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Before Lynch, Chief Judge, Boudin and Howard, Circuit Judges.

Two Puerto Rican community health centers, Concilio de Salud Integral de Lo_za, Inc. (“Lo_za”), and Junta del Centro de Salud Communal Jos_ S. Belaval, Inc. (“Belaval”), appeal from a district court order denying them the relief they seek, namely, an injunction requiring payment by Puerto Rico’s Secretary of Health (“Secretary”) of Medicaid reimbursements that the two centers claim to be due to them under federal law and prior decisions in this long continuing litigation.*fn1

Medicaid is supported by both state and federal funds and administered by state governments; for the purposes of Medicaid, Puerto Rico is a “State.” 42 U.S.C. § 1301(a)(1) (2006); 42 C.F.R. § 400.203 (2009). To participate in Medicaid, states are required to provide specified health services for “underserved” areas or populations through “Federally-qualified health centers” (“FQHCs”)–healthcare facilities that are eligible to receive certain federal grants. See 42 U.S.C. §§ 254b(a), 1396a(a)(10)(A), 1396d(a)(2)(C), 1396d(l)(2)(B). Loíza and Belaval are FQHCs.

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