Late yesterday, a Federal Judge in Indianapolis issued an injunction against an Indiana law that blocks Planned Parenthood from received state Medicaid funds:
WASHINGTON — A federal judge ruled Friday that the State of Indiana could not cut off money for Planned Parenthood clinics providing health care to low-income women on Medicaid.
The judge, Tanya Walton Pratt of the Federal District Court in Indianapolis, blocked provisions of a new state law that penalized Planned Parenthood because some of its clinics performed abortions. The law, she said, conflicts with the federal Medicaid statute, which generally allows Medicaid beneficiaries to choose their health care providers.
Planned Parenthood provides services other than abortion, including family planning and screenings for cancer and sexually transmitted diseases.
In issuing a preliminary injunction late Friday, Judge Pratt said the state law “will exact a devastating financial toll on Planned Parenthood of Indiana and hinder its ability to continue serving patients’ general health needs.”
The law took effect immediately when it was signed on May 10 by Gov. Mitch Daniels, a Republican.
As of June 20, the judge said, Planned Parenthood of Indiana stopped treating its Medicaid patients and laid off two of its three specialists in sexually transmitted diseases. The judge said that “only a small percentage” of Planned Parenthood’s services involved abortion.
“States do not have carte blanche to expel otherwise competent Medicaid providers,” Judge Pratt said. And “there are no allegations that Planned Parenthood of Indiana is incompetent or that it provides inappropriate or inadequate care.”
The ruling has national significance. At least a half-dozen states have taken aim at Planned Parenthood because its clinics perform abortions, about one-fourth of all those performed in the United States.
Judge Pratt gave “some measure of deference” to a ruling by the Obama administration, which on June 1 denied approval for the changes that Indiana wanted to make in its Medicaid program.
The federal government could terminate some or all of Indiana’s Medicaid money if the state persisted in violating federal Medicaid law.
“The public interest tilts in favor of granting an injunction,” Judge Pratt declared. “The federal government has threatened partial or total withholding of federal Medicaid dollars to the State of Indiana, which could total well over $5 billion annually and affect nearly one million Hoosiers.”
On it’s surface this sounds like a simple issue of Federal law trumping state law. Federal Medicaid laws prohibit states from discriminating against qualified providers, and there doesn’t seem to be any evidence or allegation that Planned Parenthood is not qualified to provide the non-abortion services that it provides at its clincs. Two excerpts from Judge Pratt’s opinion are instructive:
Central to the present dispute, a state plan must provide that “any individual eligible for medical assistance . . . may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required . . . who undertakes to provide him such services…”. 42 U.S.C. § 1396a(a)(23) (emphasis added) (hereinafter, “‘freedom of choice’ provision”). This “freedom of choice” provision has been interpreted by the Supreme Court as giving Medicaid recipients the right to choose among a range of qualified providers, without government interference. O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773, 785 (1980).
(…)
The actual language of the “freedom of choice” provision supports the view that the defunding provision unlawfully narrows Medicaid recipients’ choice of qualified providers. To reiterate, the “freedom of choice” provision provides that “any individual eligible for medical assistance … may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required … who undertakes to provide him such services.” 42 U.S.C. § 1396a(a)(23) (emphasis added). Further, the regulations clarify that “recipients may obtain services from any qualified Medicaid provider that undertakes to provide the services to them.” 42 C.F.R. § 431.51(a)(1) (emphasis added). If the Commissioner’s interpretation were adopted, it would undoubtedly restrict the rights of Medicaid patients to obtain services from “any qualified Medicaid provider.” This would arguably rob the “freedom of choice” provision of any real meaning. In sum, a strong argument exists that Plaintiffs’ interpretation is superior in terms of giving effect to every word of the “freedom of choice” provision. See Moskal v. U.S., 498 U.S. 103, 109 (1990) (“a court should give effect, if possible, to every clause and word of a statute.”) (citations and internal quotations omitted).
In other words, this decision has nothing to do with abortion per se but with the fact that if Indiana wishes to participate in Medicaid and receive funding from the Federal Government, it must comply with Federal law. Obviously, this isn’t the end of the case. Yesterday’s ruling itself is only an injunction and a final ruling on the merits is months away, after that appeals will inevitably follow. However, this decision is likely to blunt the efforts of other states to follow Indiana’s lead and cut off Medicaid funding to Planned Parenthood.
A copy of the opinion is below:
Planned Parenthood of Indiana v. Indiana Dept. Of Health et al
