Planned Parenthood of Gulf Coast, Inc. v. Gee
837 F.3d 477
5th Cir.2016Background
- Planned Parenthood Gulf Coast (PPGC) operates two Louisiana clinics serving >5,200 Medicaid patients; clinics do not perform abortions or fetal tissue donation.
- After undercover videos by the Center for Medical Progress, Louisiana Department of Health and Hospitals (LDHH) moved to terminate PPGC’s Medicaid provider agreements; initial “at‑will” terminations referenced state values and were rescinded, then replaced with for‑cause termination letters citing fraud/qui tam settlements, alleged misrepresentations, and ongoing investigations.
- PPGC and three individual Medicaid beneficiaries (Doe #1–#3) sued under 42 U.S.C. § 1983, alleging LDHH’s action violated Medicaid’s free‑choice‑of‑provider mandate (42 U.S.C. § 1396a(a)(23)) and constitutional rights; Plaintiffs sought a preliminary injunction blocking termination.
- The district court granted a preliminary injunction as to the Individual Plaintiffs, finding they likely could enforce § 1396a(a)(23) under § 1983; LDHH appealed.
- The Fifth Circuit affirmed: it held plaintiffs had standing and ripe claims, § 1396a(a)(23) confers an individual right enforceable under § 1983, and LDHH’s stated grounds did not relate to provider qualifications such that termination would be lawful.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing | Individual plaintiffs face imminent injury because LDHH has terminated PPGC’s agreements and PPGC will not exhaust administrative appeals; statutory right deprivation suffices. | No injury yet because terminations were suspended and PPGC (not plaintiffs) could pursue administrative remedies; injury speculative. | Plaintiffs have standing: threatened termination is sufficiently imminent and injury is fairly traceable to LDHH; no administrative exhaustion required for §1983 plaintiffs. |
| Ripeness | Questions are purely legal (statute application to asserted grounds) and plaintiffs will suffer hardship if relief withheld. | Claims are unripe pending full administrative/factual development and final agency action; court should await record. | Claims are ripe: issues are fit for judicial decision (legal) and withholding review would impose hardship. |
| Private right of action under §1396a(a)(23) | §1396a(a)(23) confers an individual, judicially administrable entitlement to choose any ‘‘qualified’’ provider; enforceable under §1983. | LDHH relied on cases limiting remedies and argued states retain broad authority to define qualifications; some Supreme Court precedent (Armstrong/O’Bannon) counseled caution. | §1396a(a)(23) creates a §1983‑enforceable private right; provision is rights‑creating and judicially manageable. |
| Merits / Preliminary injunction (violation of §1396a(a)(23)) | LDHH’s stated reasons (qui tam settlements without liability, unspecified misrepresentations, investigations) do not show PPGC is unqualified to provide services and so are not lawful bases to exclude under §1396a(a)(23) or §1396a(p). | State may exclude providers under state law and §1396a(p)(1) and can deem providers unqualified for reasons bearing on program integrity. | Plaintiffs substantially likely to succeed: LDHH’s grounds do not relate to professional competence/qualification, are not authorized by §1396a(p)(1), and in many respects lack statutory or factual support; injunction appropriate. |
Key Cases Cited
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (U.S. 1980) (Medicaid beneficiary has right to choose among qualified providers but no enforceable expectation of benefits to pay for care at an institution determined unqualified)
- Planned Parenthood of Ariz. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (§1396a(a)(23) creates an individual right to choose any qualified provider; states may not exclude providers for reasons unrelated to qualifications)
- Planned Parenthood of Ind., Inc. v. Comm’r, Ind. State Dep’t of Health, 699 F.3d 962 (7th Cir. 2012) (same: free‑choice provision judicially administrable and protects patients against exclusions unrelated to provider fitness)
- Armstrong v. Exceptional Child Ctr., Inc., 135 S. Ct. 1378 (U.S. 2015) (plurality) (discusses limits on implying §1983 remedies where statute lacks rights‑creating language; analyzed for contrast)