Planned Parenthood of AR, etc. v. Cindy Gillespie
867 F.3d 1034
8th Cir.2017Background
- Planned Parenthood of Arkansas and Eastern Oklahoma (Planned Parenthood) had Medicaid provider contracts with Arkansas DHS; Arkansas ordered termination after controversial videos about other affiliates surfaced.
- DHS notified Planned Parenthood of termination and the provider’s right to administrative appeal; Planned Parenthood declined to pursue state administrative or judicial review.
- Three Medicaid patients (Jane Does) sued DHS Director under 42 U.S.C. § 1983, claiming § 1396a(a)(23)(A) (the Medicaid "free-choice-of-provider" provision) creates an individual right to obtain services from any "qualified" provider.
- The district court issued a temporary restraining order and then a preliminary injunction preventing DHS from suspending Medicaid payments to Planned Parenthood for the named plaintiffs and later for a certified class.
- The Eighth Circuit consolidated appeals and vacated the injunctions, holding plaintiffs lacked a likelihood of success because § 1396a(a)(23)(A) does not unambiguously create a § 1983–enforceable individual right.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 1396a(a)(23)(A) unambiguously creates an individual right enforceable under § 1983 | § 23(A) uses mandatory, beneficiary-focused language giving Medicaid recipients a right to choose any "qualified" provider; thus § 1983 relief is available | The provision is directed to the Secretary and the state-plan approval process, not an individual entitlement; Congress provided alternate enforcement (funds withholding, administrative appeals), so no unambiguous private right exists | No: the court held § 23(A) does not unambiguously confer a § 1983–enforceable individual right and vacated the injunctions |
| Whether O’Bannon (right to range of qualified providers vs right to a particular provider) bars relief | Plaintiffs: they are entitled to obtain care from a qualified provider of their choice (including Planned Parenthood) | DHS: even if § 23(A) creates a right, it is to a range of qualified providers, not to continued care from a provider the State decertified | Concurrence: agreeing with reversal, held § 23(A) (as interpreted in O’Bannon) protects choice among qualified providers but not a right to a particular provider once decertified |
| Whether the Medicaid statutory/regulatory scheme and "substantial compliance" funding regime preclude private § 1983 enforcement | Plaintiffs: alternative enforcement mechanisms do not automatically preclude § 1983 when the statutory language unambiguously confers individual rights | DHS: presence of administrative appeals, Secretary’s withholding power, and the statute’s aggregate/substantial-compliance focus indicate Congress did not intend private § 1983 enforcement | Majority: the availability of alternative enforcement mechanisms and the aggregate focus undermine any inference of an unambiguous private right |
| Whether preliminary injunction was proper (likelihood of success / irreparable harm) | Plaintiffs: likely to succeed on merits and would suffer irreparable harm without injunction | DHS: plaintiffs cannot show likelihood of success because no § 1983 right; alternative providers available for irreparable-harm analysis | Held: plaintiffs lacked likelihood of success on the § 1983 claim, so injunctions were not justified (court did not decide irreparable harm in detail) |
Key Cases Cited
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (§ 1983 requires an unambiguously conferred individual right)
- Armstrong v. Exceptional Child Ctr., Inc., 575 U.S. 320 (2015) (spending-statute rights analysis; statutes phrased as directives to agencies do not necessarily create individual rights)
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (1980) (Medicaid § 23(A) gives right to choose among a range of qualified providers, not a right to continued care from a decertified provider)
- Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1 (1981) (remedies for spending-condition noncompliance are typically enforcement by the Federal Government)
- Blessing v. Freestone, 520 U.S. 329 (1997) (multi-factor test for when federal spending statutes create enforceable rights)
- Suter v. Artist M., 503 U.S. 347 (1992) (consideration of alternative enforcement mechanisms and notice to states in spending-program rights analysis)
- Wilder v. Virginia Hosp. Ass’n, 496 U.S. 498 (1990) (earlier case recognizing enforceability of certain Medicaid provisions; later decisions limited its scope)