326 F. Supp. 3d 39
D.S.C.2018Background
- Plaintiffs: Planned Parenthood South Atlantic (PPSAT) and Medicaid beneficiary Julie Edwards challenge SCDHHS's immediate termination of PPSAT's Medicaid enrollment following South Carolina Executive Order directing exclusion of providers affiliated with abortion clinics.
- PPSAT operates Charleston and Columbia clinics and provides family planning and reproductive health services; abortions are performed but generally not paid by Medicaid.
- Edwards contends 42 U.S.C. § 1396a(a)(23)(A) guarantees Medicaid beneficiaries the right to obtain covered services from any qualified and willing provider (including PPSAT); she seeks injunctive relief to enjoin the termination.
- Defendant argued § 1396a(a)(23)(A) does not create a private right enforceable under § 1983, that state law and § 1396a(p)(1) permit exclusion, and that Edwards failed to exhaust administrative remedies.
- The district court granted a preliminary injunction restoring PPSAT's Medicaid enrollment during litigation, concluding Edwards likely succeeds on the Medicaid Act claim and satisfies the other Winter factors.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 1396a(a)(23)(A) creates a private right enforceable via § 1983 | §1396a(a)(23)(A) unambiguously confers an individual right to choose any qualified provider; thus private enforcement via §1983 is available | Statute protects aggregate plan interests; Congress intended funding-based enforcement; Does supports no private right | Court held §1396a(a)(23)(A) confers a private right enforceable under §1983 (agreeing with Fifth, Sixth, Seventh, Ninth, Tenth Circuits) |
| Whether Edwards had to exhaust state administrative remedies before suing | No exhaustion required for §1983 suits; state materials say a beneficiary "can" appeal, not must; administrative appeal would be futile given executive directive | Medicaid application and handbook provide an administrative appeal process that should be used first | Court held exhaustion not required; even if required, futility exception applies due to Governor's order directing termination |
| Whether terminating PPSAT violated §1396a(a)(23)(A) (meaning of "qualified") | "Qualified" means able to perform the required medical services competently and safely; PPSAT is qualified and termination was based on abortion provision outside Medicaid, not competence | State may exclude providers under §1396a(p)(1) and state law forbids use of state family-planning funds for abortions; exclusion is permissible | Court held PPSAT is professionally qualified to provide family planning services and termination based on non-Medicaid abortion activity violated §1396a(a)(23)(A) |
| Whether preliminary-injunction factors favor relief (irreparable harm, equities, public interest) | Edwards faces irreparable harm by losing the statutory right to her chosen qualified provider and reduced access; equities/public interest favor preserving access | State would be harmed by being forced to subsidize abortions and can direct beneficiaries elsewhere | Court found irreparable harm, that equities and public interest favor Plaintiffs, and issued a preliminary injunction restoring PPSAT's Medicaid enrollment pending litigation |
Key Cases Cited
- Gonzaga Univ. v. Doe, 536 U.S. 273 (statutory right must be unambiguously conferred to support §1983 enforcement)
- O'Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (procedural-due-process context for termination of a Medicaid provider)
- Shalala v. Ill. Council on Long Term Care, Inc., 529 U.S. 1 (futility exception to exhaustion)
- Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7 (preliminary injunction standard)
- Patsy v. Board of Regents of State of Fla., 457 U.S. 496 (no general administrative-exhaustion requirement for §1983 suits)
- Planned Parenthood of Kan. v. Andersen, 882 F.3d 1205 (10th Cir.) (holding §1396a(a)(23) creates private right)
- Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir.) (same)
- Planned Parenthood Ariz., Inc. v. Betlach, 727 F.3d 960 (9th Cir.) (same)
- Planned Parenthood of Ind., Inc. v. Comm’r, 699 F.3d 962 (7th Cir.) (same)
- Does v. Gillespie, 867 F.3d 1034 (8th Cir.) (holding no private right under §1396a(a)(23)(A))
- Harris v. Olszewski, 442 F.3d 456 (6th Cir.) (recognizing §1396a(a)(23)(A) private right)