Gloria Jane Miller v. Advantage Behavioral Health Systems , 677 F. App'x 556 ( 2017 )


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  •          Case: 15-15496   Date Filed: 01/26/2017   Page: 1 of 23
    [DO NOT PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________
    No. 15-15496
    Non-Argument Calendar
    ________________________
    D.C. Docket No. 3:14-cv-00045-CDL
    GLORIA JANE MILLER,
    Plaintiff - Appellee,
    versus
    ADVANTAGE BEHAVIORAL HEALTH SYSTEMS,
    Defendant - Appellant.
    ________________________
    Appeal from the United States District Court
    for the Middle District of Georgia
    ________________________
    (January 26, 2017)
    Case: 15-15496     Date Filed: 01/26/2017   Page: 2 of 23
    Before WILSON, ROSENBAUM, and JULIE CARNES, Circuit Judges.
    PER CURIAM:
    Plaintiff Gloria Jane Miller alleges that Defendant Advantage Behavioral
    Health Systems terminated her employment because of her age in violation of the
    Age Discrimination in Employment Act, 29 U.S.C. § 621 et seq. (“ADEA”).
    Advantage, a Georgia “community service board,” moved to dismiss on grounds of
    Eleventh Amendment immunity. The district court denied Advantage’s motion,
    finding that Advantage is not an “arm of the State” for federal sovereign immunity
    purposes with respect to Miller’s suit. Advantage appeals from the district court’s
    denial. We affirm.
    BACKGROUND
    Advantage is a community service board (“CSB”) providing mental health,
    substance abuse, and developmental disability services in the State of Georgia.
    CSBs are creatures of Georgia state law, see generally O.C.G.A. § 37-2-6, and may
    receive funding from the State to support their services. While they are subject to
    some high-level oversight by Georgia’s Department of Behavioral Health and
    Developmental Disabilities (the “DBHDD”), daily operations and personnel
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    matters are managed by locally elected boards and supporting staff. See O.C.G.A.
    § 37-2-6(a)–(b).
    Miller worked as a nurse at Advantage for several years until her
    employment was terminated in 2010. Miller contends that Advantage
    discriminated against her and ultimately fired her as a result of her age. She filed
    suit against Advantage under the ADEA in the United States District Court for the
    Middle District of Georgia in 2014. After a year of discovery, and on the eve of
    the parties’ pretrial conference, Advantage moved to dismiss the suit on grounds of
    Eleventh Amendment immunity. The district court made note of the “perplexing”
    tardiness of Advantage’s motion but declined to find that Advantage had waived
    its right to assert a federal immunity defense. The court proceeded to reject
    Advantage’s argument that it qualifies as an “arm of the State” for Eleventh
    Amendment purposes and denied Advantage’s motion to dismiss. We affirm.
    STANDARD OF REVIEW
    We review the district court’s denial of Advantage’s sovereign immunity
    defense de novo. Garrett v. Univ. of Ala. at Birmingham Bd. of Trs., 
    344 F.3d 1288
    , 1290 (11th Cir. 2003). We may affirm the district court’s decision on any
    ground supported by the record. Ironworkers Local Union 68 v. AstraZeneca
    3
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    Pharm., LP, 
    634 F.3d 1352
    , 1360 (11th Cir. 2011).
    DISCUSSION
    I.     Eleventh Amendment Immunity
    The Eleventh Amendment to the federal Constitution “protects a State from
    being sued in federal court without the State’s consent.” Manders v. Lee, 
    338 F.3d 1304
    , 1308 (11th Cir. 2003) (en banc).1 Eleventh Amendment immunity extends
    to “arms of the State,” or public entities acting as state agents or instrumentalities.
    
    Id. A defendant’s
    status as an arm of the State “must be assessed in light of the
    particular function in which the defendant was engaged when taking the actions
    out of which liability is asserted to arise.” Id.; see also Shands Teaching Hosp. &
    Clinics, Inc. v. Beech St. Corp., 
    208 F.3d 1308
    , 1311 (11th Cir. 2000) (establishing
    that arm-of-the-State status relates not to the entity’s “status in the abstract” but to
    its “function or role in a particular context.”).
    1
    It is well settled that Congress did not properly abrogate the states’ Eleventh Amendment
    immunity with respect to age-discrimination claims in enacting the ADEA. See Kimel v. Fla.
    Bd. of Regents, 
    528 U.S. 62
    , 66–67 (2000); Stroud v. McIntosh, 
    722 F.3d 1294
    , 1303 (11th Cir.
    2013) (“The Supreme Court has made it clear that the ADEA is unconstitutional as applied to the
    states . . . .”). Accordingly, there is no dispute in this appeal that Advantage would be entitled to
    immunity from Miller’s ADEA claim if Advantage were deemed to have acted as an arm of the
    State when it terminated Miller.
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    Once the relevant context is defined, this Court balances four factors (the
    “Manders factors”) to determine whether the defendant acted as an arm of the
    State: “(1) how state law defines the entity; (2) what degree of control the State
    maintains over the entity; (3) where the entity derives its funds; and (4) who is
    responsible for judgments against the entity.” 
    Manders, 338 F.3d at 1309
    . The
    entity invoking Eleventh Amendment immunity bears the burden of demonstrating
    that the Manders factors weigh in its favor. See, e.g., Woods v. Rondout Valley
    Cent. Sch. Dist. Bd. of Educ., 
    466 F.3d 232
    , 237 (2d Cir. 2006) (joining its sister
    circuits to hold that an entity seeking refuge in the Eleventh Amendment “bears the
    burden of demonstrating that it qualifies as an arm of the state”).
    Miller’s ADEA discrimination claim arises from her allegedly wrongful
    termination by Advantage. As such, the question presented is whether Advantage
    acts as an arm of the State in making hiring and firing decisions in the ordinary
    course of business. With this context in mind, we review de novo Advantage’s
    arguments as to each of the four Manders factors. We find that, under the evidence
    Advantage presents, three of the four factors weigh against finding immunity with
    respect to Miller’s claim.
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    A.     Georgia Law’s Definition of Community Service Boards
    The first Manders factor considers how Georgia law defines CSBs. As we
    have noted, “federal law, not state law, [ ] ultimately governs whether an entity is
    immune under the Eleventh Amendment,” Lightfoot v. Henry County School
    District, 
    771 F.3d 764
    , 771 (11th Cir. 2014), but the manner in which state law
    treats a public entity serves to guide our Eleventh Amendment analysis. See 
    id. at 769–71
    (considering Georgia statutory framework, Georgia constitution, and
    related state case law to assess first Manders factor).
    We first consider the language with which the relevant Georgia statute
    characterizes CSBs. The opening section of the CSB enabling statute states that
    the entities “shall be considered public agencies” and that each individual CSB
    “shall be a public corporation and an instrumentality of the state.” O.C.G.A. § 37-
    2-6(a). While the terms “public agency” and “public corporation” are too vague to
    tip the balance toward arm-of-the-State status, entities considered
    “instrumentalities” of the State presumptively share in the State’s Eleventh
    Amendment immunity. See 
    Manders, 338 F.3d at 1308
    (noting that the phrase
    “arm of the State” encompasses “agents and instrumentalities of the State”).
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    The Georgia legislature, however, clouded this presumption later in the same
    statutory section by declaring that CSBs “shall not be considered agencies of the
    state” and shall “have the same immunity as provided for counties.” O.C.G.A.
    § 37-2-11.1(c)(1). Georgia law—unlike federal law—grants counties sovereign
    immunity along with state agencies, but it defines county immunity and state-
    agency immunity differently. Compare Stewart v. Baldwin Cty. Bd. of Educ., 
    908 F.2d 1499
    , 1509 (11th Cir. 1990) (noting that Eleventh Amendment immunity
    “does not extend to counties”) with Toombs Cty., Ga. v. O’Neal, 
    330 S.E.2d 95
    , 97
    (Ga. 1985) (holding that sovereign immunity under Georgia constitution “is
    extended to the counties of the State of Georgia” but that state legislature may
    waive that immunity by law). This provision thus runs counter to the statute’s
    opening language, suggesting that the legislature intended CSBs to function as
    analogues of counties even if the statute nominally deemed them state
    “instrumentalities.”
    At best, the plain language of the relevant statutory provisions cuts only
    weakly in favor of finding that Georgia law views CSBs as arms of the State. And
    because Georgia law grants immunity to counties as well as state agencies, we
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    cannot easily import its statutory language into a federal immunity framework that
    draws a sharp distinction between these two types of entities.
    Georgia case law helps clarify this picture. In Youngblood v. Gwinnett
    Rockdale Newton Cmty. Serv. Bd., 
    545 S.E.2d 875
    (Ga. 2001), the Georgia
    Supreme Court unambiguously held that CSBs are arms of the State for purposes
    of state constitutional immunity, looking beyond the statutory language to find that
    the Georgia legislature designed CSBs to function as state entities rather than as
    independent political subdivisions. 
    Id. at 877
    & n.2. The legal effect of
    Youngblood was to invalidate the statutory provision that purported to grant CSBs
    “the same immunity as provided for counties.” O.C.G.A. § 37-2-11.1(c)(1). The
    effect of Youngblood in our analysis is to tip the balance toward a finding that
    Georgia state law views CSBs like Advantage as arms of the State. 2
    2
    Advantage makes a broader inference: “[W]hen the court in Youngblood ruled that CSBs are
    the ‘state’ for the purpose of suit under [Georgia law], it was necessarily holding that . . . the
    State of Georgia considers them to be entitled to Eleventh Amendment immunity.” Advantage’s
    reading of Youngblood goes too far. The court made no assertions as to the status of Georgia’s
    CSBs under the Eleventh Amendment, and indeed the court had no occasion in that case to opine
    about federal immunity law. And as the Georgia Supreme Court has acknowledged, state
    immunity analysis need not align with federal immunity analysis. Hines v. Ga. Ports Auth., 
    604 S.E.2d 189
    , 195 (Ga. 2004). Furthermore, the first Manders factor asks us to consider whether
    state law treats an entity more like a state agency or more like a political subdivision—it does not
    require us to discern how state courts believe federal courts should treat the entity under the
    Eleventh Amendment. Our conclusion on the first Manders factor is, therefore, narrow: In light
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    Because the Georgia Supreme Court’s classification of CSBs as state
    agencies is clear and definitive, we reserve our analysis of the practical function of
    CSBs under the state’s statutory scheme for the remaining Manders factors.
    B.     Where Georgia Law Vests Control
    The second Manders factor requires us to determine the degree of control
    the State maintains over the activity from which the defendant’s alleged liability
    arises. The question in this case is whether the State of Georgia exercises
    meaningful control over Advantage’s hiring and firing practices in the ordinary
    course of business. We find that it does not.
    As a general matter, CSBs in Georgia are managed at the local level and
    without significant state involvement. The operations of each CSB are controlled
    by a local Governing Board, whose members are appointed by authorities of the
    communities the CSB serves. See O.C.G.A. § 37-2-6(b). While state law defines
    the mechanism by which Board members are appointed and provides guidance
    regarding the selection of members, the State is not entitled to oversee or control
    of Youngblood, Georgia state law views CSBs as state agencies entitled to immunity under state
    law.
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    the appointment process in any capacity. See O.C.G.A. § 37-2-6(b)(1) (outlining
    Board appointment process); O.C.G.A. § 37-2-6(c) (encouraging local authorities
    to ensure diversity in Board membership).
    The Governing Board is, in turn, empowered to appoint an Executive
    Director to “direct[] the day-to-day operations” of the CSB. The Board may
    delegate “any power, authority, duty, or function” to the Director or other CSB
    staff members as it deems appropriate. O.C.G.A. § 37-2-6.1(a)(1). Appointment
    and compensation of the Executive Director are subject to approval by the
    Commissioner of the DBHDD, but the Governing Board retains sole authority to
    remove and replace the Director. See O.C.G.A. § 37-2-6.1(a)(1); O.C.G.A. § 37-1-
    1(3). The Executive Director is directly responsible for hiring and firing CSB
    staff, O.C.G.A. § 37-2-6.1(a)(1), while the Board (or the Director, if the Board so
    delegates) sets the terms of compensation for CSB personnel, O.C.G.A. § 37-2-
    6.1(b)(9), and determines whether and how to provide employee benefits.
    O.C.G.A. § 37-2-6.1(b)(7). The State has no authority to review staff hiring or
    firing activity or to alter the CSB’s provision of compensation or benefits. 3 Nor is
    3
    Advantage additionally argues that CSB personnel practices are governed by the
    antidiscrimination provision of the Rules of the State Personnel Board, Ga. Comp. R. & Regs.
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    the State empowered to train, discipline, or terminate CSB staff, to dismiss a CSB
    Executive Director, or to replace locally appointed Governing Board members.
    Cf., e.g., Lake v. Skelton, 
    840 F.3d 1334
    , 1343 (11th Cir. 2016) (noting that the
    State’s direct involvement in “training and discipline of deputies [within sheriff’s
    office] provides further evidence of control by the state”).
    Advantage contends that, because the Commissioner approves the selection
    and compensation of the Executive Director, and because the Director controls the
    hiring and firing of CSB staff, it follows that “the state has a great deal more
    control over personnel decisions than does any local authority.” We disagree.
    There is no question that Georgia law dictates the operational structure of each
    478-1, and thus the decision to terminate Miller was subject to substantial state control. See Ga.
    Comp. R. & Regs. 478-1-.03; O.C.G.A. § 45-20-2(6) (defining “agency” for purposes of
    application of Rules of the State Personnel Board to include CSBs). Miller counters with
    reference to a letter that Advantage transmitted to her upon her termination. In that letter,
    Advantage informs Miller that “the Rules and Regulations of the State Personnel Board do not
    cover you.” As the district court identified, there was further ambiguity in the record below as to
    whether state personnel standards apply to Advantage employees in general, and the parties have
    not successfully clarified this issue on appeal.
    In light of this ambiguity and Advantage’s own admission, we conclude that Advantage has
    failed to show that state personnel standards applied to Miller’s employment. We also note that
    applicability of state personnel standards would still not be sufficient to tilt the second Manders
    factor in favor of immunity in light of the evidence we highlight above.
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    CSB, but CSBs retain substantial autonomy over day-to-day operations and
    ordinary personnel management, signaling meaningful local control. We came to a
    similar conclusion in 
    Lightfoot, 771 F.3d at 771
    –75, in which we declined to find a
    local Georgia school district entitled to federal immunity under Manders. In
    assessing the second Manders factor, we found that control of the school district
    was locally oriented because it was “subject to the . . . management of county
    boards of education,” which were, in turn, composed of locally elected county
    residents. 
    Lightfoot, 771 F.3d at 771
    (internal quotation marks omitted). We
    acknowledged that the State of Georgia crafted certain aspects of the school
    board’s operations by setting school-board regulations, specifying the manner in
    which board members would be elected, and setting employee evaluation
    standards, but we ultimately concluded that “[e]stablishing minimum
    requirements” for the operation of the school district was “not sufficient to
    demonstrate [state] control.” 
    Id. at 773.
    Our analysis in Pellitteri v. Prine, 
    776 F.3d 777
    (11th Cir. 2015), presents a
    useful contrast. In that case, we considered the immunity of a local Georgia
    sheriff’s office in the exercise of employment procedures. We concluded that the
    second Manders factor weighed in favor of immunity, highlighting several crucial
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    limitations on the sheriff’s autonomy in personnel management: the State strictly
    regulated the sheriff’s power to hire deputies and peace officers by requiring State-
    administered background checks, physical and mental examinations, and an
    entrance examination for all candidates; the State retained the power to
    “functionally terminate” deputy sheriffs through disciplinary measures without the
    sheriff’s consent; and the Governor of Georgia held ultimate authority to discipline
    or suspend the sheriff himself for incidents of misconduct. 
    Id. at 781–82.
    See also
    Stanley v. Broward Cty. Sheriff, 
    2016 WL 7229745
    (11th Cir. Dec. 14, 2016)
    (noting that, while the State was empowered to remove local sheriff for
    misconduct, the State had no control over the appointment or removal of deputies
    hired by the sheriff; this fact weighed against finding state control); 
    Lake, 840 F.3d at 1343
    (following Pellitteri to conclude that State’s direct involvement in sheriff
    training and discipline evidenced state control). The State of Georgia retains no
    such control over CSB personnel decisions, is powerless to remove the Executive
    Director or Board members, and does not limit the Governing Board’s discretion to
    manage personnel matters in the service of local concerns. Cf. 
    Pellitteri, 743 F.3d at 782
    (noting that the sheriff was primarily accountable to the State—rather than
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    to local authorities—in discharging his duties, and citing this fact as further
    evidence of substantial state control).
    We find our analysis in Lightfoot persuasive in this case, especially as
    contrasted with our conclusion in Pellitteri. 4 The existence of state guidelines
    regarding the appointment of CSB Governing Boards and state standards for the
    provision of CSB services is not sufficient to demonstrate substantial state control
    over Advantage in this case, especially in light of the significant autonomy state
    law grants to locally appointed Governing Boards. Advantage has not met its
    burden of demonstrating that the DBHDD’s limited, high-level involvement in the
    structure and function of CSBs justifies a finding that Advantage is an arm of the
    State. Thus, we concur with the district court that the second Manders factor
    weighs against Eleventh Amendment immunity.
    4
    Advantage urges that any reference to our reasoning in Lightfoot would be misplaced in this
    case. To advance this argument, Advantage lists the various ways in which CSBs are unlike
    state school districts, implicitly asking us to make the following deduction: Because school
    districts are not arms of the State, and because CSBs are unlike school districts, it follows that
    CSBs must be arms of the State. There are, indeed, many distinctions to be drawn between
    Georgia-state school districts and CSBs—but there are useful similarities to consider as well.
    We decline to ratify Advantage’s faulty reasoning, and we therefore consider Lightfoot and other
    Circuit opinions wherever they illuminate the proper application of the Manders factors in this
    case.
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    C.     Source of Defendant’s Funding
    We next ask where the defendant derives its funding. In answering this
    question, we focus primarily on the quantum of funding the State provides to the
    defendant entity. See Stanley, 
    2016 WL 7229745
    , at *8 (citing Abusaid v.
    Hillsborough Cty. Bd. of Cty. Comm’rs, 
    405 F.3d 1298
    , 1311 (11th Cir. 2005)).
    Where relevant, we may also consider the level of control the State exercises over
    the entity’s funding structure, budget, and overall financial autonomy. See, e.g.,
    
    Pellitteri, 776 F.3d at 782
    –83 (finding that, although sheriff’s office was funded
    primarily by the county rather than the State, the third Manders factor weighed in
    favor of immunity because the State dictated the office’s funding structure);
    Williams v. Dist. Bd. of Trs. of Edison Cmty. Coll., Fla., 
    421 F.3d 1190
    , 1194 (11th
    Cir. 2005) (noting in analysis of third Manders factor that “state approval of
    institutional budgets evidences state control,” which weighed in favor of finding
    immunity); 
    Lightfoot, 771 F.3d at 776
    –77 (concluding that school board’s receipt
    of “significant funding from the State” was not sufficient to tip the balance toward
    immunity on third Manders factor, as the school board itself retained substantial
    local control over its own budget).
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    Advantage asserts that the State funds a substantial portion of its operations,
    but it fails to provide any evidence demonstrating (or even estimating) the actual
    proportion of state to non-state funding on which it relies. This dearth of evidence
    is surprising: Advantage’s argument relies heavily on the proposition that the State
    is its primary funder, and Advantage is, of course, uniquely positioned to prove the
    truth of this assertion. In the absence of such evidence, we also consider the
    State’s involvement in Advantage’s financial operations. We ultimately conclude
    that Advantage has failed to carry its burden of demonstrating that the State
    exercises meaningful control over the source of its funding or the nature of its
    budget.
    In support of its argument that “the state controls the sources of funds to
    CSBs,” Advantage cites to a single provision of Georgia’s enabling statute, under
    which the State forbids CSBs to tax, to issue bonds, and to “financially obligate the
    state.” O.C.G.A. § 37-2-6.1(e). But Advantage neglects several key elements of
    the CSB funding structure that weigh against a finding of immunity. As 
    discussed supra
    , CSBs like Advantage are managed locally by Governing Boards, whose
    members are appointed by county authorities. O.C.G.A. § 37-2-6(b). Each CSB’s
    Governing Board chooses whether to contract with the DBHDD or other state
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    departments to provide health services. O.C.G.A. § 37-2-6(a). The State does not
    mandate that CSBs contract with it, nor does it require them to contract with
    parallel local or federal healthcare programs.
    The Governing Board also has authority to cease operations of the CSB
    altogether, O.C.G.A. § 37-2-6.5, or to end its contractual relationship with the State
    by converting the CSB to a private nonprofit, a unit of a local county, or an arm of
    a hospital. O.C.G.A. § 37-2-6.4(a). The State has no authority to approve or reject
    such changes. And as Advantage has made clear, its state funding is service-
    based—that is, Advantage receives no funding from the State if it does not contract
    with the State and bill its services to the State under the terms of that contract.
    Upon review of this statutory framework, is clear to us that the Governing
    Board holds unfettered discretion to design its own funding mix. It can, for
    example, choose to rely primarily on state funds, to contract only with private
    organizations, or to diversify its funding sources by contracting with private or
    local organizations in addition to the State. This level of autonomy precludes the
    State from dictating Advantage’s funding portfolio and limits the State’s control
    over Advantage’s financial decision-making.
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    Furthermore, Governing Boards enjoy broad autonomy to allocate funds on
    personnel matters. The Board of each CSB is entitled to review and approve the
    CSB’s annual budget, which “shall provide for securing . . . professionals
    necessary for the provision of disability and health services.” O.C.G.A. 37-2-
    6.1(b)(2); O.C.G.A. 37-2-6.1(a). The Board is further empowered to determine
    when and how to provide employment benefits, O.C.G.A. § 37-2-6.1(b)(7); to fix
    employee compensation, O.C.G.A. § 37-2-6.1(b)(9); and to raise revenues to
    support daily operations. O.C.G.A. § 37-2-6.1(f)(2). The only personnel-related
    matter the State is entitled to oversee relates to the employment of the CSB’s
    Executive Director, who exercises daily managerial authority as delegated by the
    Governing Board. O.C.G.A. § 37-2-6.1(a)(1) (permitting commissioner of
    DBHDD to review and approve Governing Board’s offer of employment to
    Executive Director and any substantial alterations to terms of compensation but
    omitting to empower commissioner to remove Director at his discretion).
    The fact that the Governing Board, not the State, exercises primary control
    over Advantage’s financial decision-making—especially in the arena of personnel
    management—weighs against immunity. Cf., e.g., Ross v. Jefferson Cty. Dep’t. of
    Health, 
    701 F.3d 655
    , 660 (11th Cir. 2012) (finding the fact that health department
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    was funded by county insufficient to “‘tip the balance’ against immunity” because
    there was no evidence that county exerted control over the department); 
    Manders, 338 F.3d at 1323
    (finding that relevant funding of sheriff’s office was derived from
    the State, even though county bore “the major [funding] burden,” because State
    mandated the source of funding, set sheriff’s compensation, and limited county’s
    autonomy over sheriff’s spending decisions).
    D.     Liability for Judgments against Defendant
    Under the final Manders factor, we consider “whether the State would bear
    ultimate responsibility for an adverse judgment” against the defendant entity.
    
    Lightfoot, 771 F.3d at 777
    . Georgia law speaks directly to this factor, establishing
    that “the liabilities, debts, and obligations of a community service board shall not
    constitute liabilities, debts, or obligations of the state or any county or municipal
    corporation and neither the state nor any county or municipal corporation shall be
    liable for any liability, debt, or obligation of a community service board.”
    O.C.G.A. § 37-2-6(a). The United States Supreme Court does not require “an
    actual drain on the state treasury as a per se condition of Eleventh Amendment
    immunity,” Manders v. Lee, 
    338 F.3d 1304
    , 1327 (11th Cir. 2003), but the
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    statutory limitation of state liability for any judgment against Advantage weighs
    strongly against finding it an arm of the State.
    Advantage acknowledges this statutory limitation but argues that the
    Georgia state treasury would be meaningfully and unavoidably impacted in the
    event of an adverse judgment against Advantage. We disagree.
    In support of this argument, Advantage attempts to analogize itself to the
    sheriff’s office at issue in Manders and the public water utility we considered in
    U.S. ex rel. Lesinski v. South Fla. Water Mgmt. Dist., 
    739 F.3d 598
    (11th Cir.
    2014). In both cases, we found the state treasury indirectly implicated in the
    defendant entity’s liabilities, which cut in favor of immunity. But both cases are
    distinguishable. In Manders, we concluded that the local sheriff’s office was
    subject to direct state control, was financially dependent on the State, and would
    have been unable shrink its law-enforcement budget in the event of an adverse
    
    judgment. 338 F.3d at 1328
    . By contrast, we find Advantage independent from
    state control and financially self-sufficient, especially in light of its ability to
    contract freely and raise its own revenue. See O.C.G.A. § 37-2-6(a); O.C.G.A.
    § 37-2-6.1(f)(2). And in Lesinski, we explained that, if judgment creditors
    “deplete[d] the [water district’s] funds, . . . the State would ultimately have to
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    choose between increasing its appropriation to make up the shortfall or shirking its
    constitutionally mandated duty to ‘conserve and protect [the State’s] natural
    resources and scenic 
    beauty.’” 739 F.3d at 605
    . Advantage concedes that the State
    of Georgia is under no constitutional duty to provide mental health, developmental
    disability, or addictive disease services. Our reasoning in Lesinski is, therefore,
    inapposite.
    Most significantly, Advantage has failed to present evidence that the State of
    Georgia would be obligated or incentivized to prop up Advantage in the event of
    its financial distress or insolvency. Advantage asserts that “CSBs are formed with
    geographical limitations” set by the State and that, as a result, “[t]here is no legal
    basis for the state to simply choose to work with another CSB” in a given region if
    the preexisting CSB were forced to liquidate. This assertion is not supported by
    Georgia law, which expressly provides that the State may alter and merge the
    boundaries of each CSB’s service area as it deems necessary. O.C.G.A. § 37-2-
    3(a)–(b). And Advantage provides no evidence that the State could not contract
    with a private provider if Advantage ceased its operations and neighboring CSBs
    were unable to absorb its patient base. To be sure, such a service transition would
    not be costless for the State. But it is not the case—as it was in Manders and
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    Lesinski—that a judgment against Advantage would require the State to make the
    difficult choice between footing Advantage’s bill and leaving vulnerable citizens
    without needed care.
    We concur with the district court that Advantage has not carried its burden
    of showing that the state treasury is meaningfully implicated in Advantage’s legal
    liabilities. The final Manders factor weighs decisively against finding Advantage
    an arm of the State for federal immunity purposes.
    II.   Waiver of Eleventh Amendment Immunity
    Because we find that Advantage is not entitled to Eleventh Amendment
    immunity on the evidence presented, we need not consider whether Advantage
    waived its right to assert this defense by failing to move for dismissal in a timely
    manner. In so concluding, we echo the district court’s observation that “[t]he test
    to determine [whether] a state has waived its sovereign immunity ‘is a stringent
    one.’” Barnes v. Zaccari, 
    669 F.3d 1295
    , 1308 (11th Cir. 2012) (quoting Coll.
    Sav. Bank v. Fla. Prepaid Postsecondary Educ. Expense Bd., 
    527 U.S. 666
    , 675
    (1999)).
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    CONCLUSION
    We conclude that three of the four Manders factors weigh strongly against
    finding that Advantage acted as an “arm of the State” for purposes of Eleventh
    Amendment immunity with respect to Miller’s termination. Under this Court’s
    precedent, Advantage has therefore failed to meet its burden of proving its
    entitlement to immunity from Miller’s suit. The district court’s denial of
    Advantage’s motion to dismiss is AFFIRMED.
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