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The issue in this case is whether a federal court has authority to insist that state defendants comply with the terms of a consent decree that the state freely negotiated and signed. The case started as a class-action lawsuit by Texas parents over the state's failure to provide adequate healthcare for children under a federally mandated program for the poor, called Early and Periodic Screening, Diagnosis and Treatment (EPSDT). After the case settled, Texas health officials claimed courts had no authority to enforce what had been agreed on in the settlement. The ACLU's position is that the Eleventh Amendment is not a barrier to the enforcement of such decrees. Simply put, the state cannot both agree to a court order and then refuse to comply with it.