In John B v Goetz (pdf), the Sixth Circuit refused to vacate a consent decree that required Tennessee to provide various medical screening, diagnostic and treatment services to over a half million children under the Medicaid statute.  Tennessee argued that Gonzaga University v. Doe, 536 U.S. 273 (2002), compelled the conclusion that the statute does not confer individually enforceable rights (and that the consent decree should therefore be vacated).  Rejecting this argument, John B. held that some Medicaid provisions may be privately enforced – and that determination should be made by “examining individual provisions of the statute to determine whether a private right of action exists under each portion.”  The Court noted one provision that could be privately enforced, 42 U.S.C. § 1396a(a)(43)(A), one that could not, 42 U.S.C. § 1396a(a)(30), and remanded so the district court could examine the enforceability of other provisions.

John B. went even further, holding that consent decrees should receive the benefit of a doubt, placing the burden on Tennessee to show that the decree was wholly dependent on provisions that could not be privately enforced.  Because there was no such showing, only portions of the decree clearly reliant on unenforceable provisions of the Medicaid statute could be vacated.

The Court also removed the district court judge from the case, citing his “increasingly accusative language,” inaccuracies, and failure to move the case forward.  While such removal is rare enough, it was especially surprising since that was the second judge to preside over the case.  The first voluntarily recused himself after similar accusations were made. 

Note that while the opinion was per curiam, the court sought to avoid the (unjustified) perception that such opinions have less precedential force by stating it was only styled that way because “it was prepared in the chambers of more than one judge.”