McCarthy Ex Rel. Travis v. Hawkins , 381 F.3d 407 ( 2004 )


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  •                                                  United States Court of Appeals
    Fifth Circuit
    F I L E D
    REVISED SEPTEMBER 2, 2004
    August 11, 2004
    IN THE UNITED STATES COURT OF APPEALS
    Charles R. Fulbruge III
    FOR THE FIFTH CIRCUIT                     Clerk
    No. 03-50608
    CHRISTY MCCARTHY, By and through her next friend Jamie
    Travis; TODD GORDON, By and through his next friend Trisha
    Gordon; ALLISON PRATT, By and through her next friend Paula
    Pratt; GAIL TRUMAN, By and through her next friend Ken
    Truman; JIM FLOYD, JR, By and through his next friend Jim
    Floyd, Sr; SAM LINDSAY, By and through his next friend Betty
    Lindsay; OSHEA BROOKS; JOE RAY COMACHO; MICHA CHASTAIN, By
    and through his next friend Lori Chastain; AL, By and
    through his next friend LL; ARC OF TEXAS, On behalf of its
    members and for those similarly situated; SUE ANN ORTIZ;
    PATRICK SOSTACK, By and through their parents and next
    friends Gary and Lisa Sostack; SCOTT SOSTACK, By and through
    their parents and next friends Gary and Lisa Sostack; SHYAN
    FOROUGH, By and through his parents and next friends Reza
    and Arzu Forough; DAVID ZWEIFEL, By and through his parents
    and next friends Linda and Leroy Zweifel; ASHTON BOWLEN, By
    and through her mother and next friend Patricia Bowlen;
    TYLER BLANCHARD, By and through his mother and next friend
    Faith Blanchard; GARRETT GILLARD, By and through his mother
    and next friend Keeya Gillard; KAMERON LANE, By and through
    his mother and next friend Angie Lane; MADISON POLK, By and
    through her father and next friend John Polk; PAIGE SMITH,
    By and through her mother and next friend Gretta Smith
    Plaintiffs - Appellees
    v.
    ALBERT HAWKINS, Etc.; ET AL
    Defendants
    ALBERT HAWKINS, In his official capacity as Commissioner of
    the Texas Health and Human Services Commission;
    KAREN F HALE, In her official capacity as Commissioner of
    the Texas Department of Mental Health & Mental Retardation;
    JAMES R HINE, In his official capacity as Commissioner of
    the Texas Department of Human Services
    Defendants - Appellants
    _________________________________________________________________
    Appeal from the United States District Court
    for the Western District of Texas
    _________________________________________________________________
    Before KING, Chief Judge, and REAVLEY and EMILIO M. GARZA,
    Circuit Judges.
    KING, Chief Judge:
    Plaintiffs sued several Texas state officials, asserting
    violations of the Medicaid statute, the Americans with
    Disabilities Act, and the Rehabilitation Act.      Relying in part on
    state-sovereign immunity, Defendants moved the district court to
    dismiss Plaintiffs’ claims.      The district court denied
    Defendants’ motion in part, concluding that the doctrine of Ex
    parte Young, 
    209 U.S. 123
    (1908), provided jurisdiction over this
    official-capacity suit seeking prospective relief against state
    officers.    Disappointed, Defendants filed this interlocutory
    appeal, seeking to vindicate their Eleventh Amendment immunity
    from suit.   We agree with the district court that state officers,
    sued in their official capacities for prospective relief, are
    proper defendants under Title II of the Americans with
    Disabilities Act and are not immune under the Eleventh Amendment.
    Further, we hold that Defendants’ other contentions on appeal
    relate to the merits of this controversy, not the Eleventh
    Amendment; therefore, these arguments are beyond the scope of
    this interlocutory appeal.      We affirm.
    I.    Background
    2
    Plaintiffs are twenty-one mentally disabled Texas residents
    (most of whom sue through their next friends) and the Arc of
    Texas (a nonprofit organization that advocates for the rights of
    individuals with mental disabilities).     In September 2002, they
    brought this action, on behalf of themselves and all others
    similarly situated,1 against Defendants.    Defendants are three
    Texas state officers sued in their official capacities as
    Commissioners of the Texas Health and Human Services Commission,
    the Texas Department of Human Services, and the Texas Department
    of Mental Health and Mental Retardation.2    Plaintiffs allege that
    Defendants are not adequately providing community-based living
    options to individuals, like themselves, with mental retardation
    and other developmental disabilities.
    The programs to which Plaintiffs seek access are offered by
    Texas as part of its Medicaid plan.   Title XIX of the Social
    Security Act established Medicaid, a cooperative federal-state
    program that provides federal funding to states that furnish
    medical services to needy individuals.     See 42 U.S.C. §§ 1396-
    1396v (2000); Frew v. Hawkins, 
    124 S. Ct. 899
    , 901 (2004).      While
    state participation is voluntary, if a state elects to join the
    program, it must administer a state plan that meets federal
    1
    Plaintiffs filed a motion for class certification,
    which is still pending in the district court.
    2
    We also refer to Defendants collectively as “Texas” or
    “the State.”
    3
    requirements.    See 42 U.S.C. § 1396a(a) (describing the required
    contents of a state plan); 
    Frew, 124 S. Ct. at 901
    .       States can,
    however, obtain certain waivers, which allow them to deliver
    experimental services under a relaxed set of regulatory
    strictures.   One such waiver permits states to offer home and
    community-based services for disabled individuals who would
    otherwise require institutional care.     See 42 U.S.C.
    § 1396n(c)(1).   Under a § 1396n(c) waiver, certain obligations
    that otherwise attach to states’ provision of Medicaid services
    are waived, and participating states may obtain federal
    reimbursement for services that would not normally be
    reimbursable under the Medicaid program.     See 
    id. § 1396n(c)(3)
    (detailing the requirements that may be waived under a § 1396n(c)
    waiver); 
    id. § 1396n(c)(4)(B)
    (explaining the services that may
    be provided under a § 1396n(c) waiver).
    Plaintiffs’ claims center on two § 1396n(c) waiver programs
    offered by Texas for mentally disabled individuals.       First, the
    Home and Community-Based Waiver Services program (the “HCS”
    program) provides services that enable individuals with mental
    retardation to remain at home, live independently, or live in
    small home-like settings.   The HCS program thereby helps those
    individuals avoid institutional living environments.      Second, the
    Community Living Assistance and Support Services waiver program
    (the “CLASS” program) provides similar assistance to individuals
    with other developmental disabilities.
    4
    II.   Proceedings in the District Court
    Plaintiffs’ second amended complaint alleges that Defendants
    have denied them access to the HCS and CLASS programs.   According
    to Plaintiffs, this denial of access violates several provisions
    of federal law--namely, (1) four subsections of the federal
    Medicaid statute, including its due process provision (i.e.,
    § 1396a(a)(3)3), and its implementing regulations; (2) Title II
    of the Americans with Disabilities Act of 1990, 42 U.S.C.
    §§ 12131-12165 (2000), and its implementing regulations;
    (3) § 504 of the Rehabilitation Act of 1973, as amended, 29
    U.S.C.A. § 794(a) (West 1999 & Supp. 2004), and its implementing
    regulations; and (4) the Due Process and Equal Protection Clauses
    of the Fourteenth Amendment.   Plaintiffs assert causes of action
    under 42 U.S.C. § 1983, Title II, and § 504, and they seek
    declaratory and injunctive relief.
    Defendants moved to dismiss under Rule 12(b)(6) and Rule
    12(b)(1), contending that several of Plaintiffs’ claims failed to
    state a claim upon which relief could be granted and asserting
    Eleventh Amendment immunity from the entire suit.   In May 2003,
    the district court granted Defendants’ motion in part and denied
    it in part.   The district court dismissed, for failure to state a
    3
    According to this subsection, a state’s Medicaid plan
    must “provide for granting an opportunity for a fair hearing
    before the State agency to any individual whose claim for medical
    assistance under the plan is denied or is not acted upon with
    reasonable promptness.” 42 U.S.C. § 1396a(a)(3).
    5
    claim, Plaintiffs’ Due Process and Equal Protection claims.
    Similarly, the court dismissed, for failure to state a claim, all
    but one of Plaintiffs’ § 1983 claims regarding alleged
    infringements of the Medicaid statute, concluding that only the
    due process provision in § 1396a(a)(3) was enforceable under
    § 1983.4    Concerning Plaintiffs’ Title II and § 504 causes of
    action, the court ruled that Plaintiffs’ complaint did state
    actionable claims under each statute.    Further, since Plaintiffs
    sued state officers for prospective relief, the court relied on
    the doctrine of Ex parte Young in holding that the Eleventh
    Amendment did not bar Plaintiffs’ Title II and § 504 claims.
    In sum, the district court allowed three of Plaintiffs’
    causes of action to proceed: (1) their § 1983 claim based on
    violations of the due process provision of the Medicaid statute
    (§ 1396a(a)(3)); (2) their Title II claim; and (3) their § 504
    claim.     Defendants appeal from that portion of the district
    court’s May 2003 order that denied their motion to dismiss on the
    basis of Eleventh Amendment immunity.    Under the collateral order
    doctrine, this court has jurisdiction over an interlocutory
    appeal from a denial of a motion to dismiss asserting Eleventh
    4
    While the district court did not expressly discuss
    Defendants’ Eleventh Amendment-immunity defense to Plaintiffs’
    surviving § 1983 claim (for violation of § 1396a(a)(3)), since
    this claim was not dismissed, the court must have rejected that
    defense, probably believing that this claim was also permissible
    under Ex parte Young. On appeal, Defendants do not complain
    about this omission from the district court’s opinion.
    6
    Amendment immunity.     See P.R. Aqueduct & Sewer Auth. v. Metcalf &
    Eddy, Inc., 
    506 U.S. 139
    , 144-45 (1993).      In November 2003, this
    court granted the United States’s unopposed motion to intervene
    on behalf of Plaintiffs.5
    III.   Standard of Review
    This court reviews denials of Eleventh Amendment immunity de
    novo.    Cozzo v. Tangipahoa Parish Council--President Gov’t, 
    279 F.3d 273
    , 280 (5th Cir. 2002).
    IV.   Texas’s Entitlement to Eleventh Amendment
    Immunity From Suit
    The Eleventh Amendment has been interpreted by the Supreme
    Court to bar suits by individuals against nonconsenting states.
    Bd. of Trs. of the Univ. of Ala. v. Garrett, 
    531 U.S. 356
    , 363
    (2001).    In addition, the principle of state-sovereign immunity
    generally precludes actions against state officers in their
    official capacities, see Edelman v. Jordan, 
    415 U.S. 651
    , 663-69
    (1974), subject to an established exception: the Ex parte Young
    doctrine.    Under Ex parte Young, “a federal court, consistent
    with the Eleventh Amendment, may enjoin state officials to
    conform their future conduct to the requirements of federal law.”
    Quern v. Jordan, 
    440 U.S. 332
    , 337 (1979).      Here, the district
    court relied on the Ex parte Young exception in ruling that the
    Eleventh Amendment does not bar Plaintiffs’ claims.
    5
    We refer to the United States as “the government” in
    this opinion.
    7
    A.   The Parties’ Contentions
    Texas maintains that a plaintiff may not proceed under Ex
    parte Young unless she asserts a violation of a federal right
    that arises from a valid federal law that is enforceable against
    the defendant state.   In Texas’s view, Plaintiffs’ § 1983, Title
    II, and § 504 claims do not satisfy these prerequisites to an Ex
    parte Young action because none alleges a violation of a valid
    federal right that is enforceable against Defendants.    Texas
    presents four arguments on appeal.    First, Texas contends that
    the district court incorrectly determined that Plaintiffs can
    enforce the due process provision of the federal Medicaid law,
    § 1396a(a)(3), under § 1983.    Second, Texas asserts that an
    action cannot be brought under Ex parte Young to enforce Title II
    of the ADA, since a state officer is not a proper defendant under
    Title II.   Third, the State argues that Congress lacked the power
    under either § 5 of the Fourteenth Amendment or the Commerce
    Clause to enact the substantive requirements in Title II and that
    Title II violates the Tenth Amendment.    Fourth, Texas maintains
    that § 504 of the Rehabilitation Act is unconstitutional as
    applied to Defendants because it violates the relatedness
    requirement imposed on Spending Clause legislation in South
    Dakota v. Dole, 
    483 U.S. 203
    , 207 (1987).    Accordingly, Texas
    contends that state-sovereign immunity bars Plaintiffs’ suit
    because Plaintiffs have not alleged a violation of any valid
    8
    federal law.
    Plaintiffs and the government respond that Texas is
    attempting impermissibly to broaden the scope of this
    interlocutory appeal.    By articulating these “prerequisites” to
    an Ex parte Young suit, they assert, the State invites this court
    to reach the merits of Plaintiffs’ claims and Defendants’
    defenses to liability.   Instead, Plaintiffs argue, this court
    must limit its review to whether the district court correctly
    concluded that Texas’s Eleventh Amendment immunity from suit does
    not bar it from hearing Plaintiffs’ § 1983, Title II, and § 504
    claims.   Accordingly, Plaintiffs and the government maintain that
    this court should refuse to consider all but one of Texas’s
    arguments, i.e., its contention that an Ex parte Young suit
    cannot be brought to enforce Title II.
    Since Plaintiffs and the government concede that Texas’s
    second contention is an appropriate subject of consideration in
    this interlocutory appeal, we address this argument first.
    B.   Whether state officers are proper defendants under Title II
    Title II provides in relevant part that “no qualified
    individual with a disability shall, by reason of such disability,
    be excluded from participation in or be denied the benefits of
    the services, programs, or activities of a public entity, or be
    subjected to discrimination by any such entity.”   42 U.S.C.
    § 12132 (2000).   The State asserts that the district court erred
    9
    in denying it Eleventh Amendment immunity from Plaintiffs’ cause
    of action under Title II because a claim cannot be brought under
    Ex parte Young to enforce that statute.   Texas maintains that a
    state officer is not a proper defendant under Title II; only
    public entities can be sued under the statute.   Thus, since Ex
    parte Young only allows suits against state officers, Texas
    reasons that Plaintiffs’ Title II claims must be dismissed.      In
    response, Plaintiffs and the government argue that Title II can
    be enforced through suits for prospective relief against state
    officers, even though the substantive requirements of the statute
    apply only to public entities, because a suit against a state
    officer in her official capacity is really a suit against the
    state agency itself.
    Texas’s contention presents an issue of first impression in
    this circuit.   The State relies primarily on the Seventh
    Circuit’s opinion in Walker v. Snyder, 
    213 F.3d 344
    (7th Cir.
    2000).6   In Walker, the court held that a plaintiff could not
    6
    Texas also cites Lewis v. N.M. Dep’t of Health, 94 F.
    Supp. 2d 1217 (D.N.M. 2000). There, the court held that an Ex
    parte Young action could not be maintained under Title II because
    state officials are not proper defendants under the statute. 
    Id. at 1230.
    Without engaging in much analysis, the court relied on
    one circuit court opinion involving state officers sued in their
    individual capacities, see Alsbrook v. City of Maumelle, 
    184 F.3d 999
    , 1005 n.8 (8th Cir. 1999) (en banc), and several district
    court decisions. 
    Lewis, 94 F. Supp. 2d at 1230
    . While the Lewis
    court’s judgment was upheld on appeal, the Tenth Circuit did not
    pass on this holding, since the plaintiffs had dropped their ADA
    claim. Lewis v. N.M. Dep’t of Health, 
    261 F.3d 970
    , 975 (10th
    Cir. 2001).
    10
    bring an Ex parte Young suit to enforce Title II because the only
    proper defendant “is the public body as an entity.”     
    Id. at 347.
    But Walker, decided in 2000, has been undermined by the Supreme
    Court’s subsequent statement in Garrett that Title I of the ADA
    could be enforced in an Ex parte Young action.     
    Garrett, 531 U.S. at 374
    n.9.    Indeed, the Seventh Circuit has disavowed Walker’s
    holding on this issue, concluding that it “did not survive”
    Garrett.     Bruggeman v. Blagojevich, 
    324 F.3d 906
    , 912-13 (7th
    Cir. 2003).    Even though Walker has been abrogated, Texas still
    contends this court should follow that decision, since the remark
    from Garrett that the Bruggeman court relied on was dictum.
    Although the Court’s comment in Garrett was not essential to
    the judgment, the courts of appeals have been unanimous in
    rejecting arguments that state officers cannot be sued for
    prospective relief in their official capacities for violations of
    Title II.7    In addition to this substantial authority from other
    7
    See Henrietta D. v. Bloomberg, 
    331 F.3d 261
    , 288 (2d
    Cir. 2003) (refusing to “embrace the state defendant’s statutory
    claim that an individual sued in his or her official capacity
    under the doctrine of Ex parte Young is not a ‘public entity’
    subject to liability” under Title II and explaining that, “[t]he
    real party in interest in an official-capacity suit is the
    government entity. As a result, it is irrelevant whether the ADA
    would impose individual liability on the officer sued; since the
    suit is in effect against the ‘public entity,’ it falls within
    the express authorization of the ADA.” (citation omitted));
    Miranda B. v. Kitzhaber, 
    328 F.3d 1181
    , 1187-88 (9th Cir. 2003)
    (following “the Sixth, Seventh, and Eighth Circuits in holding
    that Title II’s statutory language does not prohibit [the
    plaintiff’s] injunctive action against state officials in their
    official capacities”); 
    Bruggeman, 324 F.3d at 912-13
    ; Carten v.
    Kent State Univ., 
    282 F.3d 391
    , 396-97 (6th Cir. 2002) (holding
    11
    circuits, Supreme Court precedent makes clear that “a suit
    against a state official in his or her official capacity is not a
    suit against the official but rather is a suit against the
    official’s office.”   Will v. Mich. Dep’t of State Police, 
    491 U.S. 58
    , 71 (1989); accord Kentucky v. Graham, 
    473 U.S. 159
    ,
    165-66 (1985) (“Official-capacity suits . . . generally represent
    only another way of pleading an action against an entity of which
    an officer is an agent.   As long as the government entity
    receives notice and an opportunity to respond, an
    official-capacity suit is, in all respects other than name, to be
    treated as a suit against the entity.   It is not a suit against
    the official personally, for the real party in interest is the
    entity.” (citations and internal quotation marks omitted)).     Only
    for the purposes of the Eleventh Amendment are “official-capacity
    actions for prospective relief . . . not treated as actions
    against the State.”   
    Graham, 473 U.S. at 167
    n.14 (citing Ex
    parte Young).
    We thus join the Second, Sixth, Seventh, Eighth, and Ninth
    Circuits in holding that Plaintiffs’ Ex parte Young suit to
    that “an official who violates Title II of the ADA does not
    represent ‘the state’ for purposes of the Eleventh Amendment, yet
    he or she nevertheless may be held responsible in an official
    capacity for violating Title II”); Randolph v. Rodgers, 
    253 F.3d 342
    , 348 (8th Cir. 2001) (citing Garrett’s dictum and refusing to
    accept the contention that “because the statutory language of the
    ADA provides only for ‘public entity’ liability, an Ex parte
    Young claim against the state officials in their official
    capacities, premised upon an ADA violation, must fail”).
    12
    enforce Title II can proceed; Defendants have been sued in their
    official capacities and are therefore representing their
    respective state agencies (which are proper Title II defendants)
    for all purposes except the Eleventh Amendment.8
    C.   Texas’s other arguments on appeal
    When stripped of their Eleventh Amendment gloss, Texas’s
    three remaining arguments essentially target the merits of
    Plaintiffs’ claims, rather than Plaintiffs’ reliance on the
    doctrine of Ex parte Young to establish jurisdiction.   As we will
    see, these defenses to liability are beyond the scope of this
    interlocutory appeal from a denial of Eleventh Amendment immunity
    from suit.   See P.R. Aqueduct & Sewer 
    Auth., 506 U.S. at 144
    8
    Texas, relying on Seminole Tribe of Florida v. Florida,
    
    517 U.S. 44
    (1996), also suggests that Title II’s use of the
    phrase “public entity” evidences Congressional intent to preclude
    Ex parte Young actions to enforce the Act. But Seminole Tribe
    provides no comfort to the State. There, the Court merely
    explained that, “where Congress has prescribed a detailed
    remedial scheme for the enforcement against a State of a
    statutorily created right, a court should hesitate before casting
    aside those limitations and permitting an action against a state
    officer based upon Ex parte Young.” 
    Id. at 74
    (emphasis added).
    Here, Plaintiffs do not seek under Ex parte Young any remedies
    that have been limited by the terms of Title II. In addition, at
    least two other circuits have specifically rejected arguments,
    based on Seminole Tribe, that Congress intended to preempt Ex
    parte Young actions to enforce Title II. See Henrietta 
    D., 331 F.3d at 289
    (“In our view, Seminole Tribe does not bar Ex parte
    Young relief under Title II against a state official in her
    official capacity. Neither § 504 nor Title II displays any
    intent by Congress to bar a suit against state officials in their
    official capacities for injunctive relief, nor does either create
    a remedial scheme so elaborate that it could be thought to
    preclude relief under Ex parte Young.”); Miranda 
    B., 328 F.3d at 1188-89
    .
    13
    (explaining that the Eleventh Amendment “confers an immunity from
    suit”).
    1.    The constitutionality of Title II and § 504
    We first turn to Texas’s contentions that Congress lacked
    the power to enact the substantive provisions of Title II and
    § 504.    The State provides no authority for its assertion that a
    federal court must determine the constitutionality of a federal
    law in the course of determining the applicability of the Ex
    parte Young exception.   Instead, the State misleadingly quotes
    the Supreme Court’s opinion in Gonzaga University v. Doe for the
    proposition that, “[a]s a prerequisite to bringing a Young suit,
    . . . ‘a plaintiff must assert the violation of a federal right,
    not merely a violation of federal law.’”    Texas Br. at 13
    (quoting Doe, 
    536 U.S. 273
    , 282 (2002)).    But this passage in Doe
    involved the prerequisites for stating a claim under § 1983, not
    the requirements for avoiding an Eleventh Amendment defense to
    suit through the vehicle of an Ex parte Young action.9   Texas
    relies heavily on this misinterpretation of Doe in contending
    that Plaintiffs cannot proceed under Ex parte Young unless this
    9
    The full sentence from the opinion reads, “We
    emphasized: ‘[T]o seek redress through § 1983, . . . a plaintiff
    must assert the violation of a federal right, not merely a
    violation of federal law.’” 
    Doe, 536 U.S. at 282
    (quoting
    Blessing v. Freestone, 
    520 U.S. 329
    , 340 (1997)) (alterations in
    original) (first emphasis added). Of course, Plaintiffs’ Title
    II and § 504 claims do not arise under § 1983; both Title II and
    § 504 are enforceable directly through private causes of action.
    See Barnes v. Gorman, 
    536 U.S. 181
    , 185 (2002).
    14
    court first determines that their claims rely on federal laws
    that are both constitutional and enforceable against the State.
    But Texas simply provides no support for its contention that a
    court must determine the validity of a plaintiff’s cause of
    action in the course of deciding whether an Ex parte Young suit
    can proceed in the face of a state’s Eleventh Amendment defense.
    Texas’s broad understanding of the scope of this
    interlocutory appeal is not only unprecedented, more importantly,
    it flies in the face of the Supreme Court’s reasoning in Verizon
    Maryland, Inc. v. Public Service Commission, 
    535 U.S. 635
    (2002).
    There, Verizon brought suit in federal district court, seeking
    relief from an order of the Maryland Public Service Commission.
    
    Id. at 640.
       Verizon alleged that the Commission’s order violated
    federal law.     
    Id. In ruling
    that the district court lacked
    jurisdiction to hear Verizon’s action, the Fourth Circuit held,
    inter alia, that the Eleventh Amendment did not permit Verizon to
    sue individual commissioners in their official capacities.        
    Id. In the
    words of the Supreme Court, the “Fourth Circuit suggested
    that Verizon’s claim could not be brought under Ex parte Young,
    because the Commission’s order was probably not inconsistent with
    federal law after all.”      
    Id. at 646.
      The Court swiftly rejected
    this reasoning, noting that “the inquiry into whether suit lies
    under Ex parte Young does not include an analysis of the merits
    of the claim.”     
    Id. (emphasis added).
      On the contrary, the Court
    explained that “[i]n determining whether the doctrine of Ex parte
    15
    Young avoids an Eleventh Amendment bar to suit, a court need only
    conduct a ‘straightforward inquiry into whether [the] complaint
    alleges an ongoing violation of federal law and seeks relief
    properly characterized as prospective.’”    
    Id. at 645
    (quoting
    Idaho v. Coeur d’Alene Tribe of Idaho, 
    521 U.S. 261
    , 296 (1997)
    (O’Connor, J., concurring in part and concurring in the
    judgment)) (alteration in original); see also Coeur 
    d’Alene, 521 U.S. at 281
    (“An allegation of an ongoing violation of federal
    law where the requested relief is prospective is ordinarily
    sufficient to invoke the Young fiction.” (emphasis added)).
    Thus, the Court made clear that analyzing the applicability of
    the Ex parte Young exception should generally be a simple matter,
    which excludes questions regarding the validity of the
    plaintiff’s cause of action.
    Texas attempts to distinguish Verizon, asserting that its
    arguments contesting the constitutionality of Title II and § 504
    are appropriate for consideration in this interlocutory appeal,
    even though an argument that it has not violated those statutes
    would not be.   We are not persuaded.   Like other defenses to
    liability, the State’s arguments do not challenge the district
    court’s power under Ex parte Young to adjudicate Plaintiffs’
    claims.   Rather, the State seeks to have Plaintiffs’ Title II and
    § 504 claims dismissed on the merits on the ground that the
    statutes’ substantive provisions are unconstitutional; such a
    disposition would not be a determination that the Ex parte Young
    16
    exception is inapplicable or that the Eleventh Amendment bars a
    federal court from hearing Plaintiffs’ action.     In other words,
    resolution of the constitutional questions urged by Defendants is
    irrelevant to the question whether Texas’s Eleventh Amendment
    immunity from suit has been infringed.   Moreover, our refusal to
    consider the constitutional issues in this interlocutory appeal
    comports with the rationale for allowing an interlocutory appeal
    from denials of Eleventh Amendment immunity.   Unlike a State’s
    entitlement to Eleventh Amendment immunity from suit, the
    constitutionality of Title II and § 504 can be reviewed
    effectively on appeal from a final judgment.     Cf. P.R. Aqueduct &
    Sewer 
    Auth., 506 U.S. at 144
    -45 (explaining that the question of
    state-sovereign immunity is (1) conclusively determined by the
    denial of a motion to dismiss, (2) completely separate from the
    merits of the action, and (3) “effectively unreviewable on appeal
    from a final judgment”).   We consequently follow the teaching of
    Verizon and hold that the constitutionality of the substantive
    provisions of Title II and § 504 is beyond the scope of this
    appeal.
    2.   The enforceability of § 1396a(a)(3) under § 1983
    Finally, we consider Texas’s assertion that the Eleventh
    Amendment bars Plaintiffs’ surviving § 1983 claim because the due
    process provision of the Medicaid statute, § 1396a(a)(3), does
    not create a federal right enforceable under § 1983.    Although
    couched in terms of sovereign immunity, the State’s argument on
    17
    this score is entirely devoted to attacking the district court’s
    ruling that Plaintiffs can state an actionable claim under § 1983
    to enforce § 1396a(a)(3).   Even more so than Defendants’
    constitutional contentions, this argument centers on the merits
    of Plaintiffs’ § 1983 claim, not their use of Ex parte Young to
    seek injunctive relief despite the Eleventh Amendment.    Moreover,
    other than their misinterpretation of Doe (which we exposed
    above), Defendants provide no support for the notion that, to
    determine the applicability of the Ex parte Young exception, we
    must review the district court’s conclusion that a § 1983 action
    can be brought to enforce § 1396a(a)(3).   On the contrary, at
    least one court of appeals has refused to broaden this type of
    interlocutory appeal to encompass the question whether alleged
    transgressions of the Medicaid statute can be vindicated under
    § 1983.   See Rosie D. ex rel. John D. v. Swift, 
    310 F.3d 230
    ,
    233-34, 238 (1st Cir. 2002) (opining that the issue of
    enforceability under § 1983 was not ripe for review).    Similarly,
    we will confine ourselves to the question whether Plaintiffs have
    properly demonstrated jurisdiction under Ex parte Young.
    D.   The applicability of the Ex parte Young exception to
    Eleventh Amendment immunity
    Left to address the simple question whether the district
    court correctly found that Plaintiffs properly have proceeded
    under Ex parte Young, we agree with the district court.
    Plaintiffs allege that Defendants’ failure to admit them to the
    18
    HCS and CLASS programs violates § 1396a(a)(3), Title II, and
    § 504.    Further, they seek injunctive and declaratory relief.10
    Thus, the “complaint alleges an ongoing violation of federal law
    and seeks relief properly characterized as prospective.”
    
    Verizon, 535 U.S. at 645
    (internal quotation marks omitted).
    Plaintiffs have therefore satisfied the Supreme Court’s
    “straightforward inquiry,” and we hold that the Eleventh
    Amendment does not apply to this suit.       See P.R. Aqueduct & Sewer
    
    Auth., 506 U.S. at 146
    (“Young and its progeny render the
    [Eleventh] Amendment wholly inapplicable to a certain class of
    suits.”).
    V.   Conclusion
    Accordingly, we AFFIRM the order of the district court
    denying that portion of Defendants’ motion to dismiss that relies
    on the defense of Eleventh Amendment immunity.
    10
    Defendants do not contend that the relief sought by
    Plaintiffs could have an impermissibly retroactive effect.
    19
    EMILIO M. GARZA, Circuit Judge, concurring in part and dissenting
    in part:
    The majority opinion incorrectly concludes that the
    constitutionality of the federal law underlying an Ex parte Young
    suit is not properly considered as part of an Eleventh Amendment
    immunity analysis.   To sustain a Young suit a plaintiff must
    allege an ongoing violation of valid, constitutional federal law.
    As I believe that Title II of the ADA was enacted beyond
    Congress’s legislative authority, I would hold that the
    plaintiffs in this case (“the Plaintiffs”) have failed to
    establish a valid Young suit against the defendant commissioners
    (“Texas”) under Title II of the Americans with Disabilities Act
    (“ADA”) and that Texas is entitled to Eleventh Amendment immunity
    as to that claim.    However, because I believe § 504 of the
    Rehabilitation Act is valid Spending Clause legislation, I would
    hold that the Plaintiffs have properly alleged a Young suit under
    that statute.   Further, I agree with the majority opinion that
    Texas’s claim that the Medicaid Act does not provide for an
    individual cause of action is beyond the scope of this appeal and
    should not be considered.    Accordingly, I respectfully concur in
    part, and dissent in part.
    I
    This is an interlocutory appeal of an order denying Texas’s
    claim of Eleventh Amendment immunity. See Puerto Rico Aqueduct       &
    20
    Sewer Auth. v. Metcalf & Eddy Inc., 
    506 U.S. 139
    , 147, 
    113 S. Ct. 684
    (1993) (authorizing an interlocutory appeal of an order
    denying Eleventh Amendment immunity).     As there is no final order
    in this case, we are limited to considering the question of
    whether Texas is entitled to Eleventh Amendment immunity from the
    Plaintiffs’ suit.      All other issues are beyond the scope of this
    appeal.
    As part of this appeal, Texas challenges the
    constitutionality of both Title II of the ADA and § 504 of the
    Rehabilitation Act.      Texas does not independently challenge the
    constitutionality of these statutes, which would be beyond the
    jurisdiction of this appeal.     Instead, it challenges their
    constitutionality as part of its assertion of Eleventh Amendment
    immunity and its argument that the Plaintiffs have not properly
    alleged a suit under Ex parte Young.     Texas argues that because
    the permissibility of a Young suit is premised on the assumption
    that the defendant state official is engaging in an ongoing
    violation of federal law, the question of the validity of that
    federal law is a proper subject of an Eleventh Amendment immunity
    analysis.   I agree.
    Under the Eleventh Amendment, “an unconsenting State is
    immune from suits brought in federal court by [its] own citizens
    as well as by citizens of another state.”      Edelman v. Jordan, 
    415 U.S. 651
    , 663, 
    94 S. Ct. 1347
    (1974).     The Eleventh Amendment
    21
    provides states with immunity from “the indignity” of being
    subjected to the “coercive process of judicial tribunals at the
    instance of private parties.”    
    Metcalf, 506 U.S. at 146
    (citing
    In re Ayer, 
    123 U.S. 443
    , 505, 
    8 S. Ct. 164
    (1887)).      The Supreme
    Court has held that the rule that “a State may not be sued
    without its consent is [such] a fundamental rule of jurisprudence
    . . . that the entire judicial power granted by the Constitution
    does not embrace authority to entertain a suit brought by private
    parties against a State without consent given . . . .”       Pennhurst
    State Sch. & Hosp. v. Halderman, 
    465 U.S. 89
    , 99, 
    104 S. Ct. 900
    (1984) (quoting Ex parte State of New York No. 1, 
    256 U.S. 490
    ,
    497, 
    41 S. Ct. 588
    (1921)) (emphasis omitted).    Eleventh
    Amendment immunity extends to suits against state officials in
    their official capacities. See 
    id. at 101
    (A suit against a state
    official “is in fact against the sovereign if the decree would
    operate against the latter.”).    Therefore, “a suit against [a]
    state official[] that is in fact a suit against a State is barred
    regardless of whether it seeks damages or injunctive relief.” 
    Id. at 102.
    One exception to this general rule is that “a suit
    challenging the constitutionality of a state official’s action is
    not one against the State.”     Id.; see Ex parte Young, 
    209 U.S. 123
    , 
    28 S. Ct. 441
    (1908).    Under Ex parte Young, “an
    unconstitutional enactment is ‘void’ and therefore does not
    22
    impart to the officer any immunity from responsibility to the
    supreme authority of the United States.”     
    Pennhurst, 465 U.S. at 102
    (internal quotations omitted).    The Supreme Court has
    recognized that there is some “irony” in the fact that “an
    official’s unconstitutional conduct constitutes state action
    under the Fourteenth Amendment” but does not under the Eleventh
    Amendment.   
    Id. at 105.
      It, however, has concluded that the
    Young doctrine is “necessary to permit the federal courts to
    vindicate federal rights and hold state officials responsible to
    ‘the supreme authority of the United States.’” 
    Id. The Supreme
    Court, however, has sought to balance the need
    to hold state officials responsible to the “supreme authority of
    the United States” with states’ “fundamental” right to immunity
    from private suit.   To achieve this balance it has thus limited
    the scope of the Young exception.     For example, a Young suit can
    only be brought to require a state official to “conform his
    future conduct of office to the requirements of” federal law, but
    may not be applied retroactively. 
    Edelman, 415 U.S. at 664
    ; see
    Verizon Maryland Inc. v. Pub. Serv. Comm’n of Maryland, 
    535 U.S. 635
    , 645, 
    122 S. Ct. 1753
    (2002) (A Young suit requires the
    plaintiff allege “an ongoing violation of federal law and seek[]
    relief properly characterized as prospective.”).
    In crafting this limitation, the Supreme Court has noted
    that the “distinction between prospective and retroactive relief
    23
    fulfills the underlying purpose of Ex parte Young while at the
    same time preserving to an important degree the constitutional
    immunity of the States.”   
    Pennhurst, 465 U.S. at 106
    .   Further,
    it has noted the importance of consciously balancing these two
    important interests when applying the Young doctrine.    See, e.g.,
    id.; Idaho v. Couer d’Alene Tribe of Idaho, 
    521 U.S. 261
    , 270,
    
    117 S. Ct. 2028
    (1997) (noting that application of Young requires
    an “understanding of its role in our federal system”); see also
    
    Verizon, 535 U.S. at 649
    (Kennedy, J., concurring) (“Ex parte
    Young jurisprudence requires careful consideration of the
    sovereign interests of the State as well as the obligations of
    state officials to respect the supremacy of federal law.”).
    In Pennhurst State School & Hospital v. Halderman, the
    Supreme Court held that a plaintiff cannot vindicate state rights
    as part of a Young suit.   
    Pennhurst, 465 U.S. at 106
    .   After
    reviewing the policy justifications for the Young doctrine and
    noting the importance of balancing the competing interests
    outlined above, the Court concluded: “This need to reconcile
    competing interests is wholly absent, however, when a plaintiff
    alleges that a state official has violated state law.    In such a
    case the entire basis for the doctrine of Young . . .
    disappears.”   
    Id. (emphasis omitted).
      It further concluded, “[a]
    federal court’s grant of relief against state officials on the
    basis of state law . . . does not vindicate the supreme authority
    24
    of federal law.”   
    Id. (emphasis added);
    see Saahir v. Estelle, 
    47 F.3d 758
    , 761 (5th Cir. 1995) (noting that “the only legitimate
    basis for federal court intervention, consistent with the
    Eleventh Amendment is the vindication of federal rights”).
    The Supreme Court has thus made it clear that if there are
    no federal rights for the plaintiff to vindicate then the
    justification for the Young exception is not present in the case
    and the state’s right to Eleventh Amendment immunity should be
    honored.   See 
    Pennhurst, 465 U.S. at 106
    .   The justification for
    a Young suit is also absent when the plaintiff alleges the
    ongoing violation of unconstitutional or otherwise invalid
    federal law.   In such a case, there are no federal rights to
    vindicate and there can be no prospective relief under Young.
    Therefore, before we can determine whether a plaintiff seeks to
    vindicate “the supreme authority of the law” and before we can
    possibly balance the “sovereign interests of the State . . .
    [with the] obligation[] of state officials to respect the
    supremacy of federal law,” we must first determine whether the
    plaintiff seeks to vindicate valid federal rights, and by
    implication whether the federal law underlying the Young suit is
    constitutional.
    The majority opinion concludes that if we were to address
    the constitutionality of the statutes underlying the Plaintiffs’
    Young suit we would be impermissibly addressing the merits of
    25
    their claims.   The Supreme Court has specifically held that “the
    inquiry into whether a suit lies under Ex parte Young does not
    include an analysis of the merits of the claim.” 
    Verizon, 535 U.S. at 646
    , see Couer 
    d’Alene, 521 U.S. at 281
    (“An allegation
    of an ongoing violation of federal law . . . is ordinarily
    sufficient . . . .”).
    Verizon, however, does not address the relevance of the
    constitutionality of the federal law underlying the Young suit.
    In Verizon, the Maryland Public Service Commission (“the
    Commission”) argued that it was not subject to discipline under
    the provisions of the federal statute (The Telecommunications Act
    of 1996) underlying Verizon’s Young suit.   See 
    Verizon, 535 U.S. at 646
    .   It did not argue that the law underlying the Young suit
    was unconstitutional or was otherwise not valid federal law.    The
    Supreme Court held that the Commission had improperly argued the
    merits of the underlying claim))whether the Commission had
    violated the dictates of the Telecommunications Act))as part of
    its assertion of Eleventh Amendment immunity. 
    Id. However, the
    proposed constitutional inquiry in this case is not a review of
    the merits of the Plaintiffs’ substantive claims))whether Texas
    violated either Title II of the ADA or § 504 of the
    Rehabilitation Act.   Rather, it is part of the inquiry into
    whether the Plaintiffs seeks to vindicate valid federal rights.
    Further, the majority opinion fails to heed the Supreme
    26
    Court’s warning not to be held captive to the “mechanics of . . .
    pleadings” and forget that our application of “the Young
    exception must reflect a proper understanding of [the doctrine’s]
    role in our federal system and respect for state courts instead
    of a reflexive reliance on an obvious fiction.” Couer 
    d’Alene, 521 U.S. at 270
    .   As the Court noted, to do so “would be to
    adhere to an empty formalism and to undermine the principle . . .
    that the Eleventh Amendment immunity represents a real limitation
    on a federal court’s federal question jurisdiction.”      
    Id. In blindly
    applying Verizon to this case, the majority opinion
    ignores the policy justifications behind the Young exception and
    needlessly subjects Texas to a suit in federal court without
    first determining whether the Plaintiffs seek to vindicate valid
    federal rights.
    Additionally, there is no reason to delay resolving these
    issues.   The Supreme Court has emphasized the importance of
    quickly resolving Eleventh Amendment claims because “the value to
    the States of their Eleventh Amendment immunity . . . is for the
    most part lost as litigation proceeds past motion practice.” See
    
    Metcalf, 506 U.S. at 145
    .    This suggests that resolving the
    constitutionality of the federal law underlying the Young suit
    should be completed sooner rather than later.   This is
    particularly true here because there is no policy reason for
    delaying the resolution of these issues.   The constitutionality
    27
    of these statutes is a purely legal question that can be resolved
    without the aid of either discovery or trial. Compare Mitchell v.
    Forsyth, 
    472 U.S. 511
    , 528, 
    105 S. Ct. 2806
    (1985) (authorizing
    interlocutory review of denials of qualified immunity because
    “[a]ll [the court] need determine is a question of law”) and
    Johnson v. Jones, 
    515 U.S. 304
    , 317, 
    115 S. Ct. 2151
    (1995)
    (“[I]mmunity appeals interfere less with the final judgment rule
    if they are limited to cases presenting neat abstract issues of
    law.”), with 
    Metcalf, 506 U.S. at 147
    (holding that “factual
    complexities” provide no excuse for refusing to resolve a claim
    of Eleventh Amendment immunity).
    Further, appellate courts routinely resolve constitutional
    issues in interlocutory appeals as part of determining whether
    Congress has validly abrogated states’ Eleventh Amendment
    immunity pursuant to their authority under § 5 of the Fourteenth
    Amendment.     See e.g., Reickenbacker v. Foster, 
    274 F.3d 974
    , 979
    (5th Cir. 2001) (finding that Congress went beyond its § 5 powers
    by abrogating states’ Eleventh Amendment immunity under Title II
    of the ADA).    It is similarly appropriate to resolve these
    constitutional issues during this appeal.
    The Government suggest that if we were to decide that the
    constitutionality of these statutes is properly part of an
    Eleventh Amendment immunity analysis we should remand to the
    district court so that it may consider and address these issues.
    28
    The Supreme Court, however, has held that an “Eleventh Amendment
    defense sufficiently partakes of the nature of a jurisdictional
    bar [] that it need not be raised in the trial court.”     See
    
    Edelman, 415 U.S. at 678
    (ruling on an Eleventh Amendment
    immunity claim raised for the first time in the appellate court).
    Further, as these are purely legal questions which would be
    reviewed de novo in a future appeal there is no reason to remand
    for a ruling by the district court.
    Accordingly, I would hold that a challenge to the
    constitutionality of a statute underlying a Young suit is a
    proper subject of an Eleventh Amendment immunity analysis and
    that consideration of such a challenge is within the scope of an
    interlocutory appeal from the denial of a claim of Eleventh
    Amendment immunity.     Texas challenges the constitutionality of
    both Title II of the ADA and § 504 of the Rehabilitation Act.      As
    I believe these constitutional challenge are within the scope of
    this appeal, I will address the merits of Texas’s contentions.
    II
    Texas challenges the constitutionality of Title II of the
    ADA.    It argues that Title II was enacted beyond the scope of
    Congress’s authority under    both § 5 of the Fourteenth Amendment
    and the Commerce Clause.     See 42 U.S.C. § 12101(b)(4) (invoking
    both Congress’s § 5 authority and Commerce Clause power in
    enacting the ADA).    Texas also argues that Title II improperly
    29
    impedes on state authority in violation of the Tenth Amendment.
    A
    Texas first argues that we should extend our ruling in
    Reickenbacker v. 
    Foster, 274 F.3d at 976
    (holding that Title II
    of the ADA was enacted beyond Congress authority under § 5 for
    purposes of abrogating states Eleventh Amendment immunity), to
    this case and hold that Congress acted beyond its § 5 authority
    in enacting Title II.   Plaintiffs and the Government argue that
    Reickenbacker is not controlling because in that case we did not
    engage in a full § 5 analysis.   See 
    id. at 982
    n.60 (refusing to
    consider Congressional findings of discrimination by local
    entities in § 5 abrogation analysis because local entities cannot
    assert sovereign immunity).   Further they argue that our decision
    in Reickenbacker has been, at least partially, superseded by the
    Supreme Court’s recent decision in Tennessee v. Lane, 
    124 S. Ct. 1978
    , 1992 (2004) (finding that “extensive record of disability
    discrimination” by states justified “prophylactic legislation”),
    and argue that, in light of Lane, Title II’s accommodation
    requirement is a “congruent and proportional” response to
    irrational discrimination against the disabled by state and local
    public entities.
    By its own terms, Reickenbacker cannot simply be extended to
    this case.   In Reickenbacker, we held that Title II of the ADA
    was enacted beyond the scope of Congress’s § 5 powers for
    30
    purposes of abrogating states’ Eleventh Amendment immunity.     See
    
    Reickenbacker, 274 F.3d at 982-83
    (finding that because Congress
    never established that states engaged in unconstitutional
    discrimination against the disabled Title II’s “affirmative
    accommodation obligation on the part of public entities” was
    enacted beyond Congress’s § 5 authority); cf. Bd. of Trustees of
    Univ. of Alabama v. Garrett, 
    531 U.S. 356
    , 367-68, 
    121 S. Ct. 955
    (2001) (“States are not required by the Fourteenth Amendment to
    make special accommodations for the disabled, so long as their
    actions towards such individuals are rational.”).
    We, however, noted that “Title II of the ADA could still be
    a valid exercise of Congress’s § 5 power, but simply not provide
    the . . . power to abrogate” states’ Eleventh Amendment immunity.
    See 
    Reickenbacker, 274 F.3d at 982
    n.60.   This limiting language
    was premised on our refusal to review Congressional findings as
    to discrimination by local entities as part of that § 5 analysis
    because local entities cannot claim Eleventh Amendment immunity.
    See id.; see also 
    Garrett, 531 U.S. at 369
    (“[Local] entities are
    subject to private claims for damages under the ADA without
    Congress ever having to rely on § 5 . . . . It would make no
    sense to consider constitutional violations on their part, as
    well as by the States themselves, when only the States are the
    beneficiaries of the Eleventh Amendment.”); but see Lane, 124 S.
    Ct. at 1991 n.16 (suggesting that “constitutional violations on
    31
    the part of nonstate governmental actors” is “relevant” to this
    inquiry).    In contrast, “the analysis of whether Congress has the
    power to enact legislation requires [an] inquiry into
    constitutional violations by [local] entities in addition to
    entities entitled to Eleventh Amendment immunity.” 
    Reickenbacker, 274 F.3d at 982
    n.60 (emphasis added) (quoting Thompson v.
    Colorado, 
    258 F.3d 1241
    , 1253 n.7 (10th Cir. 2001), republished
    at 
    278 F.3d 1020
    ).   This inquiry was absent from Reickenbacker
    and must be included here to determine whether Title II is proper
    § 5 legislation.
    Section 5 grants Congress the power “to enforce” the
    substantive guarantees of the Fourteenth Amendment through
    “appropriate legislation.”    
    Garrett, 531 U.S. at 365
    .   In
    exercising this power, Congress is not limited to remedying
    violations of the substantive rights guaranteed by the Fourteenth
    Amendment.    See Katzenbach v. Morgan, 
    384 U.S. 641
    , 648-76, 86 S.
    Ct. 1717 (1966).   “Congress’ power ‘to enforce’ the Amendment
    includes the authority both to remedy and to deter violation of
    rights guaranteed thereunder by prohibiting a somewhat broader
    swath of conduct, including that which is not itself forbidden by
    the Amendment’s text.” 
    Garrett, 531 U.S. at 365
    (quoting Kimel v.
    Florida Bd. of Regents, 
    528 U.S. 62
    , 81, 
    120 S. Ct. 631
    (2000)).
    “In other words, Congress may enact so-called prophylactic
    legislation that proscribes facially constitutional conduct, in
    32
    order to prevent and deter unconstitutional conduct.”     Nevada
    Dep’t of Human Res. v. Hibbs, 
    538 U.S. 721
    , 727-28, 
    123 S. Ct. 1972
    (2003).
    There are limits on Congress’s power to pass prophylactic
    legislation.   Congress may not pass prophylactic legislation that
    is in effect a “substantive redefinition of the Fourteenth
    Amendment right at issue.” 
    Id. at 728;
    see City of Boerne v.
    Flores, 
    521 U.S. 507
    , 519, 117 S. Ct 2157 (1997) (“Congress does
    not enforce a constitutional right by changing what the right
    is.”).   “Accordingly, § 5 legislation reaching beyond the scope
    of § 1's actual guarantees must exhibit ‘congruence and
    proportionality between the injury to be prevented or remedied
    and the means adopted to that end.’” 
    Garrett, 531 U.S. at 365
    (quoting City of 
    Boerne, 521 U.S. at 520
    ).
    The first step in this analysis is to identify the scope of
    the constitutional right to be protected.    
    Id. The Supreme
    Court
    has concluded that “classifications based on disability violate
    [the Fourteenth Amendment] if they lack a rational relationship
    to a legitimate governmental purpose.”   
    Lane, 124 S. Ct. at 1988
    ;
    see 
    Garrett, 531 U.S. at 367
    (“States are not required . . . to
    make special accommodations for the disabled, so long as their
    actions toward such individuals are rational.”).    Congress thus
    may seek through its § 5 power to enforce a prohibition on
    “irrational disability discrimination.” 
    Lane, 124 S. Ct. at 33
    1988.11
    The next step is to determine “whether Congress identified a
    history and pattern of unconstitutional . . . discrimination by
    the States against the disabled.”      
    Garrett, 534 U.S. at 368
    .   The
    Supreme Court, in Tennessee v. Lane, appears to have resolved
    this question.   Relying almost exclusively on federal case law,
    the Court concluded that “Congress enacted Title II against a
    backdrop of pervasive unequal treatment in the administration of
    state services and programs . . . .”      
    Lane, 124 S. Ct. at 1989
    .
    It found in the case law examples of irrational discrimination by
    states against the disabled in the contexts of: voting; marriage;
    jury eligibility; state mental institutions; zoning decisions;
    public education; the penal system; and access to the judicial
    system.   
    Id. at 1989.12
      The Supreme Court has thus concluded
    11
    In contrast, a higher standard of review may apply when
    other types of classifications or rights are at issue. See e.g.,
    
    Hibbs, 538 U.S. at 728
    (“[S]tatutory classifications that
    distinguish between males and females are subject to heightened
    scrutiny.”); 
    Lane, 124 S. Ct. at 1992
    (“[R]ight to the access to
    the courts . . . call[s] for a standard of judicial review at
    least as searching . . . [as] the standard that applies in sex-
    based classifications.”).
    12
    The Supreme Court has in the past required that Congress
    itself identify a history and pattern of discrimination by
    states. See Coll. Sav. Bank v. Florida Prepaid Post-secondary
    Edu. Expense Bd., 
    527 U.S. 666
    , 639, 
    119 S. Ct. 2219
    (1999)
    (“[F]or Congress to invoke § 5, it must identify conduct
    transgressing the Fourteenth Amendment’s substantive
    provisions.”) (emphasis added); see also, 
    Garrett, 531 U.S. at 370-72
    (rejecting the use of documents that are not “legislative
    findings” to establish “adverse, disparate treatment by state
    officials.”). In Lane, the Supreme Court appears to have
    34
    that the “inadequate provision of public services and access to
    public facilities [for the disabled are] appropriate subject[s]
    for prophylactic legislation.”   
    Id. at 1992.
    The final step in this analysis is to determine whether
    Title II is a congruent and proportional response to irrational
    discrimination by states against the disabled as identified in
    Lane.   See 
    Lane, 124 S. Ct. at 1992
    (“The only question that
    remains is whether Title II is an appropriate response to this
    history and pattern of unequal treatment.”); see City of 
    Boerne, 521 U.S. at 530
    .    In outlining this test, the Supreme Court has
    counseled: “The appropriateness of remedial measures must be
    considered in light of the evil presented. Strong measures
    appropriate to address one harm may be an unwarranted response to
    another, lesser one.”   
    Id. at 530.
      To survive scrutiny, Title II
    must be tailored to remedy or prevent the “identi[fied] conduct
    transgressing the Fourteenth Amendment’s substantive provisions.”
    Coll. Sav. Bank    v. Florida Prepaid Post-secondary Edu. Expense
    Bd., 
    527 U.S. 666
    , 639, 
    119 S. Ct. 2219
    (1999); see City of
    
    Boerne, 521 U.S. at 520
    (“There must be a congruence and
    proportionality between the injury to be prevented or remedied
    and the means adopted to that end.”) (emphasis added).
    abandoned this requirement. See 
    Lane, 124 S. Ct. at 1999
    (Rehnquist, J. dissenting) (noting that “the majority identifies
    nothing in the legislative record that shows Congress was
    responding to widespread violations of the . . . rights of
    disabled persons.”).
    35
    The Supreme Court concedes in Lane, that taken as a whole,
    Title II may not be permissible § 5 legislation.      See 
    Lane, 124 S. Ct. at 1992
    (“[T]he fact that Title II applies not only to
    public education and voting-booth access but also to seating at
    state-owned hockey rinks indicates that Title II is not
    appropriately tailored to serve its objectives.”); but see 
    id. at 1992-3
    (refusing to consider the constitutionality of Title II as
    a whole).   This conclusion is consistent with the Supreme Court’s
    case law.   In finding that the Religious Freedom Restoration Act
    of 1993 was not permissible § 5 legislation the Supreme Court
    noted that the act’s “[s]weeping coverage ensures its intrusion
    at every level of government, displacing laws and prohibiting
    official actions of almost every description regardless of
    subject matter.”   City of 
    Boerne, 521 U.S. at 532
    .    Title II’s
    coverage is just as sweeping.   It regulates, by it own terms,
    “any State or local government; any department, agency, special
    purpose district, or other instrumentality of a State or local
    government.” See 42 U.S.C. § 12131(1).   It regulates every state,
    every local government, and every state or local agency in the
    United States regardless of whether that entity (or one like it)
    has ever engaged in irrational disability discrimination.     Taken
    as a whole, there can be little doubt that “the accommodation
    obligation imposed by Title II . . . far exceeds that imposed by
    the Constitution” and is not a congruent and proportional
    36
    response to the findings of irrational discrimination by states
    as outlined in Lane.     See 
    Reickenbacker, 274 F.3d at 983
    .
    Ordinarily this would have been the end of the inquiry.
    Until Lane, the constitutionality of a statutory provision was
    considered as a whole.     See e.g., 
    Garrett, 531 U.S. at 365
    -74
    (applying § 5 analysis to Title I as a whole); City of 
    Boerne, 521 U.S. at 529-36
    (applying § 5 analysis to RFRA as a whole).
    However, in Lane, the Supreme Court took a different approach.
    While admitting that taken as a whole Title II may “not [be]
    appropriately tailored to serve its objectives,” it concluded
    that as-applied in some circumstances Title II is appropriate § 5
    legislation.    See 
    Lane, 124 S. Ct. at 1992
    -93.   Specifically, it
    held that “Title II unquestionably is valid § 5 legislation as it
    applies to the class of cases implicating the accessibility of
    judicial services.”    
    Id. at 1993.
       It then refused to address the
    application of Title II in any other circumstance.      See 
    id. The Supreme
    Court has thus structured a new test involving an “as-
    applied analysis” whereby courts do not evaluate the
    constitutionality of the statute as written, but instead       posit
    “a hypothetical statute . . . that applies only to” the relevant
    circumstance.   See 
    id. at 1993
    n.18 (holding that courts “need
    not examine the full breath of the statute at once”); see also
    
    id. at 2005
    (Rehnquist J., dissenting) (acknowledging the change
    in approach).
    37
    As this is a brand new approach to considering the
    constitutionality of a statute there is a dearth of precedent on
    which to rely in considering how to apply this test.    However,
    Lane itself provides a roadmap for how to appropriately determine
    whether Title II, as-applied to the circumstances of this case,
    is appropriate § 5 legislation.    In Lane, the Court first
    referred back to its findings regarding “unequal treatment of
    disabled persons in the administration of judicial services.”
    
    Id. at 1993.
      It then concluded that Title II’s requirement that
    states take “reasonable measures to remove architectural and
    other barriers to accessibility” is appropriate legislation
    because as-applied it is a congruent and proportional response to
    the Court’s findings of irrational discrimination by states in
    the administration of judicial services.     See 
    id. at 1993
    .     The
    Court thus identified the specific constitutional problem to be
    remedied (as evidenced by its findings) and then evaluated Title
    II as it regulates that specific problem.     See 
    id. at 1994.
    The Supreme Court identified eight general areas where there
    is a demonstrated history of irrational discrimination by states
    against the disabled: voting; marriage; jury eligibility; state
    mental institutions; zoning decisions; public education; the
    penal system; and access to the judicial system.     See 
    id. at 1989.
      The only one of these areas possibly applicable to this
    case is state mental institutions.     The Court found that there is
    38
    a “documented history” of unconstitutional discrimination by
    state agencies in the settings of “unjustified commitment” and
    “the abuse and neglect of disabled persons committed to state
    mental institutions.”   It documented this history by citing two
    of its cases: Jackson v. Indiana, 
    406 U.S. 715
    , 
    92 S. Ct. 1845
    (1972), and Youngberg v. Romeo, 
    457 U.S. 307
    , 
    102 S. Ct. 2452
    (1982).
    In Jackson v. Indiana, the petitioner, Theon Jackson, had
    been committed to a state mental institution for an indefinite
    period of time on account of his incompetency to stand trial for
    petty burglary.   
    Jackson, 406 U.S. at 717-20
    .   The trial judge
    ordered Jackson confined to a state mental institution until it
    was determined that he was competent to stand trial.     
    Id. at 719.
    Based on the evaluation of Jackson by two physicians, he would
    likely never be competent to stand trial and would thus be
    confined to a mental institution for the rest of his life.     
    Id. The Supreme
    Court held that Indiana violated Jackson’s rights to
    equal protection and due process by condemning him to    permanent
    institutionalization without the benefit of a civil commitment
    hearing applying the proper state standards governing forced
    institutionalization.   
    Id. at 730-31.
      In making its ruling, the
    Court did not question the ability of states to order
    institutionalization or the normal process by which states
    determine whether an individual should be committed.     See 
    id. at 39
    736 (“States have traditionally exercised broad power to commit
    persons found to be mentally ill.”).   Instead, it concluded that
    the method by which Jackson had been committed violated his
    constitutional rights.
    In Youngberg v. Romeo, Nicolas Romeo, who was confined to a
    state mental institution pursuant to proper procedures, sued the
    state mental institution to recover damages for injuries caused
    by his own violent behavior and attacks from other residents of
    the facility.   
    Romeo, 457 U.S. at 311
    .   The Court considered the
    question of whether Romeo, as an “involuntarily committed
    retarded person,” had a “constitutionally protected liberty
    interest in safety, freedom of movement and training within the
    institution.”   
    Id. at 314-15.
      It concluded that
    institutionalized persons like Romeo do have these constitutional
    rights and that states are obliged to protect them. 
    Id. at 324
    However, recognizing the difficulty of operating a state mental
    institution and balancing the protection of these rights with the
    orderly operation of such a facility, the Court concluded that
    the decisions of the professional personnel who operate these
    institutions “are entitled to a presumption of correctness.”     
    Id. While the
    Court delineated the rights possessed by
    institutionalized persons when they are in forced state custody,
    it did not reprimand the state mental institution for its
    decisions concerning the care of Romeo or other similarly
    40
    situated persons.
    These two cases relate solely to the process by which a
    disabled person is committed to a state mental institution and
    the treatment of that person in such a facility once
    institutionalized.   To the extent that Title II regulates the
    process by which disabled persons are institutionalized and their
    treatment in state mental institutions once they have been
    committed it may be a congruent and proportion response to the
    irrational discrimination highlighted in Jackson and Romeo.13
    Such an analysis must be left to another day because the
    defendant commissioners in this case neither run a state mental
    institution nor do they make decisions regarding forced
    institutionalization.   They run Texas’s Home and Community-based
    Waiver Services program which provides home and community based
    services for disabled individuals.   The Plaintiffs seek to
    participate in this program, they do not seek to overturn a
    decision forcing their institutionalization nor do they seek to
    challenge the care they receive in a state mental institution.
    Title II’s regulation of Texas’s decisions regarding
    participation in this program has nothing to do with either
    forced institutionalization or the treatment of disabled
    13
    Title II, which regulates decisions regarding
    participation in state run services and programs, appears to
    regulate neither decisions regarding forced institutionalization
    or the care for disabled person in state mental institutions.
    41
    individuals who reside in state mental institutions.    Therefore,
    even under the broadest understanding of these terms, Title II,
    to the extent that it regulates Texas’s decisions regarding
    participation in the Medicaid programs at issue in this case,
    cannot be considered to be a “congruent and proportional”
    response to the findings of irrational disability discrimination
    by states and local entities as outlined in Lane.
    B
    Texas next argues that because Title II does not regulate
    “economic activity”it is not a valid regulation of commerce under
    the Commerce Clause.     See United States v. Morrison, 
    529 U.S. 598
    , 613, 
    120 S. Ct. 1740
    (2000) (“[C]ases have upheld Commerce
    Clause regulation of intrastate activity only where the activity
    is economic in nature.”); United States v. Lopez, 
    514 U.S. 549
    ,
    559-60, 
    115 S. Ct. 1624
    (1995).    Plaintiffs and the Government
    counter that because state entities, including the defendant
    agencies, covered by Title II engage in economic activity they
    can be regulated by the federal government, and that the economic
    activity of disabled individuals who are unable to access public
    services sufficiently impact interstate commerce to justify
    Congress’s regulation.    Further the Government argues that even
    if Title II does not sufficiently regulate economic activity to
    be justified under the Commerce Clause, the ADA as a whole does
    and Title II is such an integral part of the ADA’s permissible
    42
    regulation that Title II is itself constitutional.    See Hodel v.
    Indiana, 
    452 U.S. 314
    , 329 n.17, 
    101 S. Ct. 2376
    (1981); see also
    
    Lopez, 514 U.S. at 561
    ; Groome Resources Ltd v. Parish of
    Jefferson, 
    243 F.3d 192
    , 210 (5th Cir. 2000).
    “In reviewing an act of Congress passed under its Commerce
    Clause authority, we apply the rational basis test . . . .”
    
    Groome, 234 F.3d at 203
    .    Therefore, “we invalidate a
    congressional enactment only upon a plain showing that Congress
    has exceeded its constitutional bounds.”    
    Morrison, 529 U.S. at 607
    .
    In United States v. Lopez and United States v. Morrison the
    Supreme Court outlined the framework for evaluating whether a
    federal law constitutes permissible Commerce Clause
    legislation.14   There are three broad categories of activity that
    Congress may regulate under its commerce power: 1) channels of
    interstate commerce; 2) the instrumentalities of interstate
    commerce, or persons or things in interstate commerce; 3) those
    activities having a substantial relation to interstate commerce,
    i.e. those activities that substantially affect interstate
    commerce.    
    Id. at 609.
    14
    In Lopez, the Supreme Court struck down the Gun-Free
    Zones Act of 1990 which criminalized the knowing possession of a
    firearm within a school zone. 
    Lopez, 514 U.S. at 551
    . In
    Morrison, it struck down the Violence Against Women Act which
    provided civil remedies for victims of gender-motivated violence.
    
    Morrison, 529 U.S. at 601
    .
    43
    Title II provides that “no qualified individual with a
    disability shall, by reason of such disability, be excluded from
    participation in or be denied benefits of the services, programs,
    or activities of a public entity, or be subjected to
    discrimination by such entity.” 42 U.S.C. § 12132.   Like the
    statutes in both Lopez and Morrison Title II cannot be justified
    under either of the first two types of permissible Commerce
    Clause legislation because it solely regulates intrastate
    activity.   Plaintiffs and the Government instead rely on the
    argument that Title II regulates activity that “substantially
    affects interstate commerce.”
    The Supreme Court has outlined four factors to be taken into
    account when deciding whether Congress is regulating an activity
    that substantially affects interstate commerce: 1) whether the
    activity regulated is “economic [in] nature”; 2) whether the
    statute has an “express jurisdictional element” limiting its
    reach to activities with a connection to interstate commerce; 3)
    whether the statute’s “legislative history contains express
    congressional findings regarding the effects upon interstate
    commerce”; and 4) whether the link between the regulated activity
    and interstate commerce are too attenuated to be considered a
    regulation of interstate commerce.   
    Morrison, 529 U.S. at 610-12
    (restating the requirements outlined in Lopez); see 
    Groome, 234 F.3d at 203
    -04 (recognizing the Lopez-Morrison framework).
    44
    The first factor is whether the regulated activity is
    economic in nature.   “This query derives from the general Lopez
    requirement that the regulated intrastate activities, ‘arise out
    of or are connected with a commercial transaction, which viewed
    in the aggregate, substantially affects interstate commerce.’”
    
    Groome, 234 F.3d at 205
    (quoting 
    Lopez, 514 U.S. at 561
    )
    (emphasis added). In Morrison, the Supreme Court specifically
    emphasized the importance of this factor in this framework.      See
    
    Morrison, 529 U.S. at 610
    (“[A] fair reading of Lopez shows that
    the noneconomic, criminal nature of the conduct at issue was
    central to our decision in that case.”).
    We have interpreted Lopez to define two types of economic
    activity: 1) activity that is in any sort of economic enterprise;
    and, 2) activity that exists as an essential part of a larger
    regulation of economic activity, in which the regulatory scheme
    would be undercut unless the intrastate activity were regulated.
    See 
    Groome, 234 F.3d at 205
    (citing 
    Lopez, 514 U.S. at 561
    ).
    Economic activity as defined by Lopez and understood by Groome
    requires a “commercial transaction,” see 
    Lopez, 514 U.S. at 561
    ,
    or “commercial intercourse,” see 
    Groome, 234 F.3d at 206
    ; see
    also United States v. Ho, 
    311 F.3d 589
    , 598-99 (5th Cir. 2002)
    (emphasizing that Congress may only regulate “commercial
    activity”).   “It bears reminding that at issue is the power to
    regulate interstate commerce.   In that sense commerce is ‘the
    45
    exchange of goods and services’ or ‘trade and other business
    activities.’” GDF Realty Investments Ltd v. Norton, 
    326 F.3d 622
    ,
    629 (5th Cir. 2003) (quoting BLACK’S LAW DICTIONARY 263 (7th Ed.
    1999)).
    Texas argues that Title II does not regulate economic or
    commercial activity, rather, by its own terms, it regulates
    “participation in . . . services, programs, or activities of a
    public entity.”    See 42 U.S.C. § 12132.   While admitting that
    states often engage in commercial activity both as an entity in
    the market and as a regulator, Texas argues that its decisions
    concerning who is eligible to participate in its programs and
    receive its entitlements do not constitute commercial activity as
    contemplated by Lopez and Morrison.     These decisions do not
    involve “commercial transactions,” see 
    Lopez, 514 U.S. at 561
    ,
    nor do they regulate “commercial intercourse,” see 
    Groome, 234 F.3d at 205
    -06 (finding that zoning decisions regulate “the
    commercial transaction[s] of purchasing a home and the commercial
    rental of housing”).
    Plaintiffs and the Government first claim that Title II is a
    regulation of an economic enterprise.    They argue that public
    entities like the defendants engage in the commercial activity of
    hiring and paying staff, purchasing or renting facilities, and
    borrowing money.   Although all of this is true, none of it is
    relevant.   Texas does not challenge the provisions of the ADA
    46
    that regulate its commercial activity, namely Title I, which
    regulates its hiring practices. See United States v. Mississippi
    Dep’t of Public Safety, 
    321 F.3d 495
    , 500-01 (5th Cir. 2003)
    (finding that employment is commerce, and that Title I is
    permissible commerce clause legislation as applied to states).
    It only challenges Title II, which regulates its decisions as to
    who receives the benefits of its social services.   Title II does
    not regulate any of the activities highlighted by the Plaintiffs.
    Further, if this argument was accepted there would be no
    limit on Congress’s ability to regulate state entities.    All
    state entities, including state legislatures and courts, hire and
    pay staff and engage in other commercial and economic activity
    such as purchasing goods and services.   One would not conclude
    that Congress can therefore regulate all the activities of state
    legislatures and courts.   Although, under the commerce clause,
    Congress may regulate state entities as they engage in commercial
    transactions, Congress does not have carte blanche authority to
    regulate state entities in all their activities))commercial or
    not))simply because these entities sometimes engage in commercial
    transactions.   See discussion infra.
    Plaintiffs next counter that Title II regulates economic
    activity because discrimination against disabled persons
    substantially affects those persons’ commercial and economic
    47
    activities and the national economy.    Plaintiffs argue that when
    disabled individuals are denied access to public services it
    affects their ability to engage in economic activity which
    affects interstate commerce. This argument misreads Lopez.     The
    relevant question is not whether the regulated activity affects
    commerce, it is whether the regulated activity is commerce. See
    
    Lopez, 514 U.S. at 560-61
    ; GDF 
    Realty, 326 F.3d at 630
    (noting
    that the key question is “whether the nature of the regulated
    activity is economic”).     The “substantially affecting” language
    is only relevant once it is determined that economic activity is
    being regulated and the court must determine whether that
    intrastate economic activity substantially affects interstate
    commerce.   See 
    Lopez, 514 U.S. at 560
    (“Where economic activity
    substantially affects interstate commerce, legislation regulating
    that activity will be sustained.”) (emphasis added); see also
    
    Morrison, 529 U.S. at 613
    (“[O]ur cases have upheld Commerce
    Clause regulation of intrastate activity only where that activity
    is economic in nature.”) (emphasis added).     The substantially
    affecting test is inapplicable when determining whether the
    federal law regulates economic activity.
    Moreover, in Morrison, the Supreme Court explicitly rejected
    this kind of reasoning.15    First noting that “Congress found that
    15
    We also explicitly rejected this reasoning in United
    States v. Ho. See 
    Ho, 311 F.3d at 599
    (“[A]ny imaginable
    48
    gender-motivated violence affects interstate commerce,” it
    rejected the use of “reasoning that . . . [employs] the but-for
    causal chain from the initial occurrence of violent crime . . .
    to every attenuated effect upon interstate commerce.”    
    Morrison, 529 U.S. at 615
    . It noted that employment of this “reasoning
    would allow Congress to regulate any crime as long as the
    nationwide, aggregated impact of that crime has substantial
    effects on employment, production, transit, or consumption.”      
    Id. Further it
    could “be applied equally as well to family law and
    other areas of traditional state regulation since the aggregate
    effect of marriage, divorce, and childrearing on the national
    economy is undoubtably significant.”   
    Id. at 615-16.
      This is
    exactly what Congress seeks to do with Title II, namely regulate
    the traditional activities of states by linking their non-
    economic activities to some tangential effect they have on the
    national economy. This is not permitted under the Commerce
    Clause.
    Finally, Plaintiffs point to this Court’s decision in Groome
    Resources   v. Parish of Jefferson as evidence that Congress can
    regulate discrimination by state entities against the disabled.
    activity of mankind can affect the alertness, energy, and mood of
    human beings, which in turn can affect their productivity in the
    workplace, which when aggregated together could reduce national
    economic productivity. Such reasoning would eliminate any
    judicially enforceable limit on the Commerce Clause, thereby
    turning that clause into what it most certainly is not, a general
    police power.”).
    49
    In Groome, we considered a commerce clause challenge to the
    application of § 3604(f)(3)(B) of the Fair Housing Amendments Act
    (“FHAA”) to zoning decisions.   This provision prohibits the
    refusal to make reasonable accommodations in rules or policies
    that prevent disabled persons from     full and equal use of
    dwellings.   See 42 U.S.C. § 3604(f)(3)(B).    Plaintiffs, a local
    zoning board, challenged the constitutionality of the provision
    as applied to their zoning decisions.     We held that FHAA’s
    regulation of zoning decisions is a regulation of commerce
    because zoning decisions regulate the economic activity of
    purchasing a home or renting property.     See 
    Groome, 234 F.3d at 205
    -06.   That is not the case here.    The FHAA, as applied in
    Groome, applied to state commercial regulation.     The zoning
    decisions in Groome were fundamentally commercial in nature
    because they regulated obviously commercial activity, namely “the
    commercial transaction of purchasing a home and the commercial
    renting of housing.”   See 
    id. at 205.
       Thus, Groome stands solely
    for the proposition that Congress may regulate states’ regulation
    of commercial activity under the Commerce Clause. But see New
    York v. United States, 
    505 U.S. 144
    , 166, 
    112 S. Ct. 2408
    (1992)
    (“The allocation of power contained in the Commerce Clause . . .
    does not authorize Congress to regulate state governments’
    regulation of interstate commerce.”).     It does not stand for the
    proposition that it can regulate states’ non-economic decisions
    50
    as those decisions are not by their nature commercial regulation.
    The Government claims that Title II fits under the second
    category of economic regulation, non-economic regulation that is
    integral part of a permissible regulation of commerce.    It argues
    that Title II is an integral part of the ADA’s permissible
    regulation of economic activity. See 
    Hodel, 452 U.S. at 329
    n.17
    (“[A] complex regulatory program . . . can survive a Commerce
    Clause challenge without a showing that every single facet of the
    program is independently and directly related to a valid
    congressional goal.    It is enough that the challenged provisions
    are an integral part of the regulatory program and that the
    regulatory scheme when considered as a whole satisfies this
    test.”); see also 
    Lopez, 514 U.S. at 561
    ; GDF 
    Realty, 326 F.3d at 633
    .
    The Government argues that the ADA is a comprehensive
    economic regulation of the activities of the disabled in the
    national economy.    It further argues that in providing Title II
    services states often compete with private entities in areas such
    as housing, education, transportation, communication and health
    services such that exempting the states from the ADA’s
    prohibitions against disability discrimination would unduly
    burden private sector entities in relation to state agencies.
    This, it argues, would undermine the willingness of private
    entities to voluntarily engage in behavior benefitting disabled
    51
    persons.   Finally, it argues that allowing disability
    discrimination in the providing of public services perpetuates
    stereotypical attitudes about the disabled that will spill over
    into the private sector and undermine the effectiveness of both
    Title I and III.   These arguments fail.
    Title I’s regulation of employment discrimination is
    permissible Commerce Clause legislation, see Mississippi Dep’t of
    Public 
    Safety, 321 F.3d at 500-01
    (finding that employment is
    commerce, and that Title I is permissible commerce clause
    legislation as applied to states). Title III does not apply to
    states, see Bloom v. Bexar County, Texas, 
    130 F.3d 722
    , 726-27
    (5th Cir. 1997), and Congress specifically limited the
    application of Title III’s regulation of privately owned places
    of public accommodation to those involved in commerce, see 42
    U.S.C. § 12181; cf. Spector v. Norwegian Cruise Line Ltd., 
    356 F.3d 641
    , 644 (5th Cir. 2004).    The ADA, considered as a whole,
    is reasonably considered permissible Commerce Clause legislation.
    However, Title II is not an integral or necessary part of the
    ADA’s economic regulation. See 
    Lopez, 514 U.S. at 561
    ; GDF
    
    Realty, 326 F.3d at 631
    (noting that Congressional regulation is
    permissible only if “failure to regulate the . . . activity could
    ‘undercut’ the entire scheme”).
    Title II regulates the provision of public services and more
    specifically states’ decisions regarding who receives the
    52
    benefits of their public services.   State governments do not
    compete with private entities in the provision of these services.
    For example, states do not compete with the private sector in the
    distribution of the free health care provided by the defendants.
    Although low-cost health care providers and charities provide
    similar services to similar people, in no sense are states
    competing with these entities in the health care market.16 States
    are simply providing a government created entitlement.   Therefore
    states’ decisions in this realm cannot possibly competitively
    disadvantage private sector entities as they are not competing
    with states in any commercial market.    Regardless, private
    sector entities are bound by the requirements of the ADA whether
    they are competitively disadvantaged or not.   Even if states are
    not regulated by the ADA, all private entities are subject to its
    restrictions.   In fact, private entities are subject to broader
    restrictions than states because Title III applies exclusively to
    them. See 
    Bloom, 130 F.3d at 726-27
    (finding that Title III only
    applies to private entities).   Further, when states do directly
    compete with private entities in a market states are engaging in
    commercial activity that can be regulated under the Commerce
    Clause.   See, e.g., Mississippi Dep’t of Public 
    Safety, 321 F.3d at 500-01
    (finding that Congress can regulate states as they act
    16
    Nor would, for example, local police be in competition
    with a private security service, or a local fire department with
    a squad of volunteer firemen.
    53
    in the “national labor market”); cf. Reno v. Condon, 
    528 U.S. 141
    , 151, 
    120 S. Ct. 166
    (2000) (finding that Congress can
    regulate states as “the owners of databases.”).
    Additionally, although the Government is correct that
    allowing discrimination against disabled individuals in the
    providing of public services helps entrench negative stereotypes
    against the disabled that may spill over into the private sector,
    Congress has passed laws forbidding such discrimination by
    private entities, including Title I and III of the ADA.17
    Further, although changing those negative stereotypes is a noble
    goal it is not in of itself economic or commercial regulation.
    Title II is not an integral part of the ADA’s economic regulation
    of disability discrimination as Congress can achieve its
    permissible goals solely through the use of commercial
    regulation.
    This is in contrast to the federal regulations in Wickard
    v. Filburn, 
    317 U.S. 111
    , 
    63 S. Ct. 82
    (1942).    Wickard
    considered the application of restrictions on production of wheat
    to a farmer growing wheat for personal use.   The Supreme Court
    noted in Lopez that although Wickard was not engaging in economic
    17
    States, like Texas, have also passed such laws. See
    e.g. TEX. LAB. CODE. § 21.051 (forbidding employment
    discrimination based on disability); TEX. PROP. CODE § 301.025
    (forbidding discrimination based on disability in sale or rental
    of property); TEX HEALTH & SAFETY CODE §§ 592.015, 592.016
    (forbidding discrimination against mentally retarded individuals
    in both employment and housing).
    54
    activity, the purpose of Congress’s legislation was economic in
    nature, namely to regulate the price of wheat.     See 
    Lopez, 514 U.S. at 560
    .    Restricting Wickard’s non-economic production and
    personal consumption of wheat was necessary to achieve Congress’s
    economic goal of propping up the price of wheat.    See 
    Wickard, 317 U.S. at 128
    (finding that widespread “home-consumed wheat
    would have a substantial influence on price and market
    conditions”).    That is not the case here, Congress’s permissible
    economic purposes, namely regulating discrimination in interstate
    commerce, can be achieved solely through prohibitions on
    discrimination by entities (including states) engaged in
    commercial activity.
    “[B]y its terms [Title II]    has nothing to do with
    ‘commerce’ or any sort of economic enterprise,” nor is it “an
    essential part of a larger regulation of economic activity, in
    which the regulatory scheme could be undercut unless the
    intrastate activity were regulated.” See 
    Lopez, 514 U.S. at 561
    .
    The second factor is whether the regulated activity has an
    express jurisdictional element limiting its reach to activities
    with a connection to interstate commerce.    The parties agree that
    there is no such jurisdictional element in Title II.    Plaintiffs
    and the Government argue that this is not particularly telling
    because Title II so clearly regulates interstate commerce.    As
    discussed above, this is not correct.    Congress made no explicit
    55
    restriction on Title II’s applicability to services and benefits
    that are economic in nature and substantially affect interstate
    commerce.18
    The third factor is whether the legislative history contains
    express congressional findings regarding the regulated activities
    effects upon interstate commerce.    Both Plaintiffs and the
    Government cite to ample congressional findings indicating that
    the purpose of the ADA is to regulate interstate commerce.     They
    also cite to findings that disability discrimination leads to
    “unnecessary expenses resulting from dependency and non-
    productivity.”   See 42 U.S.C. § 12101(a)(9).   However, as Texas
    points out, they cite to no Congressional findings that connect
    disability discrimination in the providing of social services to
    interstate commerce.   In fact, the findings they cite relate to
    employment discrimination.   See, e.g., S. Rep. No. 101-116, at 17
    (reprinted in 1990 U.S.C.C.A.N. 267, 325-26) (“Certainly, the
    elimination of employment discrimination and the main streaming
    of persons with disabilities will result in more persons with
    disabilities working . . . .”) (emphasis added).
    Considering most of the ADA, as a general proposition,
    regulates commerce, congressional findings that the ADA’s general
    purpose is to regulate commerce are not terribly helpful, and
    18
    In contrast, Congress did limit the applicability of
    Title III’s regulation of public accommodations to those involved
    in commerce. See 42 U.S.C. § 12181.
    56
    findings related to employment discrimination are wholly
    irrelevant.   Although it would be too much to say that Congress
    made no relevant findings that can be interpreted as connecting
    Title II to interstate commerce, it is safe to say that
    Plaintiffs and the Government have highlighted no “legislative
    history contain[ing] express congressional findings regarding
    [Title II’s] effects upon interstate commerce.”    See 
    Morrison, 529 U.S. at 612
    (emphasis added).    The Supreme Court emphasized
    the need for express findings because the purpose of reviewing
    these findings is to “enable us to evaluate the legislative
    judgment that the activity in question substantially affects
    interstate commerce, even though no such substantial effect is
    visible to the naked eye.”   
    Morrison, 529 U.S. at 612
    .
    Plaintiffs and the Government highlight no findings that negate
    the obvious, that Title II does not regulate economic activity.
    The fourth and final factor is whether the link between the
    regulated activity and interstate commerce is too attenuated to
    be considered a regulation of interstate commerce.    This factor
    relates to whether the regulated economic activity substantially
    affects interstate commerce and is only applicable if Congress is
    regulating economic activity.   The Supreme Court did not apply
    this factor when striking down the statutes in Lopez and Morrison
    and it is also inapplicable in this case.
    Title II of the ADA is not permissible Commerce Clause
    57
    legislation to the extent that it regulates states’ decisions
    regarding who will participate in or receive the benefits of
    state entitlement programs.
    C
    I do not believe that Congress acted within its powers under
    the Commerce Clause in enacting Title II of the ADA.   I further
    do not believe that it acted within its authority under § 5 of
    the Fourteenth Amendment as applied in this case. Consequently, I
    do not believe that Title II is valid federal law to the extent
    that it regulates Texas’s decisions regarding participation in
    the programs at issue in this case, and I do not believe that
    Plaintiffs have alleged a continuing violation of valid federal
    law.19    Thus, I would reverse the district court’s ruling as to
    Title II and hold that Texas has Eleventh Amendment immunity from
    Plaintiffs’ Title II claim.
    III
    Texas asserts that § 504 of the Rehabilitation Act is
    invalid Spending Clause legislation.20   It argues that because
    19
    Because I find that Title II was enacted beyond
    Congress’s legislative authority I do not consider Texas’s
    contention that it violates the Tenth Amendment.
    20
    Whether Texas may have already waived its sovereign
    immunity to suit under § 504, or whether Congress may have
    already abrogated it under its § 5 authority are both questions
    presently being considered by this Court en banc. See Pace v.
    Bogalusa City Sch. Bd., 
    325 F.3d 609
    (5th Cir. 2003), reh’g
    granted en banc, 
    339 F.3d 348
    (5th Cir. 2003); Johnson v.
    Louisiana Dep’t of Educ., 
    330 F.3d 362
    (5th Cir. 2003), reh’g
    58
    conditions on federal funding must be “related” to the funding
    received by   states Congress cannot broadly place conditions on
    all federal funding accepted by states; it must instead directly
    tie its conditions to the specific funding received by the state.
    Texas thus argues that because it “receive[s] no § 504 funding”21
    its receipt of federal Medicaid funding cannot constitutionally
    be conditioned by § 504.   I disagree.
    Under the Spending Clause, “Congress may attach conditions
    on the receipt of federal funds . . .[and may] condition[]
    receipt of federal moneys upon compliance by the recipient with
    federal statutory and administrative directives.”     South Dakota
    v. Dole, 
    483 U.S. 203
    , 206, 
    107 S. Ct. 2793
    (1987).    Congress may
    condition the receipt of federal monies if the conditions: 1) are
    in “the general welfare”; 2) were “unambiguously”communicated
    such that “the States [are] . . . cognizant of the consequences
    of” receiving the federal funding; 3) are related “to the federal
    interest in particular national projects or programs”; and, 4)
    granted en banc, 
    343 F.3d 732
    (5th Cir. 2003); Miller v. Texas
    Tech, 
    330 F.3d 691
    (5th Cir 2003), reh’g granted en banc, 
    342 F.3d 563
    (5th Cir. 2003). I do not express an opinion on these
    questions. Assuming that Texas has either waived its immunity or
    Congress has abrogated it, this challenge to the
    constitutionality of § 504 is beyond the scope of our
    jurisdiction in this appeal. See 
    discussion supra
    . However, as
    these questions are as of yet unresolved by this Court and as I
    believe Texas’s constitutional challenge fails, I will address
    the merits of its argument.
    21
    More accurately, Texas receives no funding under the
    Rehabilitation Act.
    59
    are not otherwise barred by the Constitution.   
    Id. at 207-08.
    Section 504 of the Rehabilitation Act provides that: “No
    otherwise qualified individual with a disability in the United
    States . . . shall, solely by reason of her or his disability, be
    excluded from the participation in, be denied the benefits of, or
    be subjected to discrimination under any program or activity
    receiving Federal financial assistance . . . .” 29 U.S.C. §
    794(a).    It specifically applies to state entities that receive
    federal funding.   See 29 U.S.C. § 794(b)(1).
    Texas concedes receiving federal financial assistance under
    the Medicaid Act to operate the state programs at issue in this
    case.   It also implicitly concedes that it was aware of § 504 and
    its restrictions at all times it was receiving federal monies.
    Therefore, Texas does not argue that it was unaware that its
    receipt of federal money was governed by § 504, rather it argues
    that because the restrictions were not specifically tied to its
    Medicaid funding they were not part of its “contract” with the
    federal government.   See Barnes v. Gorman, 
    536 U.S. 181
    , 186, 
    122 S. Ct. 2097
    (2002) (comparing Congress’s conditions on the
    receipt of federal money to a “contract” between the states and
    the federal government).
    Texas incorrectly concludes that Congress may not generally
    condition the receipt of federal monies.   Title VI of the Civil
    Rights Act of 1964, using language almost identical to that found
    60
    in § 504, requires that no person on the basis of “race, color,
    or national origin [shall] be excluded from participation in, be
    denied the benefits of, or be subjected to discrimination under
    any program or activity receiving Federal financial assistance.”
    42 U.S.C. § 2000d; see 
    Barnes, 536 U.S. at 186
    (noting the Title
    VI and § 504 are “coextensive”).    The Supreme Court has already
    held that Title VI is valid Spending Clause legislation.     See
    Guardians Ass’n v. Civil Service Comm’n of City of New York, 
    463 U.S. 582
    , 598-99, 
    103 S. Ct. 3221
    (1983) (“I note first that
    Title VI is spending-power legislation.”).    The Court reasoned
    that the conditions in Title VI were like any other conditions
    Congress could have made on the receipt of federal money.     See
    
    id. at 599
    (“Title VI imposes no obligations but simply extends
    an option that potential recipients are free to accept or
    reject.”) (internal quotations omitted).   It did not appear to
    see a distinction between conditions specific to a particular
    allocation of federal money and those generally applicable to all
    federal monies available to states. See 
    id. In fact,
    it
    concluded that Congress’s purposes in enacting Title VI were
    related to the spending it provided.    See 
    id. (“Title VI
    rests on
    the principle that taxpayers’ money, which is collected without
    discrimination, shall be spent without discrimination.”).
    It is no different with § 504.    In § 504, Congress connects
    its funding of state-run programs with its prohibition on
    61
    discrimination regarding participation in those programs.
    Congress does not seek to generally regulate the activities of
    the recipient state entities, or to regulate their activities
    unrelated to the use of   federal funds.    Instead, Congress seeks
    to control how the federal monies it provides are spent.
    Specifically, it seeks to ensure that the federal monies are not
    used to fund state programs that discriminate against the
    disabled.   Congress’s purpose and its conditions on the receipt
    of federal money are directly related.     The fact that Congress
    sought to efficiently apply these conditions to all federal
    funding in one legislative act rather than in multiple ones has
    no effect on the constitutionality of its restrictions.
    Section 504 of the Rehabilitation Act is valid Spending
    Clause legislation.   Consequently,   the Plaintiffs seek to
    vindicate valid federal rights and have alleged an ongoing
    violation of valid federal law under Ex parte Young.     I would
    therefore affirm the district court’s ruling denying Texas’s
    claim of Eleventh Amendment immunity.
    IV
    Texas argues that Plaintiffs cannot bring a Young suit under
    the Medicaid Act because the act does not provide an individual
    right of action.   See Gonzaga v. Dole, 
    536 U.S. 273
    , 282, 122 S.
    Ct. 2268 (2002) (“[A] plaintiff must assert the violation of a
    federal right, not merely a violation of federal law.”); Blessing
    62
    v. Freestone, 
    520 U.S. 329
    , 340, 
    117 S. Ct. 1353
    (1997).      And
    further contends that because the statute provides no cause of
    action the Plaintiffs have not properly alleged a Young suit.
    Texas does not challenge the constitutionality of the
    Medicaid Act or its status as valid federal law.   Instead Texas
    questions whether Congress has provided a means of seeking
    redress for violations of the act through private causes of
    action in federal courts.   The question of whether Congress
    created such a cause of action goes beyond the “inquiry into
    whether the complaint alleges an ongoing violation of federal law
    and seeks relief properly characterized as prospective.”      See
    
    Verizon, 535 U.S. at 645
    .   Texas does not challenge Congress’s
    authority to create such a cause of action, but only questions
    whether Congress exercised that authority with respect to the
    Medicaid Act.   Texas’s contention therefore does not address the
    balance between the supremacy of federal law and states’ right to
    immunity from suit.   Rather, it assumes the validity of the
    federal law underlying the Plaintiff’s Young suit and questions
    whether federal courts, as a function of federal statutory law,
    can provide relief.   This is a merits question that is beyond the
    scope of this appeal. See 
    id. at 646.
    V
    To sustain a Young suit a plaintiff must seek to “vindicate
    the   supreme   authority   of   federal   law.”   Therefore,       the
    63
    constitutionality of the federal law underlying a plaintiff’s
    Young suit is properly considered as part of an interlocutory
    review of a district court’s refusal to grant a state Eleventh
    Amendment   immunity.     Title     II,    as    a   whole,   is   impermissible
    Commerce    Clause   legislation.         It    is   also   impermissible   §   5
    legislation as-applied to this case.             Therefore, I do not believe
    that the Plaintiffs Young suit under Title II can be sustained and
    Texas is entitled to Eleventh Amendment immunity.                   I, however,
    believe that the Rehabilitation Act is valid spending clause
    legislation and that the Plaintiffs Young suit under this statue is
    proper.     Finally, I believe that Texas’s contention that the
    Medicaid Act does not provide an individual cause of action is
    beyond the scope of this appeal.                I thus concur in part, and
    dissent in part.
    64
    

Document Info

Docket Number: 03-50608

Citation Numbers: 381 F.3d 407, 2004 WL 1789945

Judges: King, Reavley, Garza

Filed Date: 9/2/2004

Precedential Status: Precedential

Modified Date: 10/19/2024

Authorities (43)

henrietta-d-henrietta-s-simone-a-ezzard-s-john-r-pedro-r-on , 331 F.3d 261 ( 2003 )

Wickard v. Filburn , 63 S. Ct. 82 ( 1942 )

United States v. Lopez , 115 S. Ct. 1624 ( 1995 )

Seminole Tribe of Florida v. Florida , 116 S. Ct. 1114 ( 1996 )

Blessing v. Freestone , 117 S. Ct. 1353 ( 1997 )

City of Boerne v. Flores , 117 S. Ct. 2157 ( 1997 )

United States v. Morrison , 120 S. Ct. 1740 ( 2000 )

Board of Trustees of Univ. of Ala. v. Garrett , 121 S. Ct. 955 ( 2001 )

Ex Parte State of New York, No. 1 , 41 S. Ct. 588 ( 1921 )

ronnie-randolph-v-bill-rodgers-don-roper-paul-delo-michael-bowersox-dora , 253 F.3d 342 ( 2001 )

Frew Ex Rel. Frew v. Hawkins , 124 S. Ct. 899 ( 2004 )

College Savings Bank v. Florida Prepaid Postsecondary ... , 119 S. Ct. 2219 ( 1999 )

Gonzaga University v. Doe , 122 S. Ct. 2268 ( 2002 )

Nevada Department of Human Resources v. Hibbs , 123 S. Ct. 1972 ( 2003 )

Cozzo v. Tangipahoa Parish Council-President Government , 279 F.3d 273 ( 2002 )

Spector v. Norwegian Cruise Line Ltd. , 356 F.3d 641 ( 2004 )

In Re Ayers , 8 S. Ct. 164 ( 1887 )

Jackson v. Indiana , 92 S. Ct. 1845 ( 1972 )

phoebe-thompson-dean-ecoff-and-marcia-e-wade-on-behalf-of-themselves , 278 F.3d 1020 ( 2001 )

Reickenbacker v. Foster , 274 F.3d 974 ( 2001 )

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