586 F.Supp.2d 22 Page 3586 F.Supp.2d 22
(Cite as: 586 F.Supp.2d 22)
arguments. Rather, he posits that theCommonwealth Secretary's challengehas been improperly raised, given that inthe summary judgment context he didnot present any constitutional arguments.This is correct. However, the argumentsraised by the Secretary in his summaryjudgment motion focused on whether theCommonwealth as a matter of fact wasin compliance with the federal statute atissue. Now the plaintiffs have moved for preliminary injunctive relief and theCommonwealth, in turn, has raised theconstitutional arguments as a defense.This is certainly not improper given thatthe Court must now consider evidence asto each of the four requisites necessaryfor an injunction to issue, to wit, (i)plaintiffs' likelihood of success on themerits, (ii) the potential of irreparableharm to plaintiffs, (iii) the effect of aninjunction to defendant, and, (iv) theeffect of an injunction to the public.
Cir.2008).Before addressing plaintiffs' contentions,however, it is essential to first provide somebackground on the Medicaid "wraparound"statute as it pertains to Puerto Rico.
The Medicaid Wraparound Statute and itsApplicability to Puerto Rico
begun in 1965, is jointly supported withfederal and state funds and directly administeredby state governments. Its purpose is to providemedical assistance to indigent families withdependent children, as well as indigent disabled,blind, and aged individuals.
.A state need not participate in the Medicaidprogram. However, once it opts to do so, it mustcomply with all federal requirements. TheCommonwealth of Puerto Rico opted toparticipate in the Medicaid program.
at 61-62.One requirement of the Medicaid program,relevant here, is that participating jurisdictionsmust provide federally-qualified health center services.42 U.S.C. §§ 1396a(a)(10)(A);1396d(a)(2)(C);
Plaintiffs here are "federally-qualified healthcenters" ("FQHCs") operating in Puerto Rico,which receive grants under Section 330 of thePublic Health Service Act and serve medicallyunderserved areas.42 U.S.C. § 254b.Federal law regulates how FQHCs receivepayment of services provided to Medicaidpatients.
EffectiveJanuary 1, 2001, Congress established a newpayment system known as the "ProspectivePayment System" ("PPS").42 U.S.C. § 1396a(bb)(2)-(3);
Applying a mathematical formula set by thestatute, each participating jurisdiction wasinitially required to make a baseline calculationfor Medicaid reimbursement to FQHCs. Theinitial calculation was to take into accountFQHC data from 1999, 2000 and 2001. Eachsubsequent year each jurisdiction has toprospectively revise its data for that particular year's FQHC Medicaid reimbursements.
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