882 F.3d 1205
10th Cir.2018Background
- Kansas issued notices (May 3, 2016) terminating Medicaid provider status for two Planned Parenthood affiliates (PPGP/PPKM and PPSLR), citing waste-inspection cooperation, billing practices, and edited videos implicating the national organization (PPFA).
- Three Medicaid patients (Jane Does) and the Providers sued KDHE Secretary Mosier under 42 U.S.C. § 1983, claiming violation of Medicaid’s free-choice-of-provider clause (42 U.S.C. § 1396a(a)(23)) and the Fourteenth Amendment; they sought a preliminary injunction to block termination.
- Kansas’s termination letters stated an effective date (initially May 10, extended in litigation), and regulations allowed but did not require administrative appeals; the Providers declined to pursue (further) administrative remedies and sued in federal court.
- The district court granted a preliminary injunction enjoining termination; Kansas appealed. The Tenth Circuit reviewed justiciability (standing, ripeness, Younger abstention), whether § 1396a(a)(23) creates a private right enforceable via § 1983, and preliminary-injunction factors.
- The Tenth Circuit affirmed the injunction as to PPGP (finding Patients have a § 1983 cause of action under § 1396a(a)(23) and are likely to succeed on the merits) but vacated the injunction as to PPSLR for lack of the Patients’ standing and remanded to determine whether PPSLR itself has standing.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing (Patients) | Patients face imminent loss of chosen qualified provider; termination letters were final and created a substantial risk of injury giving Article III standing | Termination was not final pending administrative appeal and contractual timing; injuries speculative and caused by Plaintiffs’ failure to exhaust remedies | Patients have standing re: PPGP (injury imminent and traceable); no standing shown re: PPSLR (no Plaintiff alleged use of that affiliate) |
| Ripeness / Younger abstention | Final termination letters produced concrete injury and primarily legal issues; no ongoing coercive state proceeding requiring abstention | Plaintiffs should exhaust administrative remedies; administrative process ongoing so case not ripe and Younger abstention appropriate | Claim ripe; Younger abstention inapplicable because no ongoing coercive state enforcement proceeding and Patients have no administrative remedy |
| Private right under § 1396a(a)(23) | Free-choice-of-provider language unambiguously confers individual right enforceable under § 1983; statutory terms are concrete (qualified and willing) | Spending-Clause/Armstrong reasoning argues against a private § 1983 remedy for Medicaid claims; congressional enforcement scheme suffices | § 1396a(a)(23) provides a private right enforceable via § 1983 for Medicaid beneficiaries (joining four circuits) |
| Merits of termination (PPGP) | Kansas’s bases (hindering solid-waste inspection; affiliation with PPFA re: fetal tissue videos; billing allegations elsewhere) do not demonstrate the Providers are unqualified to provide medical services | State may exclude providers for reasons bearing on professional competence, performance, or integrity and may rely on investigations/affiliation and billing concerns | Plaintiffs likely to succeed: evidence does not show PPGP unqualified; inspections produced no violations, affiliation insufficient to attribute PPFA misconduct, and fraud allegations against other affiliates don’t justify termination |
Key Cases Cited
- Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (statutory rights enforceable under § 1983 exist only when Congress unambiguously conferred them)
- Blessing v. Freestone, 520 U.S. 329 (1997) (three-part test for determining whether statutory provisions create enforceable rights under § 1983)
- Wilder v. Va. Hosp. Ass'n, 496 U.S. 498 (1990) (Medicaid enforcement scheme not so comprehensive as to preclude § 1983 remedies)
- Armstrong v. Exceptional Child Ctr., Inc., 135 S. Ct. 1378 (2015) (Spending-Clause context and private enforcement; distinguished on facts)
- Winter v. Nat. Res. Def. Council, 555 U.S. 7 (2008) (four-factor preliminary injunction standard)
- Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017) (free-choice-of-provider confers enforceable right; persuasive precedent)
- Planned Parenthood of Ind., Inc. v. Comm'r of Ind. State Dep't of Health, 699 F.3d 962 (7th Cir. 2012) (same)
- Planned Parenthood of Ariz. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (same)
- Harris v. Olszewski, 442 F.3d 456 (6th Cir. 2006) (same)