Humphreys v. Clinic for Women, Inc.

796 N.E.2d 247, 118 A.L.R. 5th 771, 2003 Ind. LEXIS 795, 2003 WL 22204336
CourtIndiana Supreme Court
DecidedSeptember 24, 2003
Docket49S00-0011-CV-714
StatusPublished
Cited by24 cases

This text of 796 N.E.2d 247 (Humphreys v. Clinic for Women, Inc.) is published on Counsel Stack Legal Research, covering Indiana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humphreys v. Clinic for Women, Inc., 796 N.E.2d 247, 118 A.L.R. 5th 771, 2003 Ind. LEXIS 795, 2003 WL 22204336 (Ind. 2003).

Opinions

SULLIVAN, Justice.

Indiana's Medicaid program will pay for a poor woman to have an abortion but only if necessary to preserve her life or if rape or incest caused her pregnancy. The plaintiffs in this case argue, and the trial court held, that Medicaid must pay for any abortion that is medically necessary, citing the Indiana Constitution's requirement that privileges or immunities cannot be granted to a citizen or class of citizens that do not equally belong to all citizens on the same terms.

For the reasons set forth in this opinion in part I under "Discussion," I believe that this provision of the Indiana Constitution does not require Medicaid to pay for all abortions that are medically necessary. [249]*249Chief Justice Shepard and Justice Dickson join in this part of this opinion.

However, for the reasons set forth in this opinion in part II under "Discussion," I also conclude that, so long as the Indiana Medicaid program pays for abortions to preserve the lives of pregnant women and where rape or incest cause pregnancy, it must also pay for abortions in cases of pregnancies that create for pregnant women serious risk of substantial and irreversible impairment of a major bodily function. Justices Bochm and Rucker join in this part of this opinion.

Background

In 1965, Congress established the Medicaid program, a joint federal-state program that pays for some health care costs of low-income people, by amending Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396v. Under the Medicaid program, the federal government reimburses participating states for the health care services provided pursuant to the state's medical assistance or Medicaid plan. Id. at §§ 1396a(a)(10), 1896d(a). States are not required to participate in the Medicaid program but states that choose to participate must conform their Medicaid program to federal Medicaid law. Id. at § 1896a(a).

In 1978, the Supreme Court held that the Due Process Clause of the Fourteenth Amendment protected, to a certain extent, the freedom of a woman to terminate a pregnancy. Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1978).

In 1976, Congress first adopted legislation, referred to as the "Hyde Amendment" for its author, Representative Henry J. Hyde, that prohibits the federal government from reimbursing states under the Medicaid program for abortions except where a woman would be placed "in danger of death unless an abortion is performed" or where "the pregnancy is the result of an act of rape or incest." Pub.L. No. 106-113, §§ 508-509, 118 Stat. 1501, 1501A-274 (1999). Although the provisions of the Hyde Amendment have varied from time to time, this is the language of the prohibition and exception in effect today.1

[250]*250In 1977, the Supreme Court held that the constitutional right to abortion recognized in Roe v. Wade did not include an entitlement to Medicaid payments that were not medically necessary. Maher v. Roe, 432 U.S. 464, 470, 97 S.Ct. 2376, 53 L.Ed.2d 484 (1977). In 1980, the Supreme Court was faced with a challenge to the constitutionality of the Hyde Amendment, i.e., whether Congress could prohibit the use of federal Medicaid funds to reimburse states for medically necessary abortions. The court held that the Hyde Amendment did not violate either the Due Process or the Equal Protection Clauses of the Fourteenth Amendment. Harris v. McRae, 448 U.S. 297, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980).

Any state that participates in the Medicaid program must cover those abortions for which federal funds are available. Zbaraz v. Quern, 596 F.2d 196, 201 (7th Cir.1979), cert. denied, 448 U.S. 907, 100 S.Ct. 3048, 65 L.Ed.2d 1136 (1980). Nevertheless, "[a] participating state is free, if it so chooses, to include in its Medicaid plan those medically necessary abortions for which federal reimbursement is unavailable ..." Harris, 448 U.S. at 309, 100 S.Ct. 2671.

Indiana participates in the federal Medicaid program and is bound by all of its requirements. Ind.Code § 12-15-1-1. The Indiana Medicaid program provides low-income Hoosier citizens with virtually all non-experimental, medically necessary health care, including some services for which federal reimbursement is not available. See eg., Ind.Code § 12-15-5-1(18) (providing coverage for nonmedical nursing care given in accordance with tenants and practices of a recognized church); cf. 42 C.F.R. § 440.170(b) (restricting federal funding for such institutions to those organized pursuant to Section 501(c)(8) of the Internal Revenue Code). Indiana Medicaid covers inpatient hospital services, physicians' services, and outpatient hospital or clinic services for all recipients and provides a full range of reproductive health care for Medicaid-eligible men. Ind.Code § 12-15-5-1. Covered services must be "medically reasonable and necessary" and are required to be provided to Medicaid recipients in a uniformly equitable manner. Ind.Code § 12-15-1-10. Indiana Medicaid defines a "medically reasonable and necessary service" as one that "meets current professional standards commonly held to be applicable to the case." Ind. Admin. Code tit. 405, r. 5-2-17 (2001). However, in the case of abortion services, the program defines an abortion as necessary (and therefore covered under the program) only if "performed to preserve the life of the pregnant woman or in other cireum-stances if the abortion is required to be covered by Medicaid under federal law," e.g., where the pregnancy was caused by rape or incest. Ind.Code § 12-15-5-1(17);2 Ind.Code § 16-34-1-2;3 Ind. Admin. Code tit. 405, r. 5-28-7.4

[251]*251The plaintiffs in this case, Clinic for Women, Inc., Women's Pavilion, Inc., rich G. Klopfer, D.0., and Martin Haskell, M.D., challenge the constitutionality of these two statutes and this regulation. The plaintiffs contend that the statutes' and regulation's collective prohibition on the use of state Medicaid funds to pay for abortions violates the Equal Privileges and Immunities Clause of Art. I, § 28, as well as Art I, §§ 1 and 12, of the Indiana Constitution.5

After hearing oral argument of the parties, the trial court granted the plaintiff's motion for summary judgment and denied the state's cross-motion for summary judgment, ruling that the challenged statutes and regulation violated Art. I, § 28. The trial court did not address plaintiffs' Art.

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Humphreys v. Clinic for Women, Inc.
796 N.E.2d 247 (Indiana Supreme Court, 2003)

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Bluebook (online)
796 N.E.2d 247, 118 A.L.R. 5th 771, 2003 Ind. LEXIS 795, 2003 WL 22204336, Counsel Stack Legal Research, https://law.counselstack.com/opinion/humphreys-v-clinic-for-women-inc-ind-2003.