Planned Parenthood of St. Louis Region v. Department of Social Services, Division of Medical Services

Supreme Court of Missouri·Decided June 30, 2020·No. SC98020·Published

Opinion

SUPREME COURT OF MISSOURI en banc

PLANNED PARENTHOOD OF ) Opinion issued June 30, 2020 ST. LOUIS REGION, ET AL., )

)

Respondents, )

)

v. ) No. SC98020 )

DEPARTMENT OF SOCIAL SERVICES, ) DIVISION OF MEDICAL SERVICES, ) ET AL., )

)

Appellants. )

APPEAL FROM THE CIRCUIT COURT OF THE CITY OF ST. LOUIS The Honorable David L. Dowd, Judge

Section 208.152.1(6), (12) 1 , provides that the MO HealthNet Division of the Missouri Department of Social Services “shall” make payments to authorized providers “on behalf of” Medicaid-eligible individuals for “physicians’ services” and “[f]amily planning.” Notwithstanding that the General Assembly appropriated money for Fiscal Year 2019 (“FY2019”) to pay for these services, and notwithstanding that Planned Parenthood of the St. Louis Region and Reproductive Health Services of Planned Parenthood (collectively, “Planned Parenthood”) was an authorized provider of these

1 References to section 208.153 are to RSMo 2016. References to section 208.152 are to RSMo Supp. 2018. All other statutory references are to RSMo 2016.

services because it had an agreement with MO HealthNet under section 208.153.2 to do so, MO HealthNet informed Planned Parenthood that it could not reimburse Planned Parenthood for these services during FY2019 due to section 11.800 of the FY2019 appropriation bill. This provision states: “No funds shall be expended to any abortion facility as defined in Section 188.015, RSMo, or any affiliate or associate thereof.” House Bill No. 2011 (“HB2011”), § 11.800 (2018).

Planned Parenthood challenged the constitutional validity of section 11.800 of HB2011, claiming it is impermissible to use an appropriation bill to amend substantive law (i.e., §§ 208.153.2 and 208.152.1(6), (12)) because this violates article III, section 23 of the Missouri Constitution. The circuit court agreed, and MO HealthNet appeals. 2 This Court has exclusive appellate jurisdiction. Mo. Const. art. V, § 3.

The central issue before this Court is whether there is a direct conflict between: (a)

the language of sections 208.153.2 and 208.152.1(6), (12) requiring MO HealthNet to pay its authorized providers (including Planned Parenthood) for covered physicians’ services and family planning provided to Medicaid-eligible individuals; and (b) the language of section 11.800 of HB2011 prohibiting MO HealthNet from doing so. If there is such a direct conflict, section 11.800 is invalid because article III, section 23 of the Missouri Constitution prohibits using an appropriation bill to amend a substantive statute.

2 Also appealing are the Missouri Department of Social Services and the Missouri Medicaid Audit and Compliance Unit. For ease of reference, however, all appellants are referred to herein collectively as MO HealthNet.

The circuit court’s judgment found such a conflict and declared section 11.800 invalid. The circuit court concluded this unconstitutional section should be severed, leaving the remainder of HB2011 unaffected. This Court agrees, and the circuit court’s judgment in this respect is affirmed.

Background

Missouri’s Medicaid program is known as MO HealthNet, and it is administered by the MO HealthNet Division of the Missouri Department of Social Services. Section 208.152.1 provides:

MO HealthNet payments shall be made on behalf of those eligible needy persons … who are unable to provide for it in whole or in part … for the following:

… (6) Physicians’ services, whether furnished in the office, home, hospital, nursing home, or elsewhere;

… (12) Family planning as defined by federal rules and regulations;

provided, however, that such family planning services shall not include abortions unless such abortions are certified in writing by a physician to the MO HealthNet agency that, in the physician’s professional judgment, the life of the mother would be endangered if the fetus were carried to term[.]

§ 208.152.1 (emphasis added). As noted in this statute, the payments are made “on behalf of” the Medicaid eligible person receiving the services, but they are made to the authorized provider from which the eligible person received the services. Section 208.153.1 further provides, “Any person entitled to MO HealthNet benefits may obtain it from any provider of services with which an agreement is in effect under this section and which undertakes to provide the services, as authorized by the MO HealthNet division.” [Emphasis added.]

MO HealthNet concedes that it has authorized Planned Parenthood to provide physicians’ services and family planning to Medicaid-eligible individuals and that Planned Parenthood had an agreement in effect for FY2019 with MO HealthNet under section 208.153.1 to do so. Prior to FY2019 at least, this was sufficient to permit Planned Parenthood to provide those services and receive payment for them from MO HealthNet from money appropriated by the General Assembly.

For FY2019, the General Assembly again appropriated funds for the “purpose of funding physician services and related services including, but not limited to, … family planning services under the MO HealthNet fee-for-service program[.]” See HB2011, § 11.455. This time, however, the General Assembly added section 11.800 to the MO HealthNet appropriation bill, HB2011. Section 11.800 provides:

In reference to all sections in Part 1 [including section 11.455, which appropriates money for physicians’ services and family planning] and Part 2 of this act: No funds shall be expended to any abortion facility as defined in Section 188.015, RSMo[ 3], or any affiliate or associate thereof.

As a result of this language, 4 MO HealthNet notified Planned Parenthood that it was prohibited from making any payments to Planned Parenthood for physician or family planning services rendered to Medicaid-eligible individuals during FY2019. 5

3 Section 188.015(2) provides, “‘Abortion facility’, a clinic, physician’s office, or any other place or facility in which abortions are performed or induced other than a hospital ....” 4 MO HealthNet originally relied on section 11.715 in Part 2 of HB2011, as well as section 11.800. It since has dropped that contention, and the validity or enforceability of section 11.715 will not be addressed further. 5 The appropriations in HB2011 pertain to obligations incurred in FY2019, which ended June 30, 2019. See Mo. Const., art. IV, § 28 (“No appropriation shall confer authority to incur an obligation after the termination of the fiscal period to which it relates ....”). Neither

Planned Parenthood filed complaints with the Administrative Hearing Commission (“AHC”). The AHC issued decisions in favor of MO HealthNet but noted it lacked authority to address Planned Parenthood’s constitutional challenges. Planned Parenthood then sought consolidated judicial review of the AHC decisions in the St. Louis City Circuit Court. The circuit court entered judgment for Planned Parenthood, declaring that section 11.800 of HB2011 violates article III, section 23 of the Missouri Constitution and severing that provision from the remainder of HB2011. 6 The circuit

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Planned Parenthood of St. Louis Region v. Department of Social Services, Division of Medical Services, (Mo. 2020).

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