Hope v. Perales

• Decision Date: 05 May 1994
• Citation: 634 N.E.2d 183,83 N.Y.2d 563,611 N.Y.S.2d 811
• Parties: , 634 N.E.2d 183, 62 USLW 2698 Jane HOPE et al., on Behalf of Themselves and All Others Similarly Situated, et al., Respondents, v. Cesar PERALES, as Commissioner of the New York State Department of Social Services, et al., Appellants. Alma Poindexter, Intervenor-Respondent.
• Court: New York Court of Appeals Court of Appeals

Page 811

611 N.Y.S.2d 811

83 N.Y.2d 563, 634 N.E.2d 183, 62 USLW 2698

Jane HOPE et al., on Behalf of Themselves and All Others Similarly Situated, et al., Respondents, v. Cesar PERALES, as Commissioner of the New York State Department of Social Services, et al., Appellants Alma Poindexter, Intervenor-Respondent.

Court of Appeals of New York.

May 5, 1994.

[83 N.Y.2d 565] G. Oliver Koppell, Atty. Gen., New York City (Judy E. Nathan, Jerry Boone and Howard L. Zwickel, of counsel), for appellants.

Catherine Weiss, New York City, Donna Lieberman, Yueh-ru Chu, Robert M. Levy, Louise Melling, Cleary, Gottlieb, Steen &

[634 N.E.2d 184] Hamilton (Deborah M. Buell, Donna Costa, Ayala Deutsch, Stephanie Cotsirilos, Anne H. Erskine and Marcia L. Narine, of counsel), Janet Benshoof, Catherine Albisa and Hollyer, Brady, Smith, Troxell, Barrett, Rockett, Hines & Mone (Laurie R. Rockett, of counsel), for respondents.

[83 N.Y.2d 566] Michael P. Tierney, New York City, for intervenor-respondent.

[83 N.Y.2d 567] John J. O'Brien, Menands, for New York State Right to Life Committee, Inc., amicus curiae.

John D. Murnane, New York City, and Joseph W. Dellapenna, of the Pennsylvania Bar, admitted pro hac vice, for American Academy of Medical Ethics, amicus curiae.

[83 N.Y.2d 568] Michael L. Costello, Albany, Richard E. Barnes, Clarke D. Forsythe, Paul Benjamin Linton, Alan J. Placa, Mildred A. Shanley, William J. Toohy and Eileen M. White, for New York State Catholic Conference, amicus curiae.

[83 N.Y.2d 569] Berle, Kass & Case, New York City (Jean M. McCarroll and Deborah Goldberg, of counsel), for American Ethical Union and others, amici curiae.

Vladeck, Waldman, Elias & Engelhard, P.C., New York City (Denny Chin and Anne L. Clark, of counsel), for Amalgamated Clothing & Textile Workers Union and others, amici curiae.

Arnold & Porter, New York City (Peter G. Neiman, of counsel), and Martha F. Davis, for NOW Legal Defense and Education Fund and others, amici curiae.

[83 N.Y.2d 570] Kramer, Levin, Naftalis, Nessen, Kamin & Frankel, New York City (Marvin E. Frankel and Jeffrey S. Trachtman, of counsel), Haywood Burns, Janet Gallagher, George Wheeler Madison, Katherine Kennedy, Alesia Selby Regan, Sandra C. Katz and Bonnie S. Edwards, for Ass'n of Bar of City of New York and others, amici curiae.

Paul A. Crotty, Corporation Counsel of New York City (Lorna Bade Goodman and Meredith Anne Feinman, of counsel), for City of New York, amicus curiae.

[83 N.Y.2d 571] Michelle Oberman, of the Ill. Bar, admitted pro hac vice, for AIDS Community Services of Western N.Y. and others, amici curiae.

OPINION OF THE COURT

KAYE, Chief Judge.

At issue is the validity, under the State Constitution, of New York's Prenatal Care Assistance Program (PCAP) (Public Health Law § 2520 et seq.). Plaintiffs claim that the statute is facially unconstitutional by reason of underinclusiveness, for its failure to include medically necessary abortions in a prenatal care public funding scheme for women with incomes up to 85% over the Federal poverty level (meaning annual income for a single pregnant woman of between $9,840 and $18,204). ¹ We now reverse the Appellate Division order and declare the statute constitutional.

The Statute in Issue

New York's PCAP statute is best understood against the backdrop of related programs.

Medicaid was created by Congress in 1965 to provide Federal reimbursement to participating States for a portion of the cost of all medically necessary services for qualified individuals. Medicaid eligibility is determined by financial need, ultimately assessed by reference to the Federal poverty level--currently annual income below $9,840 for a single pregnant woman. Federal Medicaid reimbursement is available for abortion only in cases of rape or incest, or to save the life of the mother (see, Pub.L. 103-112, § 509). States may, however, at their own option and expense, offer services additional to those reimbursed under Medicaid, and New York has consistently included all medically necessary abortions in its State Medicaid program (Social Services Law § 365-a[2], [5][b]; 18 NYCRR 505.2[e].

In 1987, Congress created PCAP to afford Federal reimbursement to States providing prenatal care and related services for needy pregnant women with household incomes exceeding the Medicaid eligibility standard (see, Omnibus Budget Reconciliation Act of 1987, Pub.L. 100-203, § 4101). Every State must offer PCAP to women with incomes at or below 133% of the poverty level, and may extend eligibility up to 185% of the poverty level, without regard to other resources these women may have (see, 42 U.S.C. § 1396a[l][2][A].

Effective January 1, 1990, New York amended its Public Health and Social Services Laws to participate in PCAP, ² offering the maximum coverage for which Federal reimbursement is authorized (L.1989, ch 584). ³ Thus, in New York, a single pregnant woman with annual income between $9,840 and $18,204 is eligible for PCAP, which covers enumerated pregnancy-related services: prenatal risk assessment, prenatal care visits, laboratory services, parental health education, referrals for pediatric care and nutrition services, mental health and related social services, transportation to and from appointments, labor and delivery, postpregnancy services such as family planning, inpatient care, dental services, emergency room services, home care and pharmaceuticals (Public Health Law § 2522[1][a]-[o].

PCAP does not provide funding for an abortion, or transportation to or from an abortion. ⁴ An eligible woman who elects to have an abortion, however, may receive all other covered pregnancy and postpregnancy services. PCAP coverage continues, without regard to a change in income, for 60 days after the month in which the pregnancy terminates, even if by abortion (see, Public Health Law § 2521[3].

While Medicaid eligibility generally depends upon verification of the application (see, Social Services Law § 366-a[2], a pregnant woman applying for PCAP is immediately presumed eligible upon a preliminary showing to a qualified provider that her household income falls below 185% of the poverty level (see, Public Health Law § 2529[2]. Similarly, Medicaid applicants are required to exhaust certain household resources for eligibility (see, Social Services Law § 366[2], while PCAP applicants need only satisfy the income requirement (see, Public Health Law § 2521[3]; Social Services Law § 366[4][o][2]. These differences are rooted in the exigencies attendant upon the need for prenatal care.

As was made explicit at the time of New York's adoption of PCAP, the available benefits are tailored to the statutory objective of combatting the State's "unacceptably high rate of low birthweight and infant mortality"--reportedly higher than the national average--and increasing healthy births by ensuring adequate prenatal care to pregnant women who, although not indigent, are deemed less likely to spend their available resources to obtain good prenatal care (see, Mem. of State Exec. Dept., 1989 McKinney's Session Laws of N.Y., at 2218). Studies have documented the correlation between infant mortality and neurological abnormalities on the one hand, and low birthweight and premature birth on the other--conditions ameliorated by proper care throughout pregnancy, which can be costly (see, e.g., House Report No. 99-727 to Pub.L. 99-509, at 99, reprinted in 1986 U.S. Code Cong. & Admin. News 3607, 3689). PCAP unquestionably is highly effective in meeting its objective.

Proceedings Below

In September 1990, plaintiffs, led by PCAP-eligible women Jane Hope and Jane Moe, ⁵ commenced this action against the Commissioners of Social Services and Health seeking a preliminary injunction against implementation of the PCAP program to the extent it excludes funding for medically necessary abortions, and a declaration that PCAP-eligible women are entitled to such funding.

Citing evidence that abortions in New York cost between $200 and $3,500 (depending on the facility and the stage of pregnancy), plaintiffs alleged that PCAP-eligible women are otherwise unable to afford abortions. Jane Hope, age 19, was then a PCAP-eligible pregnant woman advised by her doctor that an abortion was medically necessary, and unable to afford the procedure on her earnings of $230 per week. Jane Moe was income eligible under PCAP and, although not pregnant at that time, is a carrier of a fatal genetic defect that would compel her to have an abortion if she were to become pregnant.

Defendants cross-moved for summary judgment declaring the constitutionality of chapter 584. Supreme Court granted the injunction, holding that PCAP violates the Due Process (N.Y. Const., art. I, § 6), Equal Protection (N.Y. Const., art. I, § 11), Aid to the Needy (N.Y. Const., art. XVII, § 1) and Public Health (N.Y. Const., art. XVII, § 3) Clauses of the State Constitution by affirmatively and impermissibly pressuring women to choose childbirth over abortion. The court considered and rejected plaintiffs' additional argument that PCAP impinges upon the free exercise of religion under the State Constitution (N.Y. Const., art. I, § 3), a holding not challenged on appeal. Instead of invalidating PCAP as underinclusive, Supreme Court enlarged the beneficial statute to include medically necessary abortions, staying its order pending appellate review. The Appellate Division affirmed (the Presiding Justice dissenting), agreeing with the trial court that the statute was unconstitutional because it coerced, steered or pressured low-income women into choosing childbirth, thus abridging their fundamental right to choose.

Because a substantial constitutional question is directly involved, defendants appeal as of right (see, CPLR 5601[b][1]. We granted leave to intervenor-respondent Alma Poindexter, a PCAP recipient.

Analysis

Analysis begins by articulating the common ground. Plainly, PCAP satisfies Federal constitutional...