Allegheny Reprod. Health Ctr. v. Pa. Dep't of Human Servs.

• Decision Date: 26 March 2021
• Docket Number: No. 26 M.D. 2019,26 M.D. 2019
• Parties: ALLEGHENY REPRODUCTIVE HEALTH CENTER, Allentown Women's Center, Delaware County Women's Center, Philadelphia Women's Center, Planned Parenthood Keystone, Planned Parenthood Southeastern Pennsylvania, and Planned Parenthood of Western Pennsylvania, Petitioners v. PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES, Teresa Miller, in her official capacity as Secretary of the Pennsylvania Department of Human Services, Leesa Allen, in her official capacity as Executive Deputy Secretary for the Pennsylvania Department of Human Service's Office of Medical Assistance Programs, and Sally Kozak, in her official capacity as Deputy Secretary for the Pennsylvania Department of Human Service's Office of Medical Assistance Programs, Respondents
• Court: Pennsylvania Commonwealth Court

249 A.3d 598

ALLEGHENY REPRODUCTIVE HEALTH CENTER, Allentown Women's Center, Delaware County Women's Center, Philadelphia Women's Center, Planned Parenthood Keystone, Planned Parenthood Southeastern Pennsylvania, and Planned Parenthood of Western Pennsylvania, Petitioners

v.PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES, Teresa Miller, in her official capacity as Secretary of the Pennsylvania Department of Human Services, Leesa Allen, in her official capacity as Executive Deputy Secretary for the Pennsylvania Department of Human Service's Office of Medical Assistance Programs, and Sally Kozak, in her official capacity as Deputy Secretary for the Pennsylvania Department of Human Service's Office of Medical Assistance Programs, Respondents

No. 26 M.D. 2019

Commonwealth Court of Pennsylvania.

Argued October 14, 2020

Decided March 26, 2021

Susan Frietsche, Pittsburgh, for Petitioners.

Matthew J. McLees, Deputy Chief Counsel, Harrisburg, for Respondents.

David R. Dye, Camp Hill, for Intervenor Pennsylvania House of Representatives.

Jason A. Snyderman, Philadelphia, for Intervenors Senators Ryan Aument, Michele Brooks, Jacob Corman, John DiSanto, Michael Folmer, John Gordner, Scott Hutchinson, Wayne Langerholc, Daniel Lauglin, Scott Martin, Robert Mensch, Michael Regan, Mario Scavello, Patrick Stefano, Judy Ward, Kimberly Ward, and Eugene Yaw.

BEFORE: HONORABLE MARY HANNAH LEAVITT, President Judge,¹ HONORABLE RENÉE COHN JUBELIRER, Judge, HONORABLE PATRICIA A. McCULLOUGH, Judge, HONORABLE ANNE E. COVEY, Judge, HONORABLE MICHAEL H. WOJCIK, Judge, HONORABLE CHRISTINE FIZZANO CANNON, Judge, HONORABLE ELLEN CEISLER, Judge

OPINION BY PRESIDENT JUDGE LEAVITT

Petitioners are Allegheny Reproductive Health Center, Allentown Women's Center, Delaware County Women's Center, Philadelphia Women's Center, Planned Parenthood Keystone, Planned Parenthood Southeastern Pennsylvania, and Planned Parenthood of Western Pennsylvania (collectively, Reproductive Health Centers). They are medical providers licensed by the Commonwealth of Pennsylvania to provide abortion services. Reproductive Health Centers have filed a petition for review seeking declaratory and injunctive relief, asserting that Sections 3215(c) and (j) of the Abortion Control Act² are unconstitutional because they discriminate against pregnant women enrolled in Medical Assistance who choose to have an abortion.

Respondents are the Pennsylvania Department of Human Services; the Secretary of Human Services, Teresa Miller; the Executive Deputy Secretary of Human Services, Leesa Allen; and the Deputy Secretary for the Office of Medical Assistance Programs, Sally Kozak (collectively, Commonwealth Respondents). The Commonwealth Respondents have moved to dismiss the petition, asserting that Reproductive Health Centers lack standing to raise constitutional claims that belong to other persons, i.e. , women enrolled in Medical Assistance. The Commonwealth Respondents also assert, along with the Intervenors,³ that the petition for review fails to state a legally cognizable claim under the Pennsylvania Constitution.

For the reasons that follow, we sustain the preliminary objections and dismiss the petition.

Background

Medicaid is a joint federal-state public program that provides medical services to low-income persons; in Pennsylvania, it is known as Medical Assistance and administered by the Department of Human Services. Petition for Review ¶40, ¶¶44-45. Medical Assistance includes a Fee-for-Service program that "reimburses providers directly for covered medical services provided to enrollees" as well as a managed care program, HealthChoices, that "pays a per enrollee amount to managed care organizations that agree to reimburse health care providers that provide care for enrollees." Id. ¶46. "With some exceptions, Medical Assistance enrollees are required to enroll with a managed care organization participating in HealthChoices rather than the Fee-for-[S]ervice program." Id. ¶47.

Medical Assistance covers family planning and pregnancy-related care, including prenatal care, obstetrics, childbirth, neonatal, and post-partum care. Petition for Review ¶48. Medical Assistance does not cover nontherapeutic abortions. Id. ¶50. Pennsylvania's Abortion Control Act⁴ prohibits the expenditure of appropriated state and federal funds for abortion services except where (1) necessary to avert the death of the pregnant woman, (2) the pregnancy resulted from rape, or (3) the pregnancy resulted from incest. 18 Pa. C.S. § 3215(c). Likewise, regulations of the Department of Human Services prohibit Medical Assistance coverage for abortions, except in the above-listed exceptional cases.⁵ Id . ¶50. Collectively, the Abortion Control Act and the Department's regulations are referred to as the "coverage ban." Id . ¶¶49-50.

On January 16, 2019, Reproductive Health Centers filed a petition for review seeking declaratory and injunctive relief in order to end this coverage ban. Reproductive Health Centers provide approximately 95% of the abortion services performed in the Commonwealth. Petition for Review ¶33. Their patients include women enrolled in Medical Assistance. Id. ¶57. The coverage ban prohibits Reproductive Health Centers from billing or being reimbursed for abortion services provided to women enrolled in Medical Assistance whose pregnancies do not fall into one of the three above-enumerated exceptions. Id. ¶52.

The petition alleges that the coverage ban harms women enrolled in Medical Assistance because they are forced to choose between continuing their pregnancy to term or using funds needed for essentials of life to pay for an abortion procedure. Petition for Review ¶59. Because the facilities in Pennsylvania that perform abortions are few in number, some women must travel significant distances to obtain a safe and legal abortion. Id. ¶60. If abortion were a covered procedure, some of those transportation costs would be reimbursed by Medical Assistance. Id. The coverage ban causes women on Medical Assistance to delay an abortion while they raise funds to pay for the procedure. Id. ¶61. Although Reproductive Health Centers assist their Medical Assistance patients to obtain this funding, they are not always successful. Id. ¶62. The coverage ban has forced many women to carry their pregnancies to term against their will. Id. ¶¶63-64.

The petition alleges that the coverage ban has also caused direct harm to Reproductive Health Centers. Specifically, the coverage ban forces them to divert money and staff from "other mission-central work" to help women enrolled in Medical Assistance who lack the funds to pay for their abortions. Petition for Review ¶84. Reproductive Health Centers "regularly subsidize (in part or in full) abortions for Pennsylvania women on Medical Assistance who are not able to pay the fee on their own." Id. ¶85. Reproductive Health Centers expend "valuable staff resources to assist patients in securing funding from private charitable organizations that fund abortion[s] for women on Medical Assistance." Id. ¶86. Staff must also delve "into personal matters that the patient may not wish to discuss," i.e. , whether the pregnancy was the result of rape or incest. Id. ¶ 87.

The petition for review contains two counts. Count I asserts that the coverage ban violates Article I, Section 28 of the Pennsylvania Constitution, commonly referred to as Pennsylvania's Equal Rights Amendment,⁶ because it denies coverage of a medical procedure that can be used only by women. Count II asserts that the coverage ban violates several other provisions of the Pennsylvania Constitution, specifically Article I, Sections 1⁷ and 26⁸ and Article III, Section 32,⁹ that establish the guarantee of equal protection of the laws. Asserting that the coverage ban unconstitutionally restricts indigent women in the exercise of their right to terminate a pregnancy, Reproductive Health Centers request this Court to declare the coverage ban unconstitutional and to enjoin its enforcement.

The Commonwealth Respondents, along with the Senate Intervenors and the House Intervenors, have filed preliminary objections in the nature of a demurrer. Specifically, they assert that the petition for review fails to state a cause of action upon which relief can be granted. In addition, the Commonwealth Respondents assert that Reproductive Health Centers lack standing to vindicate the individual constitutional rights of other parties, i.e. , all women enrolled in Medical Assistance.¹⁰

Preliminary Objections

In reviewing preliminary objections in the nature of a demurrer, this Court "must accept as true all well pleaded material allegations in the petition for review, as well as all inferences reasonably deduced therefrom." Buoncuore v. Pennsylvania Game Commission , 830 A.2d 660, 661 (Pa. Cmwlth. 2003). We are not required to accept as true "conclusions of law, unwarranted inferences from facts, argumentative allegations, or expressions of opinion." Id. For this Court to sustain preliminary objections, "it must appear with certainty that the law will not permit recovery[.]" McCord v. Pennsylvania Gaming Control Board , 9 A.3d 1216, 1218 n.3 (Pa. Cmwlth. 2010) (quotation omitted). Where there is any doubt, this Court will overrule the preliminary objections. Fumo v. Hafer , 155 Pa.Cmwlth. 520, 625 A.2d 733, 734 (1993).

I. Standing

We begin with the assertion of the Commonwealth Respondents that Reproductive Health Centers lack standing to initiate litigation to vindicate the constitutional rights of their patients enrolled in Medical Assistance. Although the petition for review alleges that the coverage ban causes Reproductive Health Centers to provide abortion services at a loss, the Commonwealth Respondents respond that these alleged pecuniary and administrative harms do not fall within the zone of interests protected by the Equal Rights Amendment and the equal protection clause of the Pennsylvania Constitution, or by the Abortion Control Act. In short, the...