Opinion No.
Background
- This opinion examines the constitutionality of Texas Human Resources Code section 32.0248(h), which restricts HHSC contracts with entities that affiliate with abortion providers in the Medicaid demonstration project.
- Section 32.0248(a) directs HHSC to establish a Medicaid demonstration project to expand preventive health and family planning services for women under Title XIX.
- Section 32.0248(h) prohibits funds from being used to perform or promote elective abortions and bars contracting with entities that have affiliates performing or promoting abortions.
- HHSC reportedly has not fully complied with subsection (h); the executive commissioner indicated legal barriers to fully implementing the affiliate prohibition.
- The executive staff cited Planned Parenthood of Houston v. Sanchez to argue that the restrictions could exceed federal Medicaid rules and violate the Supremacy Clause, prompting this AG opinion.
- The opinion analyzes whether 32.0248(h) is preempted by federal Medicaid law (Title XIX) and concludes it is not preempted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is 32.0248(h) preempted by federal Medicaid law? | Hodges/Houston: Sanchez-like reasoning shows preemption under Title XIX. | Abbott: 42 U.S.C. 1396a(p)(1) allows states to exclude entities for state-law reasons; not preempted. | Not preempted by federal Medicaid law. |
| Do other constitutional provisions render 32.0248(h) invalid? | Plaintiffs may raise First Amendment and related challenges. | The opinion notes other constitutional issues may be fact-dependent and are not resolved here. | Not addressed in this opinion. |
Key Cases Cited
- Planned Parenthood of Houston & Southeast Tex., v. Sanchez, 403 F.3d 324 (5th Cir. 2005) (preemption analysis under Title X rider; not controlling for Medicaid)
- First Medical Health Plan, Inc. v. Vega-Ramos, 479 F.3d 46 (1st Cir. 2007) (state may exclude entities from Medicaid for reasons allowed by state law)