This case involves a dispute over Indiana's Healthy Indiana Plan 2.0 (HIP 2.0), a state Medicaid program that provides coverage to low-income adults. In 2020, the Department of Health and Human Services (HHS) approved a ten-year extension of this program. In 2023, HHS expressed concerns about the program's coverage but decided not to withdraw approval immediately. Three Medicaid beneficiaries sued HHS, arguing the 2020 approval and the 2023 decision were unlawful under the Administrative Procedure Act. Indiana intervened to defend the program. The district court granted summary judgment to the beneficiaries, vacated HHS's 2020 approval, and remanded the matter to HHS for further proceedings. While the district court stayed the vacatur to keep the program largely in effect, Indiana appealed the remand order to the D.C. Circuit, arguing the order was final and appealable.
The court applied the general rule that appellate review is postponed until a final judgment has been rendered by the trial court, as codified in 28 U.S.C. § 1291. The court reasoned that a ruling is final only if it terminates an action and completely ends the litigation on the merits. A remand order to a federal agency is typically interlocutory because it leaves the agency with work to do and the core dispute unresolved. The court noted that 'it is black letter law that a district court's remand order is not normally final for purposes of appeal under 28 U.S.C. § 1291.' The court rejected Indiana's arguments for exceptions. First, the exception allowing agencies to appeal remand orders immediately did not apply because HHS declined to appeal. Second, the remand proceedings were substantive, not ministerial, meaning the agency had to reconsider the merits of the program extension. Third, the collateral-order doctrine did not apply because the order did not conclusively determine a disputed question separate from the merits, and the issue was effectively reviewable after the remand proceedings concluded. Finally, the court held that the district court's Rule 54(b) certification could not confer jurisdiction where the order was not final under the statute. The court also struck portions of the government's brief that challenged the merits of the district court's decision without filing a cross-appeal.
Indiana's appeal is dismissed, and the case returns to the district court's remand order. HHS must now reconsider the extension of Indiana's Medicaid program. Indiana retains the right to appeal the district court's decision after HHS completes the remand proceedings and issues a new ruling. The district court's stay order remains in effect, meaning Indiana's Medicaid program continues largely as it was, though Indiana cannot collect premiums related to POWER accounts during the remand. The decision reinforces that parties must wait for final agency action on remand before seeking appellate review of the remand order itself.