Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

LEWIS v. GRINKER

January 19, 2000

LYDIA LEWIS, ETC., ET ALIA, PLAINTIFFS,
V.
WILLIAM GRINKER, ETC., ET ALIA, DEFENDANTS.



The opinion of the court was delivered by: Sifton, Chief Judge.

  MEMORANDUM AND ORDER

On March 14, 1991, this Court entered a permanent injunction in this class action enjoining the defendants from denying Medicaid coverage for prenatal care to otherwise eligible pregnant aliens on the ground that they were not permanently residing in the United States under color of law. Lewis v. Grinker, 794 F. Supp. 1193 (E.D.N.Y. 1991), aff'd, and reh'g denied, 965 F.2d 1206 (2d Cir. 1992). Those decisions held that the language of the federal Medicaid statute then at issue, which limited Medicaid coverage for undocumented aliens, should not be interpreted as applying to the provision of Medicaid benefits for prenatal care in the absence of clear evidence of Congress' intent to deny coverage for such benefits.

This action is once again before this Court on the federal defendant's motion to vacate the permanent injunction. The federal defendant contends that the permanent injunction must be vacated because Congress has now provided evidence of its specific intent to deny Medicaid coverage for prenatal care to undocumented aliens through its enactment of Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (the "Welfare Reform Act"), Pub.L. No. 104-193, 110 Stat. 2105, 2260.

For the reasons set forth below, the federal defendant's motion to vacate the permanent injunction is denied. What follows sets forth the findings of fact and conclusions of law on which this determination is based.

BACKGROUND

Statutory Framework

Medicaid was originally enacted in 1965 as Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. The Second Circuit has described Medicaid as a "cooperative federal/state cost-sharing program designed to enable participating states to furnish medical assistance to persons whose income and resources are insufficient to meet the costs of necessary medical care and services." DeJesus v. Perales, 770 F.2d 316, 318 (2d Cir. 1985). States that choose to participate in the Medicaid program are subject to the requirements of the applicable federal statutes, see 42 U.S.C. § 1396a, and to the regulations promulgated by the Secretary of the Department of Health and Human Services (the "Secretary") pursuant thereto.

The Medicaid statute requires participating states to provide coverage to two basic categories of individuals: the "categorically needy," 42 U.S.C. § 1396a(a)(10)(A), and the "medically needy," id. § 1396a(a)(10)(C). See also 42 C.F.R. § 435.4; DeJesus, 770 F.2d at 318.*fn1 "Roughly speaking, the categorically needy are those who earn no more than that necessary to cover the necessities of life; the medically needy differ in that it is only the expense of necessary medical care that strains their ability to pay for basic necessities." Lewis v. Gross, 663 F. Supp. 1164, 1174 (E.D.N.Y. 1986).

Prenatal Care Under Medicaid

Under current law, pregnant women seeking prenatal care may be eligible for Medicaid under any one of three categories, depending on their financial status. First, participating states must provide Medicaid coverage to a subgroup of the categorically needy, called the "mandatory categorically needy." 42 U.S.C. § 1396a(a)(10)(A)(i) (West Supp. 1999). Included in this subgroup are "qualified pregnant women," id. § 1396a(a)(10)(A)(i)(III), defined as any woman with a "medically verified" pregnancy whose household would have been eligible for benefits under the Aid to Families with Dependent Children ("AFDC") program "if her child had been born and was living with her in the month such aid would be paid," or who "meets the income and resource requirements" of the AFDC program, as in effect as of July 16, 1996.*fn2 42 U.S.C. § 1396d(n)(1)(A), (C).

Second, participating states may, at their option, choose to provide Medicaid coverage to individuals called the "optional categorically needy." 42 U.S.C. § 1396a(a)(10)(A)(ii), 1396a(d). This subgroup includes "pregnant women" in general, id. § 1396d(a)(viii), and "women during pregnancy" whose household incomes are between 133% and 185% of the federal poverty line, id. § 1396a(l)(1)(A), (2)(A).*fn3

Third, the states may, at their option, choose to provide coverage to "medically needy" individuals. Id. § 1396a(a)(10)(C). This subgroup includes the same groups of individuals that the states may cover as "optional categorically needy" but applies less stringent financial and resource requirements. While medically needy coverage is generally optional with the states, once a state chooses to provide any type of medical coverage to some medically needy individuals, it must provide, inter alia, prenatal and delivery services to medically needy pregnant women. Id. §§ 1396a(a)(10)(C)(ii)-(iii), 1396d(a)(viii).

Prior to 1981, pregnant women were not identified as a special eligibility group under the Medicaid statute.*fn4 Instead, the Secretary gave participating states the option to extend Medicaid benefits directly to the fetus under the assumption that fetuses were optional categorically needy "persons under the age of 21." See Lewis v. Grinker, 965 F.2d 1206, 1209 (2d Cir. 1992) ("Lewis IV-A").*fn5

In the 1980's, Congress adopted a series of laws that greatly expanded access to prenatal care while at the same time shifting the analytical focus from the fetus to the pregnant mother. In the Omnibus Budget Reconciliation Act of 1981 ("OBRA '81"), Pub.L. No. 97-35, 95 Stat. 357, 853, in place of direct AFDC coverage for the fetus, Congress permitted the states to provide AFDC benefits to women in their third trimester of pregnancy if they would be eligible for AFDC based on the constructive birth of their fetuses — if they would be eligible had their children been born and living with them at the time the benefits were provided. OBRA '81, § 2312(a), 95 Stat. 357, 853. OBRA '81, in order to provide pregnant women with prenatal care under Medicaid, also amended the Medicaid statute to authorize states to "deem" a pregnant woman an AFDC recipient for Medicaid purposes, and thus mandatorily eligible for Medicaid, if the woman would be eligible for AFDC based on the concept of the constructive birth of her fetus. OBRA '81 § 2312(b), 95 Stat. 357, 853. OBRA '81 also required states that provided coverage to medically needy individuals to provide prenatal care to medically needy pregnant women as well. Thus, states had the option to supply Medicaid coverage for prenatal care to a pregnant woman either as mandatory categorically needy or as medically needy. See 42 U.S.C. § 1396d(a)(viii) (adding pregnant women as a separate eligibility group). At the same time, the Secretary continued to give the states the option of providing Medicaid coverage directly to the fetus by considering the fetus to be an individual under age of 21.

In the Deficit Reduction Act of 1984, Pub.L. No. 98-369, 98 Stat. 494 ("DRA '84"), Congress further expanded access to prenatal care by requiring the states to provide Medicaid benefits to "any qualified pregnant woman or child" as mandatory categorically needy. The statute defined a "qualified pregnant woman" as a pregnant woman who would be eligible for AFDC "if her child had been born and was living with her in the month such aid would be paid, and such pregnancy has been medically verified." DRA '84 § 2361(b), 98 Stat. 494, 1104 (codified as amended at 42 U.S.C. § 1396d(n)). The qualified pregnant woman provision expanded access to prenatal care because, while OBRA '81 merely gave the states the option to employ the constructive birth analysis to deem pregnant women AFDC recipients for the purposes of providing Medicaid coverage for prenatal care, DRA '84 required the states to do so. By mandating coverage for "qualified pregnant women," the statute also eliminated categorical barriers in the AFDC program that had arbitrarily limited access to Medicaid for poor pregnant women such as those without any "dependent children."*fn6 DRA '84 also ensured that Medicaid coverage would follow the fetus after birth by providing that an infant born to a woman eligible for and receiving Medicaid benefits on the child's date of birth was automatically covered by Medicaid at birth. DRA '84 § 2362(a), 98 Stat. 494, 1104 (codified as amended at 42 U.S.C. § 1396a(e)(4)).

In the Consolidated Omnibus Budget Reconciliation Act, Pub.L. No. 99-272, 100 Stat. 82, 201 (1985) ("COBRA"), Congress again made it easier for pregnant women to qualify for prenatal care by breaking the link between AFDC eligibility and Medicaid eligibility. After COBRA, a prospective qualified pregnant woman only had to demonstrate that she was sufficiently poor to qualify for Medicaid benefits. Because the Secretary interpreted the constructive birth analysis to apply to all three sections of the definition of qualified pregnant woman, the fetus' interest could be considered in determining whether the woman was financially needy. In February 1985, in Program Memorandum # 853, for the first time the Secretary did not list fetuses as one of the categories of people under age 21 to whom the states could, at their option, provide Medicaid. This omission completed the shift from fetal-centered to maternal-centered analysis of coverage for prenatal care.

In the Omnibus Budget Reconciliation Act of 1986 ("OBRA '86"), Pub.L. No. 99-509, 100 Stat. 1874, Congress removed the categorical eligibility rules from the Medicaid prenatal scheme and began to expand prenatal coverage by raising financial eligibility ceilings for pregnant women. See OBRA '86 § 9401(a) & (b), 100 Stat. 1874, 2050-51 (adding subclause (IX) to 42 U.S.C. § 1396a(a)(10)(A)(ii) and subsection (1) to 42 U.S.C. § 1396a). OBRA '86 also created a new period of "presumptive eligibility" for ambulatory prenatal care in order to speed access to services while Medicaid applications are being processed.

In 1988, Congress further expanded Medicaid coverage for prenatal care by making coverage for "women during pregnancy" mandatory, at least for those households with income under 133% of the federal poverty line. See Medicare Catastrophic Coverage Act of 1988, § 302(a), Pub.L. No. 100-360, 102 Stat. 683, 750-51 (adding subclause (IV) to 42 U.S.C. § 1396a(a)(10)(A)(I)). Congress also eliminated administrative obstacles to the provision of Medicaid coverage for "women during pregnancy." 42 U.S.C. § 1396a(a)(55), (c).

Congress has also required states to coordinate the operation of Medicaid and the Special Supplemental Food Program for Women, Infants, and Children ("WIC"), 42 U.S.C. § 1396a(a)(11)(C). The WIC program helps to provide for the nutritional needs of pregnant women and postpartum women and their newborn children. 42 U.S.C. § 1786.

History of this Litigation

Plaintiffs Lydia Lewis et al. commenced this class action in 1979 to challenge a 1973 regulation of the Secretary, 42 C.F.R. § 435.402 (b), and a companion New York State regulation, 18 NYCRR § 349.3, denying Medicaid benefits to all aliens except those lawfully admitted for permanent residence or permanently residing in the United States under color of law ("PRUCOL").*fn7 Plaintiffs challenged the regulations on four grounds: (1) the Medicaid statute did not explicitly authorize such regulations; (2) the regulations violated constitutional principles of equal protection and due process; (3) the Secretary's definition of PRUCOL under the regulations was impermissibly narrow; and (4) the regulations did not apply to benefits directed to the unborn children of pregnant alien women.

On July 14, 1986, this Court issued a memorandum and order which, among other things, determined that the Secretary's regulation, 42 C.F.R. § 435.402(b), was not authorized by the Medicaid statute, 42 U.S.C. § 1396 et seq. See Lewis v. Gross, 663 F. Supp. 1164 (E.D.N.Y. 1986) (Lewis I). Having based this decision on statutory grounds, this Court did not reach any of plaintiffs' additional claims challenging the regulations. In particular, this Court did not address the application of alienage restrictions to the provision of prenatal care under Medicaid.

Following that decision but before a final judgment was entered, Congress passed OBRA '86.*fn8 Section 9406 of OBRA '86 provided the missing statutory authority for imposing restrictions on aliens' Medicaid eligibility by adding to § 1396a of the Medicaid statute the provision that,

[n]otwithstanding paragraph 10(B) or any other provision of this subsection, a State plan shall provide medical assistance with respect to an alien who is not lawfully admitted for permanently residing or otherwise permanently residing in the United States under color of law only in accordance with section 1396b(v) of this title.

42 U.S.C. § 1396a (1991 Supp.). Section 1396b(v) provided:

(2) Payments shall be made under this section for care and services that are furnished to an alien . . . only if —
(A) such care and services are necessary for the treatment of an emergency medical condition of the alien, and
(B) such alien otherwise meets the eligibility requirements for medical assistance under the State plan . . .
(3) For purposes of this subsection, the term `emergency medical condition' means a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity.

42 U.S.C. § 1396b(v) (1991 Supp.). The legislative history of OBRA '86 explains that these amendments were designed specifically to address this Court's decision in Lewis I. See H.Rep. No. 99-727, at 111 (1985), reprinted in 1986 U.S.C.C.A.N. 3607, 3701 [hereinafter 1986 House Report].*fn9

The federal defendant sought reconsideration of this Court's decision in Lewis I in light of this legislative change. While the federal defendant's motion for reconsideration of Lewis I was pending, the Secretary submitted to the Court an advance copy of an internal directive which, among other things, provided that pregnant non-PRUCOL aliens would no longer be eligible for Medicaid-sponsored prenatal care. On January 20, 1987, plaintiffs moved for a preliminary injunction to prevent this policy from going into effect on the ground that the unborn children of all alien women in this country, whether PRUCOL or not, were eligible under 42 U.S.C. § 1396d(a)(1) for Medicaid in their own names as optional categorically needy "individuals under the age of 21" under 42 U.S.C. § 1396d(a)(1).

On March 5, 1987, this Court issued a preliminary injunction enjoining defendants from denying Medicaid coverage for prenatal care to alien women residing in New York State with a medically verifiable pregnancy if their unborn children would be eligible for Medicaid had they been born at the time of the application. See Lewis v. Grinker, CV-79-1740, 1987 WL 8412 (E.D.N.Y. Mar.6, 1987) (Lewis III). This Court recognized that the federal and state defendants shared a "longstanding interpretation" of the Medicaid statute that unborn children were to be classified as "individuals . . . under the age of 21" under 42 U.S.C. § 1396d(a)(1) for Medicaid eligibility purposes. Relying on this longstanding administrative interpretation, this Court found that plaintiffs had shown a likelihood of success on the merits of their claims that the unborn children of alien mothers were eligible for Medicaid in their own names as optional categorically needy individuals under the age of 21 pursuant to § 1396d(a)(1). See Lewis III, 1987 WL 8412, at *9-10. The Secretary did not appeal this decision, "despite the fact that [this] court's determination that fetuses were eligible for Medicaid benefits in their own name conflicted with the agency's policy announced in the December 6, 1985 internal memorandum." Lewis IV-A, 965 F.2d at 1214.

In November 1989, plaintiffs moved for summary judgment seeking to convert the preliminary injunction of Lewis III into a permanent injunction. On March 14, 1991, this Court entered a permanent injunction enjoining defendants from denying Medicaid to pregnant non-PRUCOL aliens. See Lewis v. Grinker, 794 F. Supp. 1193 (E.D.N.Y. 1991) ("Lewis IV"), aff'd, and reh'g denied, 965 F.2d 1206 (2d Cir. 1992).

In Lewis IV, this Court reconsidered its earlier decision in Lewis III and found that fetuses were not eligible for Medicaid in their own name as "individuals . . . under the age of 21" under § 1396d(a)(1). See Lewis IV, 794 F. Supp. at 1198.

This Court determined, however, that pregnant non-PRUCOL aliens were themselves eligible for Medicaid-sponsored prenatal care as "qualified pregnant women" under § 1396a(a)(10)(A)(i)(III). Because the plain language of the Medicaid statute based a pregnant woman's eligibility for Medicaid on her eligibility for AFDC benefits under the AFDC statute, see 42 U.S.C. § 1396d(n), which in turn considered a pregnant woman eligible for AFDC benefits in the last three months of her pregnancy if she would be eligible based on the constructive birth of the fetus, see 42 U.S.C. § 606, this Court concluded that the "qualified pregnant woman" provision of the statute required that the fetus be deemed born and that the fetus if born would be a United States citizen. See Lewis IV, 794 F. Supp. at 1199.

The federal defendant appealed and on January 31, 1992, the Second Circuit affirmed this Court's permanent injunction somewhat on different grounds than those relied on by this Court. Lewis v. Grinker, 965 F.2d 1206 (2d Cir.) ("Lewis IV-A"). The Second Circuit held, as did this Court, that, despite the general alien eligibility restrictions in OBRA '86, Congress did not intend to bar otherwise eligible non-PRUCOL pregnant aliens from receiving Medicaid-sponsored prenatal care. The Second Circuit concluded, however, that the plain language of OBRA '86 appeared to require the Secretary to deny Medicaid benefits for prenatal care to non-PRUCOL pregnant aliens. However, after reviewing the legislative history and statutory background of OBRA '86, the Second Circuit concluded that Congress did not realize that this result would follow from the blanket alienage restriction included in OBRA '86, and that, had Congress foreseen such a result, it would not have enacted the statute as written.

The Second Circuit found several reasons to believe that Congress did not foresee the results of the language it employed in OBRA '86. First, noting that "the Medicaid Act is a statute of `unparalleled complexity' . . . [and] among the `most intricate ever drafted by Congress,'" the Second Circuit stated, "we are always mindful of the possibility that Congress may have failed to perceive a particular consequence of a blanket change in this complex statutory scheme." Id. at 1216 (internal citations omitted). It further noted that it was "particularly unwise to blindly assume that Congress will always fully anticipate every implication of the plain meaning of a particular amendment" when the amendment "comes in the form of an end-of-session, omnibus budget reconciliation bill." Id. Further, the Second Circuit found that few areas within the "contorted scheme" of Medicare "are more complex than the coverage of prenatal care" and noted that "Congress had frequently tripped over the statute's complexities" in its efforts to "radically expand[]" access to prenatal care and to shift "from a fetal centered to a maternal centered" approach to the provision of prenatal care. Id. at 1216. The Second Circuit then found that Congress had failed to recognize in the legislative history to OBRA '86 that, as a result of the 1985 amendments to the Medicaid statute, pregnant women became eligible for Medicaid as mandatory categorically needy individuals. The Second Circuit found that in light of the Secretary's longstanding use of the fiction of the constructively born child, Congress might have erroneously assumed that, even after OBRA '86, the states would be free to extend prenatal care directly to the fetus as an "individual under the age of 21." Id. at 1217. Finally, it found that construing OBRA '86 otherwise would raise serious equal protection questions. Because the statute provided that newborn children are automatically eligible for Medicaid in their own names at birth if their mothers were eligible for Medicaid-sponsored prenatal care, see 42 C.F.R. § 435.117 (1991), the Second Circuit noted that an interpretation of the statute which found non-PRUCOL pregnant aliens ineligible for Medicaid would result in discrimination against the citizen child of such an alien on the basis of the alien status of the parent. See id. at 1217.

After concluding that Congress "did not foresee that the blanket alienage restriction [in OBRA '86] would have the effect of denying prenatal care to future citizens," the Second Circuit next considered "whether this unexpected result is contrary to the clearly expressed intent of Congress." Id. at 1219. It noted that "[i]n the ordinary case, we would be reluctant to conclude that even an unexpected result conflicted with Congressional purpose." Id. However, after considering Congress' purpose in enacting OBRA '86 and "the long history of Congressional treatment of prenatal care," the Second Circuit concluded that the result of the plain language of the statute conflicted with Congress' clearly expressed intent. Noting the indisputable conclusion that prenatal care is cost-effective, the court first found that denying prenatal care to non-PRUCOL pregnant aliens would undermine the "clearly expressed Congressional purpose [behind OBRA '86] of curbing expenditures." Id. The court next found that its conclusion that denying prenatal care to non-PRUCOL pregnant aliens "conflicts with Congressional purpose is further solidified by the fact that Congress has over the years unequivocally expressed its desire to continue to expand access to prenatal care." Id. at 1219. The court thus concluded that this case

present[ed] the extremely rare instance where we can discern a clearly expressed Congressional intent contrary to the plain language of the statute. Had Congress realized the implications of the alien restriction, it would most certainly not have cut off prenatal care to non-PRUCOL women. In short, this is the rare case like Rose where refusing to extend a broad statutory prohibition to a situation Congress did not foresee is necessary to avoid impeding a clearly expressed Congressional purpose.

Id. at 1219.

While the court of appeals expressed no opinion on the constitutionality of denying prenatal care to non-PRUCOL pregnant aliens, it went on to note that "`legislation directing the onus of a parent's misconduct against his children does not comport with fundamental conceptions of justice.'" Id. at 1219-20 (quoting Plyler v. Doe, 457 U.S. 202, 220, 102 S.Ct. 2382, 72 L.Ed.2d 786 (1982)). Accordingly, it declared that "we are unwilling to over-ride Congress's clearly expressed intention to curb expenditures by expanding prenatal care without more persuasive indicia of Congressional intent than are present here." Id. at 1220. The Secretary moved for a rehearing, which was denied. The Secretary did not seek a writ of certiorari from the United States Supreme Court.

The Welfare Reform Act

Following the court of appeals' decision, Congress, in 1996, enacted the Welfare Reform Act. Title IV of that Act, codified as amended at 8 U.S.C. § 1601 et seq., obtained approximately $24 billion in cuts in federal spending by enacting sweeping new restrictions on aliens' eligibility for federal welfare benefits. Section 401(a) of the Welfare Reform Act repealed the alienage restriction on the receipt of Medicaid benefits set forth in OBRA '86 and replaced it with a more stringent alienage restriction. See Welfare Reform Act § 401(a), 110 Stat. 2105, 2261. Section 401(a), codified at 8 U.S.C. § 1611(a), provides that, in order to be eligible for any "Federal public benefit," including Medicaid, an alien must be a "qualified alien." 8 U.S.C. § 1611(a) (West Supp. 1999). Section 431(b) of the Welfare Reform Act defines a "qualified alien" to mean:

an alien who, at the time the alien applies for, receives, or attempts to receive a Federal public benefit, is —
(1) an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act,
(2) an alien who is granted asylum under section 208 of such Act,
(3) a refugee who is admitted to the United States under section 207 of such Act,
(4) an alien who is paroled into the United States under section 212(d)(5) of such Act for a period of at least 1 year,
(5) an alien whose deportation is being withheld under section 243(h) of such Act, or
(6) an alien who is granted conditional entry pursuant to section 203(a)(7) of such Act as in effect prior to April 1, 1980.

Welfare Reform Act § 431(b), 110 Stat. 2105, 2274 (codified as amended at 8 U.S.C. § 1641).*fn10 Section 401 of the Welfare Reform Act thus not only extended alien eligibility restrictions to a much wider array of federal welfare programs (any "federal public benefit"), but it also narrowed the classes of aliens eligible for programs such as Medicaid to which the PRUCOL standard had previously applied.*fn11

Section 401(b) of the Welfare Reform Act, however, continued to provide for certain limited exceptions to the general rule that only "qualified aliens" are eligible for federal public benefits. Section 401(b)(1)(A), in particular, codified as amended at 8 U.S.C. § 1611(b)(1)(A), provides that Section 401(a) does not apply to:

[m]edical assistance under title XIX of the Social Security Act [42 U.S.C. § 1396 et seq.] (or any successor program to such title) for care and services that are necessary for the treatment of an emergency medical condition (as defined in section 1903(v)(3) of such Act [42 U.S.C. § 1396b(v)(3)]) of the alien involved and are not related to an organ transplant procedure, if the alien involved otherwise meets the eligibility requirements for medical assistance under the State plan approved under such title. . . .

8 U.S.C. § 1611(b)(1)(A) (West Supp. 1999). The Medicaid statute, 42 U.S.C. § 1396b(v)(3), defines an "emergency medical condition" as:

a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in —
(A) placing the patient's health in serious jeopardy,

(B) serious impairment to bodily functions, or

(C) serious dysfunction of any bodily organ or part.

42 U.S.C. § 1396b(v)(3) (West Supp. 1999).

Section 401(b)(1)(A) is the only exception that explicitly authorizes the provision of Medicaid benefits to unqualified aliens. However, Section 401(b)(1)(C) also provides a limited exception from the general provisions of the statute for public health assistance other than Medicaid assistance for "immunizations with respect to immunizable diseases and for testing and treatment of communicable diseases whether or not such symptoms are caused by a communicable disease." Welfare Reform Act § 401(b)(1)(C), 110 Stat. 2105, 2261 (codified at 8 U.S.C. § 1611(b)(1)(C)).*fn12 In addition, the Welfare Reform Act exempts the federally funded School Lunch and Breakfast programs from Section 401(a)'s alienage restriction ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.