Monte Rose, Jr. v. Robert F. Kennedy Jr.

CourtCourt of Appeals for the D.C. Circuit
DecidedMarch 10, 2026
Docket24-5172
StatusPublished

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Bluebook
Monte Rose, Jr. v. Robert F. Kennedy Jr., (D.C. Cir. 2026).

Opinion

United States Court of Appeals FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued November 5, 2025 Decided March 10, 2026

No. 24-5172

MONTE A. ROSE, JR., ET AL., APPELLEES

v.

ROBERT F. KENNEDY, JR., SECRETARY, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, IN HIS OFFICIAL CAPACITY, ET AL., APPELLEES

INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION, APPELLANT

Appeal from the United States District Court for the District of Columbia (No. 1:19-cv-02848)

James A. Barta, Solicitor General, Office of the Attorney General for the State of Indiana, argued the cause for appellant. With him on the briefs were Theodore E. Rokita, Attorney General, Jenna M. Lorence, Deputy Solicitor General, at the time the brief was filed, and Caroline M. Brown.

Maxwell A. Baldi, Attorney, U.S. Department of Justice, argued the cause for federal appellees. With him on the brief 2 were Brett A. Shumate, Assistant Attorney General, Michael S. Raab, Attorney, and David L. Hoskins, Deputy Associate General Counsel for Litigation, U.S. Department of Health and Human Services. Steven H. Hazel, Attorney, entered an appearance.

Erica S. Turret argued the cause for plaintiffs-appellees. With her on the brief were Ian H. Gershengorn, Martha Jane Perkins, and Catherine A. McKee.

Phillip A. Escoriaza and Madelaine M. Cleghorn were on the brief for amici curiae American Public Health Association and 67 Deans, Chairs and Scholars.

Before: MILLETT, PAN and GARCIA, Circuit Judges.

Opinion for the Court filed by Circuit Judge PAN.

PAN, Circuit Judge: Indiana appeals a district court order remanding this case to the Department of Health and Human Services (HHS) for further proceedings. Because the remand order at issue is not a “final decision[]” of the district court, 28 U.S.C. § 1291, and no exception to the finality rule is applicable here, we conclude that we lack jurisdiction.

The underlying dispute concerns whether Indiana’s Medicaid program complies with the federal Medicaid Act. Medicaid beneficiaries in Indiana sued HHS, claiming that the agency illegally approved a ten-year extension of the Indiana program. Indiana intervened to defend the program. The district court granted summary judgment in favor of the beneficiaries, vacated HHS’s approval decision, and remanded the matter to HHS. But the district court stayed its vacatur order, and Indiana’s Medicaid program therefore remains largely in effect pending the outcome of HHS’s remand 3 proceedings. Under the circumstances, the order is not final and we discern no basis to exercise appellate jurisdiction: HHS will reconsider the request to extend Indiana’s Medicaid program on remand; Indiana’s right to appeal the remand order is protected because it can challenge the remand order in conjunction with an appeal of the remand proceedings once they are completed; and in the meantime, the district court’s stay order ensures that Indiana’s Medicaid program remains essentially undisturbed. We therefore dismiss Indiana’s appeal.

I.

Medicaid is a federal program that subsidizes the states’ provision of medical services to low-income persons. 42 U.S.C. § 1396-1. Each state implements its own Medicaid program, and the Medicaid Act establishes certain minimum coverage requirements that the states must include in their Medicaid healthcare plans. See id. § 1396a(a). States must comply with the Act’s requirements if they wish to receive federal funding for their programs. See id. (listing requirements). HHS is the federal agency that ensures that state Medicaid programs comply with the requirements of the Medicaid Act. See id. § 1396-1.

After passage of the Affordable Care Act, Indiana expanded its Medicaid program to cover certain low-income adults who previously did not qualify for Medicaid. Indiana’s new program, dubbed the Healthy Indiana Plan 2.0 (HIP 2.0), replaced a prior version of the state-sponsored plan. HIP 2.0 offers two tiers of benefits: (1) HIP Plus requires no co- payments for most medical services and covers vision and dental services, while (2) HIP Basic generally requires co- payments and does not include vision and dental coverage. Enrollees in HIP Plus pay monthly premiums into Personal 4 Wellness and Responsibility (POWER) accounts, which are designed to operate like health-savings accounts. Qualified individuals who have incomes over the poverty level are only eligible for HIP Plus. Enrollees who fail to pay those premiums are defaulted to HIP Basic or stripped of their coverage, depending on their income levels.

HHS first approved HIP 2.0 in January 2015, and since then, HHS has approved several extensions. In October 2020, HHS approved Indiana’s application to extend HIP 2.0 for ten years. 1

In 2023, HHS sent Indiana a letter announcing that it had “concerns” about certain features of HIP 2.0 that appeared to reduce coverage for populations that Medicaid is intended to serve. J.A. 685. The agency nonetheless stated that it would not be “taking any action now” on HIP 2.0 because, “given the totality of the circumstances,” it had “concluded that withdrawing [its approval of HIP 2.0] at [that] time [would be] too disruptive . . . .” Id.

Three Indiana Medicaid beneficiaries filed suit in the district court against HHS, the Centers for Medicare & Medicaid Services, and the heads of those agencies to invalidate (1) HHS’s 2020 approval of the ten-year extension of HIP 2.0, and (2) the agency’s 2023 letter decision that left HIP 2.0 in place despite specified “concerns.” The beneficiaries argued that both actions were unlawful under the Administrative Procedure Act, essentially because HIP 2.0 threatens coverage and therefore is contrary to the central

1 HHS also approved a five-year extension of Indiana’s “Substance Use Disorder” program. The parties debate whether that program was a part of HIP 2.0 or a separate Medicaid demonstration program. That dispute has no bearing on the jurisdictional question we decide here. 5 purpose of the Medicaid Act. Indiana intervened to defend the legality of HIP 2.0.

On cross-motions for summary judgment, the district court held that the Secretary’s 2020 approval of HIP 2.0’s extension did not reflect reasoned decision-making and was not based on consideration of all relevant factors. Rose v. Becerra, No. 19- cv-2848, 2024 WL 3202342, at *1–2 (D.D.C. June 27, 2024). In particular, the district court held that the Secretary did not adequately consider whether the program “would in fact help the state furnish medical assistance to its citizens,” the central objective of the Medicaid Act. Id. (citation omitted). The district court granted summary judgment to the plaintiff- beneficiaries, vacated the 2020 approval, and remanded the matter to HHS for further proceedings. Id. at *29. Because the “vacatur [of the 2020 approval] afford[ed] Plaintiffs full relief,” the district court reasoned that there was no need for it to determine whether the agency’s 2023 letter decision was also arbitrary and capricious. Id. at *2.

Indiana sought clarification from the district court about the legal effect of its order. Indiana maintained that it was unclear whether the order was a “judgment” and whether it had disposed of all plaintiffs’ claims. Indiana thus asked the district court either to state that it had finally resolved all the claims or to issue a separate judgment on the claim that it had resolved. In response, the district court confirmed that it had entered a judgment resolving the first count of the complaint, and found, under

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