"seachange"inconstitutional d doctrine.JusinoMercadov.CommonwealthofPuertoRico,214F.3d  34,38(1stCir.2000).Butevenseachangeshavelimited(albeit l significant)effects"andtheSupremeCourthasnotyetsignaled h awillingnesstocurtailtheExparteYoungexceptionas   drasticallyasthedefendantssuggest. p   ` Thefatalflawinthedefendants'argumentliesintheir   misreadingofSeminoleTribe.TheSupremeCourtdidnot,asthe \ defendantswouldhaveit,placeprimacyonthepresenceof X statutorylimitationsonremedies.Rather,theCourtreadthe   remediallimitationsimposedbytheIGRAmerelyasacluefrom `  whichtodeducecongressionalintent.SeeSeminoleTribe,517U.S.  \  at7576(explainingthatCongress'sdecision"toimposeuponthe   Statealiabilitythatissignificantlymorelimitedthanwouldbe d  theliabilityimposeduponthestateofficerunderExparteYoung `  stronglyindicatesthatCongresshadnowishtocreatethe   latter").Thus,thenatureandscopeoftheIGRA'sremedialscheme h wasinstrumentalintheCourt'srulingonlytotheextentthat d thoseattributesspoketocongressionalintent.Andintermsof  thatintent,thekeyfactorsinSeminoleTribeweretheintricacy l anddetailofthestatute'sremedialscheme.Id.at74.Inother h words,itwasthecomprehensivenessoftheremedialschemethat  suggestedanintentiontopretermitExparteYoungrelief.Seeid. p   ` PerscrutationoftheCourt'sdecisioninVerizon !l" reinforcesthispoint.TheVerizonCourtemphasizedthecentrality "$ ofcongressionalintent,basingitsdecisiononwhether"the1996 t$& [Telecommunications]Actdisplay[ed]anyintenttoforeclose  &p!( jurisdictionunderExparteYoung."122S.Ct.at1761.The '#* Court'spassingmentionoflimitedremediesservedonlyto x)$, highlightCongress'sapparentmotive. $+t&.  ` Properlyread,SeminoleTribeandVerizonprovideclear  guidepostsastohowlowercourtsshouldapproachtheinquiryinto \ congressionalintent.Ineachinstance,theCourtplacedgreat X emphasisonthedetailandintricacyoftheunderlyingstatute's   remedialschemeasindicatorsofcongressionalintent.Following `  thistrainofthought,theSeminoleTribeCourtconcludedthat"the  \  intricateproceduressetforthin[theIGRA]showthatCongress   intendedthereinnotonlytodefine,butalsotolimit d  significantly,the[availableremedies]."517U.S.at74.The `  Courtsimilarlykeyedthemoregeneralpropositiononstatutory   detail:"whereCongresshasprescribedadetailedremedialscheme h fortheenforcementagainstaStateofastatutorilycreatedright, d acourtshouldhesitatebeforecastingasidethoselimitationsand  permittinganactionagainstastateofficerbaseduponExparte l Young."Id.SotooVerizon,122S.Ct.at1761,inwhichthe h CourtcomparedthelevelofdetailandintricacyoftheIGRAwith  the1996TelecommunicationsActandfoundthelatterinsufficient p  tobetokenanintenttoforecloseExparteYoungrelief. !l"  ` Theshortofitisthat,asthedefendantssuggest, "$ SeminoleTribeandVerizonprovidearoadmapfortestingthe t$& continuedvitalityoftheExparteYoungexceptiononanygivenset  &p!( offacts.Butcontrarytothedefendants'importunings, #  5      ׀that '#* roadmapdirectsustopayparticularattentionto  comprehensiveness,thatis,statutorydetailandintricacy,asone \ indicationofcongressionalintentasitpertainstotheExparte X Youngexception.Applyingthismodeofanalysistothecaseatbar   yieldsastraightforwardresult. `   ` TheMedicaidActcontainsnocomprehensivesetof  \  remedies.Thesingleartifactrelieduponbythedefendants"the   fairhearingprovision"doesnotapproachthestandardof d  comprehensivenessrequiredunderSeminoleTribeandVerizonasa `  basisfortrumpingExparteYoung.Rather,section1396a(a)(3)   merelyguaranteesafairhearingtoMedicaidbeneficiaries.It h neitheroffersanydetailastohowstatesmustconductsuch d hearingsnorerectsanyancillaryremedialstructures.Thislies  insharpcontrasttotheIGRA,25U.S.C.2710(d)(3),astatute l settingforthawebofprocedures"prescrib[ing]thatacourtcould h issueanorderdirectingtheStatetonegotiate,thatitcould  requiretheStatetosubmittomediation,andthatitcouldorder p  thattheSecretaryoftheInteriorbenotified."Verizon,122S. !l" Ct.at1761(discussingtheIGRA).Indeed,thepertinent "$ provisionsoftheTelecommunicationsAct,47U.S.C.252(e)(6), t$& whichtheVerizonCourtfoundlackingincomprehensiveness(and,  &p!( thus,inadequatetosupplantanExparteYoungaction),122S.Ct. '#* at1761,affordedfarmoreintricacyanddetailthantheMedicaid  provisionatissuehere.Whereassection252(e)(6)istailoredto \ applyspecificsectionsoftheTelecommunicationsActtocertain X disputes,theMedicaidfairhearingreferenceisastandardless   generality,opentointerpretationbythestates. `   ` Weadd,moreover,thatevenasidefromitslackof  \  comprehensiveness,section1396a(a)(3)offersnointimationofa   congressionalintenttoforecloseotherremedies.Theprovision d  merelyrequiresstatestoprovideMedicaidbeneficiarieswitha `  fairhearingtocontestanagencydecision(somethingthattheDue   ProcessClausemightrequireinanycase). h  ` Forthesereasons,weholdthattheEleventhAmendment d doesnotpreventMedicaidbeneficiariesfromseekingprospective  injunctivereliefagainststateofficialsinafederalcourt.In l soholding,wepreservethreedecadesofcaselawrefusingto h construetheEleventhAmendmenttoprohibitsuitsforprospective  injunctivereliefinvolvingTitleXIXoftheSocialSecurityAct. p  E.g.,Wilderv.Va.Hosp.Ass'n,496U.S.498,52122(1990) !l" (permittingsuitagainststateMedicareintermediariesin "$ connectionwithhospitalreimbursement);Mainev.Thiboutout,448 t$& U.S.1,56(1980)(permittingsuitagainstofficialsdistributing  &p!( AFDCpayments);Rosadov.Wyman,397U.S.397,40506(1970) '#* (permittingsuitbywelfarerecipientsagainststatewelfare x)$, administrators);VisitingNurseAss'nofN.Shore,Inc.v.Bullen, $+t&. 93F.3d997,100205(1stCir.1996)(permittingsuitbyhealth  careprovidersagainstMedicaidprogramofficialsover \ reimbursementrates);Mass.Ass'nofOlderAms.v.Sharp,700F.2d X 749,75052(1stCir.1983)(permittingsuitbyfamiliestoprevent   terminationofMedicaidbenefitsvisvisstepchildren).That `  jurisprudenceincludesseveralcasesholdingthattheEleventh  \  Amendmentdoesnotbarsuitsseekingprospectiveinjunctiverelief   againststateactorsrelativetoEPSDTbenefits.E.g.,Mitchellv. d  Johnston,701F.2d337,344(5thCir.1983);Stantonv.Bond,504 `  F.2d1246,1251(7thCir.1974).Thislineofcasesseemssolidly   embeddedinconstitutionalterrainleftundisturbedbySeminole h Tribe.Reversingtheseprecedentswouldrequireadramatic"and d unwarranted"departurefromboththecommonunderstandingofEx  parteYounganditshistoricroleinadministeringtheSocial l SecurityAct. #  6       h  ` Wenote,too,thatourholdingtodayalignsuswitha  broadcoalitionofothercourtswhich,subsequenttoSeminole p  Tribe,haverejectedsimilarargumentsaimedatbarringsuitsfor !l" prospectiveinjunctivereliefcommencedbyMedicaidbeneficiaries "$ againststateactors.See,e.g.,Frazarv.Gilbert,300F.3d530, t$& 55051&n.109(5thCir.2002)(concludingthattheMedicaidAct  doesnotpossessanintricateremedialschemeregulating \ noncompliancebystatesandpermittingExparteYoungactionon X behalfofMedicaidbeneficiariestosecureEPSDTbenefits);Mo.   ChildCareAss'nv.Cross,294F.3d1034,1038(8thCir.2002) `  (concluding"thatthe[ChildWelfareActof1980,TitleIVEofthe  \  SocialSecurityAct]doesnotreflectanyintenttolimitExparte   Youngactions");Antricanv.Odom,290F.3d178,190(4thCir. d  2002)(holdingthat"theMedicaidActdoesnotprovidethetypeof `  detailedremedialschemethatwouldsupplantanExparteYoung   action");WestsideMothersv.Haveman,289F.3d852,862(6thCir. h 2002)(holdingthattheMedicaidActprovisionallowingreduction d offundstononcompliantstates"isnotadetailed'remedial'  schemesufficienttoshowCongress'sintenttopreemptanaction l underExparteYoung");JosephA.exrel.CorrineWolfev.Ingram, h 275F.3d1253,1264(10thCir.2002)(explainingthatneitherthe  AdoptionandSafeFamiliesActnortheAdoptionAssistanceand p  ChildWelfareAct"provideremedialschemessufficienttoforeclose !l" ExparteYoungjurisdiction"). "$  III.CONCLUSION  t$&  ` Weneedgonofurther.Torecapitulate,weconcludethat <&!( indeterminingwhetherastatute'sremedialprovisionspreclude '8#* prospectiveinjunctivereliefunderthedoctrineofExparteYoung, )$, thepropertestinvolvesaninquiryintoCongress'sintent.Here, @+&. thatinquirycentersondeterminingwhethertheremedialschemeis  sufficientlycomprehensivetoindicatethatCongressintendedto \ foreclosesuchrelief.Thefairhearingrequirementsetforthin X 42U.S.C.1396a(a)(3)fallswellshortofthisbenchmark.   Consequently,ExparteYoungcontrols.Weconclude,therefore, `  thatthebucklerofEleventhAmendmentimmunitydoesnotprotect  \  stateofficialsfromfederalcourtsuitsforprospectiveinjunctive   reliefundertheMedicaidAct.Theplaintiffsthusmayproceed d  withtheprosecutionoftheinstantaction. `   Affirmed.