A Planned Parenthood Reproductive Health Services Center in St Louis (Michael B. Thomas/Getty Images).
The Missouri Supreme Court on Wednesday heard arguments over whether the state’s move to block Planned Parenthood from receiving Medicaid reimbursements was constitutional — the second time in three years the issue has reached the state’s highest court.
After the state legislature voted to block Planned Parenthood from receiving Medicaid reimbursements last year, the organization sued. In December, Cole County Circuit Judge Jon Beetem concluded the state couldn’t deny access to funds available to other health care providers.
The attorney general’s office appealed on behalf of the Department of Social Services, which oversees Missouri’s Medicaid program, arguing the “entire purpose of the appropriations process is to prioritize funds.”
“I can’t stress this enough,” said Joshua Divine, solicitor general in the attorney general’s office. “A ruling for Planned Parenthood on the constitutional issue would create catastrophic aftershocks that would wreck the appropriation process that has been used for decades.”
Planned Parenthood argued that the appropriations bill conflicts with statute, so the state would only be constitutionally permitted to zero out the funding if they changed the statute.
“The $0 appropriation is an appropriation bill that changes the substantive law to deny an eligible provider with a contract access to Medicaid funding,” said attorney Chuck Hatfield, representing Planned Parenthood, “and that you cannot do.”
In a similar case in 2020, the Supreme Court struck down language in a budget bill that excluded abortion providers or their affiliates from receiving Medicaid reimbursements, calling it a “naked attempt” to legislate through a budget bill.
“Here we go again,” Hatfield said, “with a long line of cases where this court has met its responsibility…to advise the legislature on the limits of its authority when it comes to appropriation.”
Debate over proper procedure to restrict funds
Last year’s appropriations bill included a line to spend $0 for Medicaid-covered services if the provider also offers abortions or is affiliated with an abortion provider. That blocked reimbursements to Planned Parenthood for reproductive health services including STI screenings, cancer screenings and contraceptives. The state’s Medicaid program has long banned funding for abortion, with limited exceptions, and since last year’s U.S. Supreme Court decision overturning the constitutional right to an abortion, abortion is banned in the state.
Medicaid serves low-income and disabled Missourians.
Planned Parenthood and its defenders characterize legislative attempts to restrict the organization’s funding as a broader attack on access to reproductive health care. Anti-abortion advocates contend the state should not use taxpayer dollars to subsidize abortion providers.
In his December ruling, Beetem agreed with Planned Parenthood that efforts to “deny access to funds that are otherwise available to other MO HealthNet providers is ineffective and/or unconstitutional.”
The hearing Wednesday centered on whether Planned Parenthood should have first taken the matter to the Administrative Hearing Commission, as well as whether Planned Parenthood had contractually waived any claim to funding or had the legal ability to sue.
The state argued Planned Parenthood “ran straight to court” when they should have gone to the administrative hearing commission, while Planned Parenthood called those arguments “meritless procedural roadblocks.” The courts were the correct venue because the questions at hand were constitutional, the organization argued.
The judges asked questions about the point of the administrative hearing commission and whether the appropriations were being used to amend substantive law — whether the process the state used to exclude Planned Parenthood was constitutional.
Divine said this case differed from the 2020 case because lawmakers made a “literal front-end appropriation,” which provided zero dollars for Planned Parenthood.
“There has never been any dispute that the legislature can constitutionally restrict Medicaid funds from Planned Parenthood if it wants to do so,” Divine said. “It just has to go through the proper procedures.”
In 2020 the legislature “tacked on this additional language at the end,” after already appropriating the funds, Divine said, but in this case, the two categories of funding for organizations receiving Medicaid funds “simply exclude Planned Parenthood, just like they exclude many other organizations.”
Asked by a judge if any other providers were excluded, Divine said “I don’t think the record makes that clear.”
“…Here the legislature said what we’re excluding from the $60 million pot is abortion providers and their affiliates,” Divine said, “so the Planned Parenthood providers are clearly in that but I think other affiliates, some other organizations that might not be before this court would also be excluded.”
Hatfield said the way to exclude Planned Parenthood from Medicaid reimbursements constitutionally would be for lawmakers to amend the statute and said that’s what the Supreme Court concluded in 2020.
“What you said is if you want to change who an eligible provider is under Medicaid, you must change the statute: You told them very clearly how to do this,” he said, “And by the way, the legislature has the votes, in my view, this is my opinion — if they want to go change the statutes and exclude providers, they can do that. And that’s what you told them very clearly.”
The issue itself has been around for decades: Missouri lawmakers have been attempting to restrict public funds from going to Planned Parenthood since the mid-90s.
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