Planned Parenthood Arizona Inc v. Tom Betlach
727 F.3d 960
9th Cir.2013Background
- Arizona enacted HB 2800 (Ariz. Rev. Stat. § 35-196.05(B)), barring state or local contracts/grants for family-planning services with persons or facilities that perform non‑federally funded elective abortions (i.e., abortions not covered by Hyde exceptions).
- Planned Parenthood of Arizona (13 clinics, five performing abortions) and individual Medicaid patients/providers sued, alleging HB 2800 violates the Medicaid Act free‑choice‑of‑provider requirement (42 U.S.C. § 1396a(a)(23)).
- AHCCCS sent provider letters threatening termination of Medicaid provider agreements unless providers attested they would not perform non‑federally funded abortions; Planned Parenthood refused and obtained a preliminary injunction.
- The district court granted summary judgment for Planned Parenthood, holding HB 2800 violates the Medicaid Act and permanently enjoined enforcement; Arizona appealed.
- The Ninth Circuit consolidated appeals, dismissed the preliminary‑injunction appeal as moot, and affirmed the district court.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 1396a(a)(23) creates an individual § 1983 cause of action | §1396a(a)(23) confers an individual right to choose any qualified provider and is enforceable under §1983 | Arizona argued the provision fails Blessing/Gonzaga tests (too vague) and thus not enforceable under §1983 | Court: §1396a(a)(23) satisfies Blessing/Gonzaga (rights‑creating, mandatory, concrete); §1983 remedy available; affirmed other circuits’ positions |
| Proper meaning of "qualified" and scope of free‑choice‑of‑provider | "Qualified" means competent to perform the medical service (professional fitness); states cannot define "qualified" to exclude classes of legally competent providers | Arizona argued states may define qualifications for Medicaid participation (including excluding abortion‑performing providers) and cited savings/exclusion language | Court: "Qualified to perform the service required" is tethered to provider competence to perform the medical service; Arizona may not exclude providers for reasons unrelated to medical fitness or misconduct |
| Whether HB 2800 fits any statutory exceptions/waivers in Medicaid Act | HB 2800 does not fall within exceptions; it categorically excludes a class of providers based on scope of services rather than misconduct | Arizona relied on §1396a(p)(1) savings clause, other precedents, and waiver/managed‑care authorities to justify exclusions | Court: Statutory waivers and exclusion authorities do not authorize categorical exclusions for lawful scope‑of‑practice reasons; HB 2800 violates §1396a(a)(23) as applied to Medicaid reimbursement |
| Constitutional/sovereignty defenses (Tenth Amendment, state police powers, incidental burden argument) | Plaintiffs: Funding condition excluding otherwise qualified providers violates Medicaid Act; Tenth Amendment does not permit contravening federal statute | Arizona: HB 2800 regulates state spending/policy and is within police/state sovereignty; any burden is incidental; many other Medicaid providers remain | Court: Tenth Amendment/police powers not implicated in a way that permits contravening the Medicaid Act; incidental availability of other providers does not cure the statutory violation |
Key Cases Cited
- Planned Parenthood of Ind. v. Comm’r of the Ind. State Dep’t of Health, 699 F.3d 962 (7th Cir. 2012) (construing free‑choice‑of‑provider and holding similar state law unlawful)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (recognizing §1396a(a)(23) rights enforceable by recipients)
- Blessing v. Freestone, 520 U.S. 329 (1997) (three‑part test for §1983 enforceability of federal statutory provisions)
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (standards for identifying rights‑creating statutory language enforceable under §1983)
- Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837 (1984) (agency deference where statute ambiguous)
- Nat’l Fed’n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012) (background on Medicaid as cooperative federal‑state program)