Planned Parenthood of Gulf Coast, Inc. v. Gee
2017 U.S. App. LEXIS 11904
| 5th Cir. | 2017Background
- Louisiana Department of Health and Hospitals (LDHH) notified Planned Parenthood Gulf Coast (PPGC) it would terminate PPGC’s Medicaid provider agreements after undercover videos and related investigations; PPGC’s two Louisiana clinics do not perform abortions or operate fetal tissue programs.
- PPGC and three Medicaid-enrolled patients sued under 42 U.S.C. § 1983, alleging LDHH’s termination violated Medicaid’s free-choice-of-provider provision (42 U.S.C. § 1396a(a)(23)) and constitutional rights; the district court granted a preliminary injunction blocking termination.
- LDHH rescinded an initial “at-will” termination, then issued new termination letters citing FCA settlements/claims, alleged misrepresentations in PPGC’s responses, and pending investigations; PPGC declined administrative appeals.
- The appeal before the Fifth Circuit addresses only the district court’s interlocutory preliminary injunction (standing, ripeness, likelihood of success on § 1396a(a)(23), and the remaining injunction factors); merits and summary-judgment issues are not before the court.
- The majority held (affirming the preliminary injunction) that: the individual Medicaid patients have standing and ripe claims; § 1396a(a)(23) creates a private right enforceable under § 1983; and LDHH likely sought termination for reasons unrelated to provider “qualifications.”
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing | Individual plaintiffs face imminent loss of access and statutory right under §1396a(a)(23) | No injury yet because terminations were suspended and PPGC could seek administrative remedies | Standing: plaintiffs have threatened, imminent injury and need not await loss of benefits; standing affirmed |
| Ripeness | Claims present pure legal questions about whether LDHH may terminate for reasons unrelated to qualifications | Not fit for review; administrative process and factual development remain | Ripeness: claims ripe because legal issues are clean and injury likely; ripeness affirmed |
| Private right of action under §1396a(a)(23) | §1396a(a)(23) confers an individual right to choose qualified providers and is enforceable via §1983 | Rely on O’Bannon/Armstrong to argue beneficiaries cannot challenge states’ qualification determinations | Held: §1396a(a)(23) creates a private right enforceable under §1983 (joining Sixth, Seventh, Ninth Circuits) |
| Likelihood of success on §1396a(a)(23) and PI factors | LDHH terminated PPGC for reasons unrelated to competence (political values, FCA settlement, investigations), so violates free-choice-of-provider; plaintiffs would suffer irreparable harm, balance and public interest favor injunction | LDHH may exclude providers for state-law reasons, investigations, FCA issues; harms to Medicaid administration and fiscal interests outweigh plaintiffs’ inconvenience | Held: plaintiffs substantially likely to succeed because LDHH’s stated grounds do not relate to provider qualifications or to §1396a(p); irreparable harm found; balance and public interest favor injunction; preliminary injunction affirmed |
Key Cases Cited
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (1980) (Medicaid free-choice provision protects choice among qualified providers but does not give patients a right to be cared for in a provider the State has determined unqualified)
- Planned Parenthood of Ariz., Inc. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (state laws excluding otherwise-qualified providers for reasons unrelated to medical qualifications violate §1396a(a)(23))
- Planned Parenthood of Ind., Inc. v. Comm’r of Ind. State Dep’t of Health, 699 F.3d 962 (7th Cir. 2012) (same: §1396a(a)(23) creates individual enforceable rights against exclusion for non-qualification reasons)
- Armstrong v. Exceptional Child Ctr., Inc., 135 S. Ct. 1378 (2015) (plurality) (some Medicaid statutory provisions do not create private rights enforceable under §1983; provides analytical framework for rights-creation analysis)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (interpreting §1396a(a)(23) and recognizing situations in which beneficiaries may sue to vindicate provider-choice rights)