Mabel Wadsworth Women's Health Center v. Hamilton

CourtSuperior Court of Maine
DecidedOctober 24, 2017
DocketCUMcv-15-527
StatusUnpublished

This text of Mabel Wadsworth Women's Health Center v. Hamilton (Mabel Wadsworth Women's Health Center v. Hamilton) is published on Counsel Stack Legal Research, covering Superior Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mabel Wadsworth Women's Health Center v. Hamilton, (Me. Super. Ct. 2017).

Opinion

STATE OF MAINE SUPERIOR COURT

Cumberland, ss. Civil Action

Mabel Wadsworth Women's Health Center; Family Planning Association of Maine d/b/ a Maine Family Planning and Primary Care Services; and Planned Parenthood of Northern New England,

Plaintiffs

v. Docket N o. PORSC-CV-15-527

Ricker Hamilton, Acting Commissioner of the Maine Department of Health and Human Services, in his official capacity,

Defendant

DECISION AND JUDGMENT

Defendant's Motion for Summary Judgment and Plaintiffs' Cross-Motion for

Summary Judgment came before the court for oral argument September 28, 2017, at

which point the case came under advisement.

For the following reasons, Plaintiffs' Cross-Motion For Summary Judgment is

denied and Defendant's Motion for Summary Judgment is granted.

Background

A. The Medicaid/MaineCare Framework

The joint state-federal program known as Medicaid, codified as Title XIX of

the Social Security Act, provides federal funds to enable states to extend subsidized

medical care to needy persons. See 42 U.S.C. §§ 1396-1396v (2017); 42 C.F.R. § 430.0

1 (2017). See also Biewald v. State, 451 A.2d 98, 99 (Me. 1982).

State participation in Medicaid is voluntary. However, once a state chooses to

participate, it must comply with the requirements of federal law and regulations

thereunder. A participating state must have a plan that is approved by the federal

government and that provides, at minimum, certain mandatory services. See 42 C.F.R.

§§ 430.0 et seq. These mandatory services include pregnancy related services, and

family planning services. See 42 U.S.C § 1396a(a)(10).

On the other hand, federal law prohibits federal Medicaid funds from being used

to fund abortions, except in cases of rape or incest, or when the life of the mother is in

danger. The prohibition is codified in the Hyde Amendment, an appropriations

measure that Congress has enacted every year since 1976, most recently through Pub.

L. 115-31, div. H. tit. V § 507 (2017). In operation, the Hyde Amendment precludes

federal reimbursement to states for any abortion services other than those within the

exceptions Congress has deemed appropriate.

The State of Maine participates in the Medicaid program voluntarily through a

program known as "MaineCare". See Biewald, 451 A.2d at 99. See also 22 M.R.S.A. §§

3172-3184 (2016). The MaineCare program is administered by the Maine

Department of Health and Human Services (DHHS). Defendant Hamilton is acting

Commissioner of DHHS.

The specific healthcare services covered by MaineCare are defined in rules

promulgated by DHHS rather than by the MaineCare statute. Regarding pregnancy

related care, MaineCare covers "antepartum care, delivery, postpartum care, and other

2 services normally provided in uncomplicated maternity care." 10-144 C.M.R ch.

lOl(II), § 90.04-4(B) (2016). A child born to a mother covered by MaineCare will also

be covered under MaineCare for one year following birth. 10-144 C.M.R. ch. 332, pt. .)

2, § 13. l(I) (2016). This coverage will continue even if the child's mother does not

remain eligible for MaineCare throughout the year. Id. So long as family income

eligibility requirements are met, MaineCare will provide coverage for children and

teenagers through age twenty. 10-144 C.M.R. ch. 332, pt. S, § 2.1 (2016).

In contrast to its broad coverage of pregnancy and child-related services,

MaineCare covers abortion services only in the case of rape or incest, or if the

pregnancy is life-threatening. The limitation on coverage is defined in a DHHS rule,

codified at 10-144 C.M.R. ch. lOl(II), § 90.05-2(A) ["Rule 90.05-2(A)"J. 1 Rule 90.05­

2(A) in one form or another has been in effect almost as long as the federal Hyde

Amendment has been in effect.

In other words, MaineCare covers abortion services only to the extent the

services are eligible for reimbursement with federal Medicaid funds, and this has been

the case for decades.

Between 2014 and 2016 Maine spent more than one billion dollars per year

covering optional benefits under its MaineCare program. (JSMF ~94.) DHHS is not

aware of any data showing that MaineCare's lack of coverage for abortions, except

1 The rule reads, in pertinent part: "In compliance with PL lOS-112, the Health and HUlilan Services

Appropriations bill, reimbursement for abortion services will be made only if necessary to save the life of the mother, or if the pregnancy is the result of an act of rape or incest." 10-144 C.M .R. ch. 1oi(II), § 90.05-2(A). See http:!l www.maine.gov/ soslcecl rulesl I ol chl 01.htm

3 when federal reimbursement is available, provides any fiscal benefit to the State.

(JSMF ,95.)

B. Plaintiffs' Status as MaineCare Providers

The three Plaintiffs are enrolled MaineCare providers of family planning and

abortion services. (JSMF , , 1, 5, l 5.) As enrolled MaineCare providers, the Plaintiffs

are paid directly by the State, through DHHS, when they provide a patient with a

service covered by the MaineCare program.

. When a patient of Plaintiffs decides to terminate her pregnancy through

abortion, the decision may be for a variety of reasons (J.S.M.F , , 35-46.) These

reasons include: the inability to provide financial support for a child, the belief that

having a child would interfere with educational or career goals, the exacerbation of an

existing physical or mental health condition, and the desire to escape an abusive

relationship, and abnormal fetal development. (J.S.M.F , , 37-40, 43, 45).

No individual woman is a plaintiff in this matter. (JSMF , 2.)

Plaintiffs charge between $500 to $600 for abortion services performed up to

14 weeks from a patient's last menstrual period. (JSMF ,20.) After 14 weeks, the cost

ofan abortion increases to between $725 and $1000. (JSMF ,20.) However, Plaintiffs

always try to enable any woman who wishes to terminate her pregnancy to obtain an

abortion regardless of her ability to pay. (JSMF, 23.) Plaintiffs offer eligible women

financial assistance to obtain an abortion. (JSMF ,21.) One of the Plaintiffs writes off

up to $12,000 a year for abortion services provided to needy women. (JSMF 22.)

Plaintiffs have no record of any woman being denied access to abortion services due

4 to her inability to pay. (JSMF ~ 24.)

In appropriate circumstances, Plaintiffs provide abortions and then seek

reimbursement from the Maine Department of Health and Human Services. (JSMF

~25.) Between 2010 and 2015, Plaintiff Mabel Wadsworth Women's Health Center

submitted three claims for reimbursement for abortion services. (JSMF ~29.) Two of

those claims were denied. (JSMF ~ 29.)

Analysis

In this case, the parties have present~d the court with all of the facts that are

material to the court's decision on the pending Motions. 2 There are no disputed issues

of fact that could justify denying both of the pending Motions. Accordingly, the

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