United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued September 25, 2017 Decided July 20, 2018

No. 16-7065

OSCAR SALAZAR, BY HIS PARENTS AND NEXT FRIENDS, ADELA 

AND OSCAR SALAZAR, ET AL.,

APPELLEES

v.

DISTRICT OF COLUMBIA, ET AL.,

APPELLANTS

CHARTERED HEALTH PLAN,

APPELLEE

Consolidated with 16-7085, 16-7100

Appeals from the United States District Court

for the District of Columbia

(No. 1:93-cv-00452)

Richard S. Love, Senior Assistant Attorney General, 

Office of the Attorney General for the District of Columbia, 

argued the cause for appellants. With him on the briefs were 

Karl A. Racine, Attorney General, Todd S. Kim, Solicitor 

General at the time the briefs were filed, and Loren L. AliKhan, 

Deputy Solicitor General at the time the briefs were filed. 
2

Kathleen L. Millian argued the cause for plaintiffsappellees. With her on the briefs were Martha Jane Perkins, 

Zenia Sanchez Fuentes, and Lynn E. Cunningham.

Jonathan H. Levy, Allen Snyder, and Daniel Bruner were 

on the brief for amici curiae Legal Aid Society of the District 

of Columbia, et al. in support of appellees.

Before: HENDERSON and MILLETT, Circuit Judges, and 

GINSBURG, Senior Circuit Judge.

Opinion for the Court filed by Circuit Judge MILLETT.

MILLETT, Circuit Judge: This case involves an injunction 

garbed in the clothing of a consent decree modification. 

While district courts generally have discretion under Federal 

Rule of Civil Procedure 60(b)(5) to adjust the terms of an 

existing consent decree in light of changed circumstances, the 

issuance of a new injunction must meet the strict preconditions 

for such exceptional relief set out in Federal Rule of Civil 

Procedure 65. Because the district court’s order in this case 

provided brand new relief based on brand new facts alleging 

violations of a new law without the requisite findings for an 

injunction, it crossed the line from permissibly modifying into 

impermissibly enjoining. For that reason, we reverse the 

district court’s order, vacate the new injunctive relief, and 

remand for proceedings consistent with this opinion.

I

A

By way of background, under long-established practice,

federal courts may enter, as final judicial orders, consent 

decrees that reflect the agreement of the parties to forward-
3

going injunctive relief, as long as the consent decree arises 

from and resolves a dispute “within the court’s subject-matter 

jurisdiction[.]” Frew v. Hawkins, 540 U.S. 431, 437 (2004). 

Once a consent decree has been entered, Federal Rule of Civil 

Procedure 60(b) empowers the court to modify its terms to the 

same extent as any other final judgment. See United States v. 

Western Elec. Co., 46 F.3d 1198, 1205 (D.C. Cir. 1995) (citing 

System Fed’n No. 91 v. Wright, 364 U.S. 642, 651 (1961)); see

also Plaut v. Spendthrift Farm, Inc., 514 U.S. 211, 233–234 

(1995) (“Rule 60(b) * * * merely reflects and confirms the 

courts’ own inherent and discretionary power, firmly 

established in English practice long before the foundation of 

our Republic, to set aside a judgment whose enforcement 

would work inequity.”) (internal quotations and citations 

omitted). 

As relevant here, Rule 60(b) permits modification or relief 

from a judgment when: (i) it “has been satisfied, released or 

discharged;” (ii) “it is based on an earlier judgment that has 

been reversed or vacated;” (iii) “applying it prospectively is no 

longer equitable,” FED. R. CIV. P. 60(b)(5); or (iv) there is “any 

other reason that justifies relief,” FED. R. CIV. P. 60(b)(6).

When a party seeks relief under Rule 60(b), that party 

bears the threshold burden of proving that a “significant 

change” in legal or factual circumstances “warrants revision of 

the decree.” Rufo v. Inmates of Suffolk Cty. Jail, 502 U.S. 367, 

383 (1992). For a change in the law to be significant, it must 

“make legal what the decree was designed to prevent,” or 

otherwise effect a material change in the governing legal 

regime. Id. at 388. A change in the facts qualifies as 

significant if it makes compliance with the decree

“substantially more onerous,” “unworkable because of 

unforeseen obstacles,” or “detrimental to the public interest.” 

Id. at 384.
4

B

Title XIX of the Social Security Act, 42 U.S.C. § 1396, et 

seq.—commonly known as Medicaid—is a federal subsidy 

program that underwrites participating States’ provision of 

medical services to “families with dependent children and [to]

aged, blind, or disabled individuals, whose income and 

resources are insufficient to meet the costs of necessary 

medical services.” Armstrong v. Exceptional Child Ctr., Inc., 

135 S. Ct. 1378, 1382 (2015) (quoting 42 U.S.C. § 1396-1). 

Participating States receive federal funds that are subject to 

congressionally mandated controls and directives. See id. 

With exceptions not relevant here, both federal and local 

law have long required the District of Columbia to make 

Medicaid eligibility determinations within 45 days of an 

application for benefits, 42 C.F.R. § 435.912(c)(3); D.C. Code 

§ 4–205.26, and to provide Medicaid recipients timely notice 

of any proposed termination, discontinuation, or suspension of

eligibility, see, e.g., 42 C.F.R. §§ 435.919(a), 431.200 (1993). 

As a general rule, the District must annually “recertify”—that 

is, renew—the eligibility of its Medicaid recipients to maintain 

their benefits. Compare 42 C.F.R. § 435.916 (2016)

(prescribing “renewal” of Medicaid eligibility), with Salazar v. 

District of Columbia, 954 F. Supp. 278, 292–294 (D.D.C. 

1996) (“Liability Order”) (referring to the legacy eligibility 

redetermination process as “recertification”). 

Historically, the District conducted the application and 

recertification processes by paper and mail. That system 

required beneficiaries to take the affirmative step of mailing in 

the required paperwork to continue their benefit eligibility. 

See Liability Order, 954 F. Supp. at 282–283, 292. 
5

In 2010, the Patient Protection and Affordable Care Act, 

Pub. L. 111-148, 124 Stat. 119 et seq. (“Affordable Care Act”), 

wrought several changes in the District’s eligibility and 

recertification processes. Under the Affordable Care Act, the 

majority of Medicaid applicants and recipients have their

eligibility determined by the amount of modified adjusted gross 

income that they report on their federal income taxes. The Act 

thus uses household tax information to assess income, 

household composition, and family size. See 42 C.F.R. 

§§ 435.901–435.911, 435.916. 

For such tax-based eligibility determinations, the District 

had to replace its old paper recertification system with a new 

passive renewal model. The passive renewal program first 

attempts to automatically renew eligibility based on available 

electronic federal and local tax records. See 42 C.F.R. 

§ 435.916(a). If the data necessary for passive renewal are 

unavailable, then the District must ask the Medicaid recipient 

to provide the missing information before renewing Medicaid 

eligibility. Id. § 435.916(a)(3). 

The District began to implement its passive renewal 

system in late 2012 by building a new, automated eligibility 

system called the DC Access System. When the DC Access 

System is fully realized, the District plans to retire its legacy 

application and recertification system. However, the 

transition from the old system to the new DC Access System 

has been halting, due to “technology challenges, contracting 

issues, and funding.” J.A. 827. The plodding transition 

between systems proved problematic for many individuals’ 

Medicaid application and renewal process. J.A. 1298.
6

C

1

In 1993, long before the Affordable Care Act emerged on 

the scene, Plaintiffs—a broad group of Medicaid applicants 

and recipients—filed a class action against the District of 

Columbia principally alleging that the District’s administration 

of its Medicaid program violated the Medicaid statute, its 

implementing regulations, District of Columbia law, and the 

United States Constitution. 

The putative class action proved actually to be an 

amalgamation of several subclasses, and within each subclass

the Medicaid applicants and recipients asserted a distinct and 

“particular set of claims.” Salazar v. District of Columbia, 

106 F. Supp. 3d 114, 115 (D.D.C. 2015). In 1994, the district 

court certified a class consisting of five Subclasses. The first 

two Subclasses, which involved Medicaid-eligible newborns 

and certain hospitalized applicants, settled before trial and are 

not at issue here. Of the remaining three, Subclass III 

consisted of individuals who alleged delayed processing of 

their initial Medicaid applications. Subclass IV consisted of 

individuals who alleged that the District failed to comply with 

pre-Affordable Care Act requirements to provide adequate 

advance notice of the termination or suspension of Medicaid 

eligibility. Liability Order, 954 F. Supp. at 326–328. And 

Subclass V consisted of individuals alleging that the District 

failed to give notice of or to provide the early and periodic 

screening, diagnostic, and treatment services required for 

Medicaid-qualified children (“Early Childhood Services”)

required by 42 U.S.C. § 1396a(a)(43) (1996). 

After a bench trial in 1996, the District was found liable to 

Subclasses III, IV, and V for numerous violations of the law. 
7

See Liability Order, 954 F. Supp. at 280–281, 324–333. For 

the Medicaid applicants composing Subclass III, the district 

court found that the District failed to meet the 45-day deadline 

for processing Medicaid applications for over half of all 

pending applications. Id. at 325–326. The District’s delay 

left more than a hundred sick and impoverished children and 

adults without medical treatment each month. Id. at 325. 

As for the individuals in Subclass IV facing suspension or 

termination of their benefits, the court held that a pattern of 

critical failures in the District’s Medicaid recertification 

process violated the due process rights of the Subclass

members and also ran afoul of various statutes and regulations. 

Liability Order, 954 F. Supp. at 326–327.

Finally, for the children and their parents that composed 

Subclass V, the court ruled that the District was violating its 

Early Childhood Services obligations by failing (i) to 

adequately notify eligible families about Early Childhood

Services, (ii) to ensure that children eligible for such services 

receive complete screening services and necessary follow-up 

diagnoses and treatments, and (iii) to provide scheduling and 

transportation assistance to Early Childhood Services 

recipients. Liability Order, 954 F. Supp. at 328–333. 

2

The District appealed. In 1999, while that appeal was still

pending, the parties reached a settlement agreement, which the 

district court approved as the governing Consent Decree in this 

case. The Consent Decree divided the District’s obligations 

by sections that very roughly mapped onto the remaining 

Subclasses, albeit (alas) with non-corresponding roman 

numerals. 
8

Sections II and IV of the Consent Decree (which, to escape 

all the roman numerals, we will refer to as the “Eligibility 

Provisions”) addressed Subclass III’s grievances concerning 

the District’s slow handling of initial Medicaid applications. 

It generally required the District to determine Medicaid 

eligibility within 45 days of an application’s submission. 

Section III of the Consent Decree (the “Renewal 

Provisions”) addressed the District’s failure to provide the 

legally required notice to Subclass IV members of the need to 

renew their Medicaid eligibility, and it mapped out a detailed 

schedule for the District to follow in processing recertification 

forms and providing advance notice to beneficiaries of the 

District’s eligibility determinations.

Finally, Sections V and VI (the “Early Childhood 

Provisions”) remedied the District’s failures to provide notice 

of and to deliver Early Childhood Services to the Subclass V 

members by requiring the District to adopt a variety of 

measures designed to improve access to and the provision of 

Early Childhood Services. Section V of the Consent Decree 

applies only to “Medicaid recipients”—that is, persons already 

enrolled in the Medicaid program. Section VI of the Consent 

Decree required the District to “effectively inform all pregnant 

women, parents, child custodians, and teenagers” whom the 

District had “found eligible for Medicaid benefits” of the 

availability of Early Childhood Services. J.A. 286 ¶ 54.

Each Consent Decree section prescribed specific criteria

for measuring when the District had satisfied the terms of the 

Consent Decree and could exit from its governance, generally 

framed in terms of demonstrated levels of compliance over a 
9

specified period of time. 1 The Consent Decree would 

automatically terminate in its entirety “at the same time” the 

last remaining section of the Consent Decree was satisfied and 

coverage ended. J.A. 296. 

The district court “retain[ed] jurisdiction of this matter to 

make any necessary orders enforcing or construing this Order.” 

J.A. 296 ¶ 79. The Decree also provided that either party 

could, at any time, move the court to modify the Consent 

Decree if a “change of law” materially affected the District’s 

continuing obligations under the Consent Decree. J.A. 293 

¶ 70. The district court’s review of any request for 

modification was to be controlled by the “general body of 

federal law governing motions to modify orders in contested 

matters pursuant to Rule 60(b) of the Federal Rules of Civil 

Procedure[.]” J.A. 294 ¶ 72.

 1 See, e.g., J.A. 254 ¶ 8, 294 ¶ 74 (establishing that the District 

would satisfy the Eligibility Provisions’ application processing 

obligations by timely processing at least 95% of all initial 

applications averaged over any four consecutive months for three 

years); J.A. 261 ¶ 17, 262 ¶ 19, 294–295 ¶ 75 (the Renewal 

Provisions’ recertification compliance would be satisfied upon the 

District’s processing of at least 95% of all recertifications for “nonPublic Assistance, non-foster care, Medicaid recipients” averaged 

over any four consecutive months for three years); J.A. 295 ¶ 76 

(District could end court oversight of the Early Childhood 

Provisions’ eligibility renewal processes by showing its systems 

“accurately confirmed the eligibility status of 98% of all requests for 

eligibility verification for twenty-two (22) of twenty-four (24) 

consecutive months and accurately confirmed the eligibility status of 

at least 95% of all requests for each of the other two (2) months * * * 

and have accurately confirmed the eligibility status of at least 98% 

of all requests for” one month that Plaintiffs were designated to 

randomly select).
10

3

Over the next fourteen years, several provisions of the 

Consent Decree terminated. In 2009, the parties agreed that 

the District had come into compliance with the standards 

governing the timely processing of initial Medicaid 

applications for the Plaintiffs in Subclass III. As a result, the 

district court “vacated” the Eligibility Provisions (Sections II 

and IV) of the Consent Decree. Salazar v. District of 

Columbia, No. 93-452, MINUTE ORDER (D.D.C. Feb. 24, 2009)

(“2009 Vacatur Order”). The district court also specifically 

ordered that its “supervision over” the Eligibility Provisions of 

the Consent Decree “is ended.” Id. (adopting the language of 

the proposed order).

The Renewal Provisions for Subclass IV were the next to 

go. The District requested termination of the Renewal 

Provisions following enactment of the Affordable Care Act

because that law materially changed the law governing the 

renewal of beneficiaries’ Medicaid eligibility. Specifically, 

the Act required the District (and States) to implement a 

passive renewal system that started with the individual’s 

federal tax filing and generally required no affirmative action 

by the beneficiary. See 42 U.S.C. § 1396a(e)(14); 42 C.F.R. 

§ 435.916(a)(2). 

In October 2013, the district court granted the District’s 

motion. The court explained that the Affordable Care Act

“created a ‘significant change in circumstances’”—indeed, 

“almost a seismic change” in the governing law—“that justifies 

termination of the [Renewal P]rovisions of Section III[.]” 

Salazar v. District of Columbia, 991 F. Supp. 2d 34, 37 (D.D.C. 

2013) (“2013 Termination Order”) (citing FED. R. CIV. P. 

60(b)(5)). “There is simply no comparison,” the court 

continued, “between the statutory framework that existed at the 
11

time th[e] Court made its factual findings in 1996 and what 

implementation of the [Affordable Care Act] envisions.” Id. 

The two legal regimes are “apples and oranges.” Id. 

In particular, the Affordable Care Act’s “brand new 

recertification procedure” was “in direct conflict with the 

renewal process set forth in” the Renewal Provisions of the 

Consent Decree, and rendered the steps required of the District 

under the notice requirements of the Consent Decree 

“inaccurate, confusing, and unnecessary.” 2013 Termination 

Order, 991 F. Supp. 2d at 37. Even the Plaintiffs “concede[d] 

that the [Renewal P]rovisions * * * are either in conflict with 

the [Affordable Care Act] or are outdated and * * * no longer 

relevant.” Id. at 38. The court accordingly entered an order 

providing that the District was “relieved from complying with” 

the Renewal Provisions. Id. at 39. The Plaintiffs did not 

appeal that decision.

After the 2009 Vacatur Order and the 2013 Termination 

Order, no provisions of the Consent Decree relating to 

Medicaid eligibility determinations or renewals remained in 

effect. The only portions of the Consent Decree that were still 

operative on the District were the Early Childhood Provisions, 

which governed issuing notice about and the delivery of Early 

Childhood Services for already Medicaid-eligible children and 

their family members in Subclass V. Over the next two years, 

the parties continued to litigate various issues concerning those 

portions of the Consent Decree, as well as ancillary 

reimbursement issues.

D

In December 2015, the Plaintiffs filed a motion for a

preliminary injunction to require the District to (i)

provisionally approve all Medicaid applications that had been 
12

pending for more than 45 days, until the District made a final 

determination, and (ii) continue the eligibility of all Medicaid 

recipients due to be renewed, until the District was able to

demonstrate that its technology and business processing 

systems function in an adequate and timely manner. The 

motion alleged widespread failures by the District to process 

Medicaid applications and renewals under the Affordable Care 

Act, as well as significant technological problems that resulted

in the improper termination of Medicaid benefits.

While the preliminary injunction motion was being 

briefed, the District resolved “all of the thousands of 

remaining” Medicaid processing errors. Salazar v. District of 

Columbia, 177 F. Supp. 3d 418, 440 (D.D.C. 2016) (“2016 

Order”).

Roughly one week after briefing on the preliminary 

injunction concluded, the Plaintiffs filed a motion under 

Federal Rules of Civil Procedure 60(b)(5) and (b)(6) to 

“modify” the Consent Decree to achieve precisely the same 

relief as the pending motion for a preliminary injunction, with 

the small difference that the Rule 60(b) motion also asked for 

monthly reporting by the District. Salazar, No. 93-452, PLS.’

MOTION FOR MODIFICATION OF THE SETTLEMENT ORDER, ECF 

No. 2093 at 1 (Feb. 9, 2016); see 2016 Order, 177 F. Supp. 3d 

at 423 (noting that the two motions “request precisely the same 

relief”).

On April 4, 2016, the district court granted the Plaintiffs’ 

motion to modify the Consent Decree and then denied the 

motion for a preliminary injunction as moot. 2016 Order, 177 

F. Supp. 3d at 423–424. The court recognized that its decision 

provided the Plaintiffs “additional injunctive relief, based on 

the new [post-Affordable Care Act] factual circumstances.” 

Id. at 441 (internal quotation omitted) (emphases in original). 
13

The court also acknowledged that, because of its past 

modifications, “no provisions of the [Consent Decree] relating 

to Medicaid application processing or benefits renewal 

remained in effect,” and that the “only portions” of the Consent 

Decree still “in force” applied to “programmatic elements of 

the District’s Medicaid program * * * related to the delivery of 

[Early Childhood Services].” Id. at 426. The district court

nonetheless decided that “common sense” dictated that “issues 

affecting initial applications and renewals are clearly related 

to” the remaining Subclass seeking Early Childhood Services 

because “a child cannot obtain [these services] when he or she 

lacks Medicaid eligibility.” Id. at 442–443 (internal quotation

omitted). 

On that basis, the district court ordered the District (i) to 

provisionally approve all Medicaid applications pending more 

than 45 days, and (ii) to continue for ninety days the eligibility 

of Medicaid recipients who were up for renewal. See 2016 

Order, 177 F. Supp. 3d at 443–445. In neither case did the 

district court confine its relief to children or families with 

children. The court also ordered that these remedies “remain 

in place” indefinitely, “until [the District] demonstrate[d] to the 

[c]ourt” that the District’s technology systems were 

“functioning as required to ensure and protect the rights of 

Medicaid recipients and applicants[.]” Id. at 442 n.16

(internal quotation omitted). In so ruling, the court 

acknowledged the District’s “substantial progress * * * in 

addressing the problems caused by changes in its 

administration of the Medicaid program to comply with the 

[Affordable Care Act].” Id. at 423; see also id. at 430, 435. 

Still, the court decided it was appropriate to impose structural 

injunctive relief because the District had not “entirely 

remediate[d]” all of the identified problems, id. at 430, and the 

court had “no assurance” that eligibility determination issues 

“w[ould] not arise again,” id. at 441.
14

The district court subsequently entertained several 

motions concerning the 2016 Order. On May 17, 2016, the 

court granted the District’s motion to stay the 2016 Order

pending appeal. Salazar, No. 93-452, ORDER GRANTING 

MOTION TO STAY, ECF No. 2134 (D.D.C. May 17, 2016). 

Two weeks later, the court denied the District’s motion to alter 

or amend the 2016 Order because the stay was in place and the 

District’s appeal of the 2016 Order was already pending in this 

court. Id., ORDER DENYING MOTION TO AMEND, ECF No. 

2141 (D.D.C. June 2, 2016). Finally, on July 12, 2016, the 

district court granted in part Plaintiffs’ motion to narrow the

stay entered in May, causing portions of the 2016 Order to go 

into immediate effect. Id., ORDER GRANTING IN PART 

MOTION TO MODIFY STAY, ECF No. 2150 (D.D.C. July 12, 

2016). The District appealed the district court’s April 4th, 

June 2nd, and July 12th Orders separately, and we consolidated 

the three appeals.

II

The district court exercised jurisdiction over the class 

action under 28 U.S.C. § 1331, and we have jurisdiction over 

the district court’s decision granting or modifying a consent 

decree under 28 U.S.C. § 1292(a)(1). 

We generally review orders on Rule 60(b) motions for an 

abuse of discretion, Twelve John Does v. District of Columbia, 

841 F.2d 1133, 1138 (D.C. Cir. 1988), unless the decision is 

“rooted in an error of law,” id. at 1138, in which case our 

review is de novo, see, e.g., Smith v. Mallick, 514 F.3d 48, 50 

(D.C. Cir. 2008). 
15

III

There is a critical difference between a district court’s 

power to modify an ongoing consent decree and its authority to 

impose a new injunction. By trying to force the square peg of 

a new injunction into the round hole of modification, the 

district court impermissibly crossed that line.

An injunction is an exceptional form of relief. Monsanto 

Co. v. Geertson Seed Farms, 561 U.S. 139, 165–166 (2010). 

Doubly so when the judicial branch undertakes to restructure 

the operations of an executive branch of government and to 

superintend its operations on an ongoing basis. See Horne v. 

Flores, 557 U.S. 433, 449 (2009) (“Injunctions of this sort bind 

state and local officials to the policy preferences of their 

predecessors and may thereby ‘improperly deprive future 

officials of their designated legislative and executive 

powers.’”) (quoting Frew, 540 U.S. at 441); Rizzo v. Goode, 

423 U.S. 362, 379 (1976) (“[In] a system of federal courts 

representing the Nation, subsisting side by side with 50 state 

judicial, legislative, and executive branches, appropriate 

consideration must be given to principles of federalism in 

determining the availability and scope of equitable relief.”).

Ordinarily, to obtain a running structural injunction, the 

plaintiff bears the burden of proving both the facts that warrant 

such intrusive relief and that (i) the plaintiff(s) suffered an 

irreparable injury, (ii) traditional legal remedies cannot redress

the injury, (iii) the balance of hardships between the parties 

justifies extraordinary relief, and (iv) the injunction is not 

counter to the public interest. See, e.g., eBay Inc. v. 

MercExchange, LLC, 547 U.S. 388, 391 (2006); Chaplaincy of 

Full Gospel Churches v. England, 454 F.3d 290, 297 (D.C. Cir. 

2006).
16

The standard for obtaining a consent decree is somewhat 

less demanding, but that is because it depends centrally on the 

parties’ mutually agreed resolution of a legal dispute. Local 

93, Int’l Ass’n of Firefighters v. City of Cleveland, 478 U.S. 

501, 521–522, 525 (1986). To have their agreement ratified 

by a court as a consent decree, the decree’s terms must “spring 

from, and serve to resolve, a dispute within the court’s subjectmatter jurisdiction; must come within the general scope of the 

case made by the pleadings; and must further the objectives of 

the law upon which the complaint was based.” Frew, 540 U.S. 

at 437. 

When an injunction or consent decree has been entered as 

a final judgment, the district court retains the authority under 

Federal Rule of Civil Procedure 60(b) to provide “[r]elief from 

[the] Judgment” if, as relevant here, “applying it prospectively 

is no longer equitable,” or “any other reason * * * justifies 

relief” from the injunctive order. FED. R. CIV. P. 60 (title) & 

60(b)(5) & (6). Rule 60(b)’s standard is a “flexible” one. 

Rufo, 502 U.S. at 393; see Horne, 557 U.S. at 450–451. Still, 

because exercise of the court’s power under Rule 60(b) reopens 

a final judgment, the party requesting modification bears the 

burden of proving that “a significant change in 

circumstances”—whether factual or legal—justifies revision of 

the order. Rufo, 502 U.S. at 383; see id. at 384. Any 

adjustment of the order must be “suitably tailored to the 

changed circumstance[s],” id. at 383, 391, and a court “should 

do no more” than is necessary to “resolve the problems created 

by the change in circumstances,” id. at 391.

As Rule 60(b)’s title indicates, the overwhelming majority 

of motions to modify the terms of a consent decree are filed by 

the enjoined party seeking “relief from” the court’s judgment. 

That is not to say that such Rule 60(b) motions can never be 

filed by the plaintiff seeking to enforce the terms of the 
17

injunction. We have previously recognized that a court’s 

“broad[] and flexible” equitable powers, which Rule 60(b) 

codifies, may allow a district court to “tighten [a] decree” as

well. Western Elec., 46 F.3d at 1202. That makes sense. A 

district court must retain the authority to prevent evasion and 

ensure effectuation of the order it entered. But any such 

fortification of the injunction’s terms must be in service of the 

consent decree’s original “intended result.” Id.

When a plaintiff seeks to enhance a consent decree’s 

terms, courts must be careful to ensure that the new injunctive 

terms give effect to and enforce the operative terms of the 

original consent decree. Courts may not, under the guise of 

modification, impose entirely new injunctive relief. That 

practice would end run the demanding standards for obtaining 

injunctive relief in the first instance, would deny the enjoined 

party the contractual bargain it struck in agreeing to the consent 

decree at the time of its entry, and would destroy the 

predictability and stability that final judgments are meant to 

provide. Frew, 540 U.S. at 437; United States v. Armour & 

Co., 402 U.S. 673, 682 (1971) (“[T]he scope of a consent 

decree must be discerned within its four corners, and not by 

reference to what might satisfy the purposes of one of the 

parties to it.”). 

Undoubtedly in some cases, the line between the 

permissible tautening of an injunction’s terms and the 

impermissible imposition of a new injunction will be difficult 

to discern. Not so here. This injunction comes as an 

injunction.

First, the district court’s opinion admits as much. The 

decision announced that it was imposing “additional injunctive 

relief, based on the new factual circumstances,” 2016 Order, 

177 F. Supp. 3d at 441 (emphases in original), arising from the 
18

District’s asserted violations of a new law—the Affordable 

Care Act—that did not even exist at the time the Consent 

Decree was entered, see id. at 440. Nor was the district court’s 

order aimed at enforcing a point of relevant overlap between 

the longstanding Medicaid statute and the new Affordable Care 

Act. As the district court previously found, the two renewal 

schemes are “apples and oranges,” and “there is simply no 

comparison between the statutory framework[s]” because the 

Affordable Care Act worked “almost a seismic” change in the 

District’s legal obligations. 2013 Termination Order, 991 F. 

Supp. 2d at 37. Imposing a new structural injunction based on 

new facts found to demonstrate a violation of a whole new 

statute—none of which were adjudicated within the original 

Consent Decree, let alone consensually agreed to by the 

District—is out of Rule 60(b)’s bounds. See Pigford v. 

Veneman, 292 F.3d 918, 927 (D.C. Cir. 2002) (“Whatever 

tailoring method the district court ultimately adopts * * * it 

must preserve the essence of the parties’ bargain[.]”) (internal 

citation omitted).

In that same vein, it bears noting that the Plaintiffs 

themselves originally sought a brand new preliminary 

injunction to obtain the relief they wanted. It was not until 

almost three months later, after their preliminary injunction 

motion had been fully briefed, that the Plaintiffs decided to try 

the Rule 60(b) route. As it turns out, their first instinct that 

they were seeking a new injunction was the correct one.

Second, the district court’s order provided relief for 

Subclasses of Plaintiffs and corresponding sections of the 

Consent Decree that had already been vacated or terminated. 

The new injunctive obligations sought to enforce compliance 

with the Affordable Care Act’s provisions governing the initial 

eligibility for and renewal of Medicaid eligibility. 2016 

Order, 177 F. Supp. 3d at 443–444. But the Consent Decree’s 
19

Subclasses for Medicaid eligibility (Subclasses II and IV) were 

“[v]acate[d],” 2009 Vacatur Order, and the district court’s 

supervision “ended,” No. 93-452, CONSENT MOTION TO 

VACATE SECTIONS II AND IV, ECF No. 1443 at 6. Likewise, 

in 2013, the district court “terminat[ed]” the Consent Decree’s 

Medicaid Renewal Provisions, and “relieved” the District of 

any forward-going compliance obligation under the Consent 

Decree. 2013 Termination Order, 991 F. Supp. 2d at 39. 

Whatever the scope of a district court’s modification authority 

under Rule 60(b), it cannot resurrect vacated and terminated 

provisions as a vehicle for imposing novel obligations under a 

new law based on new facts.

The district court insisted that its order did not revive 

closed aspects of the Consent Decree, but instead gave effect 

to the “only [executory] portions” of the Consent Decree still 

“in force”—the Early Childhood Provisions governing 

notification for and the delivery of Early Childhood Services. 

2016 Order, 177 F. Supp. 3d at 426. The court reasoned that 

children must be eligible for Medicaid before they can receive 

such services. True enough. But the Consent Decree never 

contained an Early Childhood eligibility or renewal Subclass 

or corresponding sections of the Consent Decree. The Early 

Childhood Service Subclass, and the relevant provisions of the 

Consent Decree, were expressly limited to Medicaid 

recipients—that is, individuals who had already been 

determined to be eligible for Medicaid benefits. J.A. 271–

272, 280. All issues concerning eligibility determination and 

redetermination matters were governed by the terminated 

Provisions. None of those Provisions continued in effect at 

the time of the district court’s latest injunctive order. 

The court’s order also applies unqualifiedly to all 

Medicaid applicants and beneficiaries seeking renewal, 

without regard to whether they are children or have children. 
20

The order, in other words, based a remedy of classwide 

structural reform on anecdotal evidence and individual 

testimonies, only a subset of which implicated the children for 

whose benefit the Early Child Services exist. Indeed, despite 

a lengthy recitation of Affordable Care Act implementation 

issues culled from a voluminous record, the district court cited 

only four instances where the putative Medicaid recipients 

even had eligible children. See 2016 Order, 177 F. Supp. 3d 

at 427–437. 

 

The district court’s new injunctive obligations, in short, 

have no anchor in the remaining executory portions of the 

Consent Decree and seek to provide benefits to many 

individuals wholly outside the remaining operative Subclass. 

Writing new injunctive obligations governing eligibility and 

renewal into Consent Decree provisions that never addressed 

those matters and extending the protections to individuals 

never included within the corresponding Subclass would turn 

the power to modify a consent decree into an injunctive blank 

check. “Who would sign a consent decree if district courts 

had free-ranging interpretive or enforcement authority 

untethered from the decree’s negotiated terms?” Pigford, 292 

F.3d at 925.

Third, and finally, this case vividly illustrates the hazards 

of an uncabined conception of Rule 60(b) modification. The 

district court imposed brand new injunctive commands on 

governmental operations without any of the ordinary 

protections for such exceptional relief. The district court 

resolved factual disputes in the record against the District. See 

2016 Order, 177 F. Supp. 3d at 430, 441–443. The court then 

imposed the burden on the District to disprove the existence of 

a problem in need of classwide structural relief. See id. at 

441–442. The court, in fact, acknowledged that, at the time of 

its new order, the District had made impressive progress in 
21

improving its systems and that there were “zero individuals” in 

the case-processing backlog. Id. at 428. The district court 

nonetheless ruled that “individual errors combine to form 

systemic problems.” Id. at 430. 

Yet no such showing of a persisting structural breakdown

was made on this record. The court made no factual finding 

of a pattern or high volume of eligibility or renewal delays. 

Instead, the district court faulted the District for not “entirely

remediat[ing]” the problems arising from the transition to the 

Affordable Care Act. Id. (emphasis added). But a local 

government cannot be subjected to ongoing classwide 

structural relief simply because a problem has not been 100% 

eradicated. See Lewis v. Casey, 518 U.S. 343, 349 (1996) 

(“[T]he court’s failure to identify anything more than isolated 

instances of actual injury renders its finding of a systemic []

violation invalid.”). 

Even crediting the district court’s finding of a handful of 

individual processing errors by the District—disputed factsthat 

were resolved without a hearing or discovery—the district 

court’s assertion that it could not “separate individual 

mistakes” from “systemic” ones, 2016 Order, 177 F. Supp. 3d

at 437, admits the problem. Expansive, classwide structural 

relief that judicially superintends local government operations 

cannot issue based on a factual predicate consisting only of 

one-off errors that have, at best, a marginal connection to the 

only remaining executory portions of the Consent Decree. 

The burden was on the Plaintiffs to prove the existence of a 

continuing and widespread problem. By shoehorning the 

Plaintiffs’ new injunction into a Rule 60(b) modification, the 

district court evaded that proof problem, finding it sufficient to 

enter a sweeping injunction just because it had “no assurance” 

that already-solved problems “w[ould] not arise again.” Id. at 

441. That gets Rule 60(b) exactly backwards. See Horne, 
22

557 U.S. at 450 (“If a durable remedy has been implemented, 

continued enforcement of the order is not only unnecessary, but 

improper.”). 

* * * * *

The district court’s imposition of sweeping new injunctive 

obligations to redress new factual problems arising under a new 

law and providing relief under no longer operative provisions 

of the Consent Decree cannot be forced into the mold of a Rule 

60(b) modification. For the foregoing reasons, we reverse the 

orders of the district court, vacate the modification, and remand 

for further proceedings consistent with this opinion.

So ordered.