Low-Income Women Ex Rel. Prince v. Bost

38 S.W.3d 689, 2000 Tex. App. LEXIS 8155, 2000 WL 1784389
CourtCourt of Appeals of Texas
DecidedDecember 7, 2000
Docket03-98-00209-CV
StatusPublished
Cited by5 cases

This text of 38 S.W.3d 689 (Low-Income Women Ex Rel. Prince v. Bost) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Low-Income Women Ex Rel. Prince v. Bost, 38 S.W.3d 689, 2000 Tex. App. LEXIS 8155, 2000 WL 1784389 (Tex. Ct. App. 2000).

Opinions

BEA ANN SMITH, Justice.

The Low-Income Women of Texas1 filed a lawsuit2 against the State to challenge funding restrictions placed on abortion services provided by the State’s medical programs for low-income Texans. The restrictions prohibit state funding for abortions except in cases of rape or incest or when necessary to save the life of the mother; funding for essentially all other necessary medical procedures is available if the procedure is “medically necessary.” Low-Income Women seek a declaratory judgment that the challenged provisions restricting state funding of medically necessary abortions violate the Texas Constitution. They also request injunctive relief enjoining enforcement of the challenged provisions, as well as costs and attorneys’ fees. Competing motions for summary judgment were filed; the trial court granted the State’s motion and denied Low-Income Women’s motion. Low-Income Women appeal, claiming that the abortion-funding restrictions violate three provisions of the Texas Constitution: (1) the equal protection clause; (2) privacy guarantees; and (3) the Equal Rights Amendment (ERA). We will vacate the judgment [692]*692and dismiss any claim concerning the currently unfunded Maternal and Infant Health Improvement Act (Maternal/Infant Health Act). Because we agree that the Medicaid funding restrictions violate the ERA, we will reverse the judgment of the trial court and render judgment granting Low-Income Women’s motion for summary judgment. We will remand the cause to the trial court solely for consideration of the Low-Income Women’s request for costs and attorneys’ fees.

FACTUAL AND PROCEDURAL BACKGROUND

Statutory Framework

The lawsuit filed by Low-Income Women challenges funding restrictions on two Texas programs that subsidize health services for the poor. At issue are the Texas Medical Assistance Program, which is Texas’s Medicaid program, and the programs 'created by the Maternal/Infant Health Act.

The federal Medicaid program was established in 1965 when Congress enacted Title XIX of the Social Security Act. 42 U.S.C.A. §§ 1396-1396v (West 1992 <& Supp.2000). Medicaid is a joint federal-state indigent-assistance program that provides federal funds to each state to furnish medical assistance to certain categories of needy persons. Id. § 1396 (West 1992). The federal government pays a percentage of the total cost that a participating state incurs in providing these services. Id. § 1396b (West Supp.2000). Federal law establishes mandatory and optional categories of services a participating state may provide under Medicaid. Id. §§ 1396a, 1396d(a) (West Supp.2000).

Congress has restricted federal matching funds available for abortions by the annual enactment of the Hyde Amendment. Named for its sponsor, Representative Henry Hyde of Illinois, the Hyde Amendment is a rider to the Labor-HEW Appropriations Act that has been passed every year since 1976.3 The specific terms of the amendment have varied over the years, but the versions presently in place and in place when this lawsuit was filed prohibit federal reimbursement for abortion services except in cases of rape or incest or where the pregnancy threatens the mother’s life.4 Though the Hyde Amendment prevents states from receiving federal matching funds for most abortion services, states are free to subsidize at their own expense abortions for which federal reimbursement is not available. Harris v. McRae, 448 U.S. 297, 311 n. 16, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980); Omnibus Consolidated and Emergency Supplemental Appropriations Act of 1999, Pub. Law 105-277, sec. 509(b), 112 Stat. 2681-385 (“Nothing in the preceding section shall be construed as prohibiting the expenditure by a State ... of State ... [693]*693funds (other than a State’s ... contribution of Medicaid matching funds).”).

Texas has participated in Medicaid almost since the program’s inception, passing enabling legislation in 1967 establishing the Medical Assistance Program. See Medical Assistance Act of 1967, 60th Leg., R.S., ch. 151, §§ 1-24, 1967 Gen.Laws 310 (Tex.Rev.Civ.Stat.Ann. arts. 695j, 695j-l, since repealed and codified at Tex.Hum. Res.Code Ann. §§ 82.001-.052 (West 1999 & Supp.2000)). The program covers all “health care and related services and benefits authorized or provided under federal law for needy individuals of this state.” Tex.Hum.Res.Code Ann. § 32.008 (West Supp.2000). Services are limited, however, to those for which the State can receive federal matching funds. See id. § 32.024(e) (West Supp.2000). The Texas Medical Assistance Program therefore tacitly adopts the limits set forth by the Hyde Amendment, and physicians are reimbursed with Medicaid funds only for abortions necessary to save the woman’s life or when the pregnancy has resulted from rape or incest. By the State’s own admission, every other reproductive health service provided by a doctor with the Texas Medical Assistance Program is reimbursed if it is medically necessary; with one minor exception, abortion is the only service of any kind covered by the program that requires a showing of something more than mere medical necessity.5

In addition to their Medicaid challenge, Low-Income Women have challenged the abortion funding restrictions found in the Maternal/Infant Health Act. See Tex. Health & Safety Code Ann. §§ 32.001-045 (West 1992 & Supp.2000). This program was created in 1985 to provide medical and educational services to low-income women and infants. See Maternal and Infant Health Improvement Act, 69th Leg., R.S., ch. 592, 1985 Tex.Gen.Laws 2224 (Tex.Rev. Civ.Stat.Ann. art. 4447y, since repealed and codified at Tex.Health & Safety Code Ann. §§ 32.001-045). Under the Maternal/Infant Health Act, no funds may be used to provide abortion services unless the woman’s life is in danger. Tex.Health & Safety Code Ann. § 32.005 (West 1992). With no exception for women who are victims of rape or incest, abortion coverage under the Maternal/Infant Health Act is even more restricted than under the Texas Medical Assistance Program.

The Parties

Low-Income Women are represented in this action by physicians and health climes that provide abortion services. Doctors Robert Price and Curtis Boyd are both Texas-licensed physicians who divide their time between their private practices and the Fairmount Center, a Dallas health center that provides low-cost, outpatient abortions to Medicaid-eligible women. The physicians and the clinic each assert their own interests and those of their patients, claiming that because of the funding restrictions on medically necessary abortions, many women are forced to delay obtaining an abortion until their second trimester, when the procedure poses greater health risks, because of the time required to find money to pay for a non-subsidized abortion.

Doctor William Watkins West is also a Texas physician who specializes in abortions. He provides services at the Routh Street Women’s Clinic in Dallas, also a plaintiff-appellant in this case. Between five and ten percent of Dr. West’s Routh Street patients are Medicaid-eligible, and the clinic offers reduced-fee abortions to those women. Finally, Reproductive [694]

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95 S.W.3d 253 (Texas Supreme Court, 2002)
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Low-Income Women Ex Rel. Prince v. Bost
38 S.W.3d 689 (Court of Appeals of Texas, 2000)

Cite This Page — Counsel Stack

Bluebook (online)
38 S.W.3d 689, 2000 Tex. App. LEXIS 8155, 2000 WL 1784389, Counsel Stack Legal Research, https://law.counselstack.com/opinion/low-income-women-ex-rel-prince-v-bost-texapp-2000.