794 F. Supp. 2d 892
S.D. Ind.2011Background
- HEA 1210 (May 10, 2011) defunds abortion providers from state funding for non-abortion health services and tightens informed consent; implementation dates: defunding immediate, informed consent July 1, 2011.
- PPIN is Indiana-based provider with Medicaid and federal grants; PPIN’s Medicaid provider agreement funds STD testing, cervical smears, contraception, etc.
- PPIN’s DIS grants (federal) support STD intervention; HEA 1210's defunding cuts these funds, and PPIN ceases DIS services and stops taking new Medicaid patients.
- Plaintiffs allege the defunding provision violates Medicaid freedom of choice and is preempted by federal law, plus challenged two subsections of the informed consent provision as compelled speech.
- The court grants partial preliminary injunction: defunding provision enjoined; §16-34-2-1.1(a)(1)(E) denied; §16-34-2-1.1(a)(1)(G) enjoined as applied to first-trimester abortions; no bond ordered.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does defunding violate Medicaid freedom of choice and preemption? | PPIN argues it limits choice of qualified providers and conflicts with federal law. | Commissioner contends states may exclude providers for reasons within state law and that HHS approval governs eligibility. | Yes on both: likelihood of success on freedom of choice and DIS preemption. |
| Are the challenged provisions of the informed consent statute permissible compelled speech? | E and G statements violate practitioners’ First Amendment rights. | Statute aims to ensure informed decision and is constitutionally permissible when truthful and relevant. | E denied; G enjoined as applied to first-trimester abortions. |
| Is HHS CMS deference appropriate in reviewing the Medicaid plan amendment denial? | Deference should support PPIN’s challenge to disapproval. | CMS letter is non-final but persuasive; deference may apply. | Some deference owed; CMS denial supports likelihood of success on merits. |
| Does DIS funding preemption support injunctive relief beyond Medicaid dollars? | Federal DIS funds cannot be conditioned by state law that excludes providers. | State may impose eligibility constraints; spending clause preemption uncertain. | Plaintiffs have reasonable likelihood of success on preemption regarding DIS funds. |
Key Cases Cited
- Blessing v. Freestone, 520 U.S. 329 (U.S. 1997) (establishes Blessing framework for enforceable rights under §1983)
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (U.S. 1980) (right to choice limited by provider qualification; not absolute)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (confirms private right under freedom-of-choice provision and deference considerations)
- Bay Ridge Diagnostic Lab., Inc. v. Dumpson, 400 F. Supp. 1104 (E.D.N.Y. 1975) (freedom of choice protects access to qualified providers; not limited to existing facilities)
- Bruggeman ex rel. Bruggeman v. Blagojevich, 324 F.3d 906 (7th Cir. 2003) (limits of freedom-of-choice in Medicaid context; not create new facilities)