Planned Parenthood of the St. Louis Region v. Robert Knodell, in his official capacity as Acting Director of the Missouri Department of Social Services

CourtSupreme Court of Missouri
DecidedFebruary 14, 2024
DocketSC99966
StatusPublished

This text of Planned Parenthood of the St. Louis Region v. Robert Knodell, in his official capacity as Acting Director of the Missouri Department of Social Services (Planned Parenthood of the St. Louis Region v. Robert Knodell, in his official capacity as Acting Director of the Missouri Department of Social Services) is published on Counsel Stack Legal Research, covering Supreme Court of Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Planned Parenthood of the St. Louis Region v. Robert Knodell, in his official capacity as Acting Director of the Missouri Department of Social Services, (Mo. 2024).

Opinion

SUPREME COURT OF MISSOURI en banc PLANNED PARENTHOOD OF THE ) Opinion issued February 14, 2024 ST. LOUIS REGION, ET AL., ) ) Respondents, ) ) v. ) No. SC99966 ) ROBERT KNODELL, IN HIS OFFICAL ) CAPACITY AS ACTING DIRECTOR OF ) THE MISSOURI DEPARTMENT OF ) SOCIAL SERVICES, ET AL., ) ) Appellants. )

APPEAL FROM THE CIRCUIT COURT OF COLE COUNTY The Honorable Jon E. Beetem, Judge

Planned Parenthood of the St. Louis Region and Southwest Missouri, Planned

Parenthood Great Plains, and Comprehensive Health of Planned Parenthood Great Plains

(collectively, “Planned Parenthood”) sought declaratory judgment in the circuit court

declaring House Bill No. 3014 (“HB 3014”) unconstitutional and requested injunctive

relief preventing its implementation and enforcement. HB 3014 was an appropriation bill

the Missouri General Assembly enacted to supplement funding in fiscal 2022 for the MO

HealthNet program, which reimburses Medicaid providers for health care-related services.

HB 3014 professed to eliminate Medicaid funding for abortion providers and their affiliates, which would include Planned Parenthood. Planned Parenthood alleged HB 3014

violated the single subject requirement in article III, section 23 and the equal protection

clause in article I, section 2 of the Missouri Constitution. Planned Parenthood named the

Missouri Department of Social Services (“DSS”), the MO HealthNet Division, the

Missouri Medicaid Audit and Compliance Unit, and these entities’ respective directors

(collectively, the “State”) as defendants in its legal action due to these entities’ role in

implementing and administering HB 3014 and MO HealthNet. Following a trial, the circuit

court entered judgment for Planned Parenthood on both of Planned Parenthood’s

constitutional claims, and the State appealed. Because the State does not appeal the circuit

court’s entry of judgment for Planned Parenthood on its equal protection claim, this Court

affirms the circuit court’s judgment.

Legal and Factual Background

The MO HealthNet Division of DSS administers Missouri’s Medicaid program,

known as MO HealthNet. Health care providers must become authorized MO HealthNet

providers to seek reimbursement for providing health-related services to Medicaid-eligible

individuals. To do so, providers must sign a MO HealthNet provider participation

agreement pursuant to section 208.153.2. 1 Once authorized, providers bill DSS for eligible

services provided to Medicaid-eligible individuals, and DSS reimburses providers. 2

1 Unless otherwise indicated, all statutory references are to RSMo 2016. 2 Section 208.151 sets forth the individuals who are eligible to receive Medicaid services. Section 208.152 sets forth the health-related services eligible for reimbursement. Section 208.152.1(12) excludes elective abortions from MO HealthNet coverage; however, chapter 208 does not preclude abortion providers or their affiliates from being eligible for

2 Eligible participants in the program may obtain MO HealthNet benefits 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.” Section 208.153.1.

Planned Parenthood provides health care services, including physicians’ services

and family planning services. Physicians’ services and family planning services provided

to Medicaid-eligible individuals by authorized providers are subject to reimbursement by

MO HealthNet. Section 208.152.1(6), (12). 3 Planned Parenthood was enrolled as a MO

HealthNet provider and had a MO HealthNet provider participation agreement with DSS

during fiscal 2022. The agreement states, in relevant part:

If at any time state or federally appropriated funds available to the [Department of Social Services]/[Medicaid Audit and Compliance Unit]/[MO HealthNet Division] for payment to [me]/[the provider] for covered services under this agreement are insufficient to pay the full amount

reimbursement when providing other services that are covered under the statute. References to section 208.152 are to RSMo Supp. 2021. 3 Section 208.152.1 states, in relevant part: 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 or any abortifacient drug or device that is used for the purpose of inducing an abortion 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[.]

(Emphasis added).

3 due, [I]/[the provider] agree[s] to accept payments reduced in proportion to the funding deficiency. 4

The Missouri General Assembly funds MO HealthNet through appropriation and

supplemental appropriation bills. During the 2021 legislative session, the General

Assembly passed House Bill No. 11 (“HB 11”), which the governor signed into law. HB

11 appropriated approximately $12.6 billion in total funding for MO HealthNet for fiscal

2022. 5 In this appropriation, approximately $500 million was included for “physicians[’]

services and related services including, but not limited to, clinic and . . . family planning

services[.]” See section 11.715 of HB 11. During the beginning of fiscal 2022, Planned

Parenthood was reimbursed for physicians’ services and family planning services from this

corresponding $500 million appropriation in HB 11.

During the 2022 legislative session, the General Assembly provided supplemental

appropriations to MO HealthNet for fiscal 2022 by creating HB 3014, which the governor

signed into law. HB 3014 appropriated approximately $1.5 billion in additional funding

for MO HealthNet for the remainder of fiscal 2022. In HB 3014, as it did in HB 11, the

General Assembly appropriated funding for physicians’ services and family planning

4 Each Planned Parenthood entity in this matter had its own MO HealthNet provider participation agreement with slight variations in the terminology used. The quoted text of the agreement includes bracketed language to reflect these variations. For ease of reference, the agreements are collectively referred to as a singular agreement. One bracket in the quoted text references the Medicaid Audit Compliance Unit. This entity is a unit within DSS that manages provider participation agreements and oversees the distribution of state resources, including whether authorized providers are eligible for reimbursement. The unit must notify authorized providers of any changes in interpretation or application of reimbursement requirements. 5 In Missouri, the fiscal year runs from July 1 through June 30 of the following year. Thus, Fiscal 2022 ran from July 2021 through June 30, 2022.

4 services. The supplemental appropriation for physicians’ services amounted to $84

million. See section 14.230 of HB 3014. In HB 3014, the General Assembly included

sections 14.277 and 14.2030. Section 14.277 of HB 3014 states:

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Planned Parenthood of the St. Louis Region v. Robert Knodell, in his official capacity as Acting Director of the Missouri Department of Social Services, Counsel Stack Legal Research, https://law.counselstack.com/opinion/planned-parenthood-of-the-st-louis-region-v-robert-knodell-in-his-mo-2024.