Planned Parenthood of St. Louis Region v. Dep't of Soc. Servs.

• Decision Date: 30 June 2020
• Docket Number: No. SC 98020,SC 98020
• Parties: PLANNED PARENTHOOD OF ST. LOUIS REGION, et al., Respondents, v. DEPARTMENT OF SOCIAL SERVICES, DIVISION OF MEDICAL SERVICES, et al., Appellants.
• Court: Missouri Supreme Court

602 S.W.3d 201

PLANNED PARENTHOOD OF ST. LOUIS REGION, et al., Respondents,

v.DEPARTMENT OF SOCIAL SERVICES, DIVISION OF MEDICAL SERVICES, et al., Appellants.

No. SC 98020

Supreme Court of Missouri, en banc.

Opinion issued June 30, 2020

The state was represented by Solicitor General D. John Sauer, Deputy Solicitor General Peter T. Reed, Caleb M. Lewis and Ian Hauptli of the attorney general's office in Jefferson City, (573) 751-3321.

Planned Parenthood was represented by Charles W. Hatfield, Alixandra S. Cossette and Alexander C. Barrett of Stinson LLP in Jefferson City, (573) 636-6263.

Paul C. Wilson, 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 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.

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

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 court taxed costs against MO HealthNet, and MO HealthNet challenges both of these determinations in its appeal to this Court.

Analysis

"Constitutional challenges to a statute are reviewed de novo. " Calzone v. Interim Comm'r of Dep't of Elementary & Secondary Educ. , 584 S.W.3d 310, 315 (Mo. banc 2019) (quotation marks omitted). An act of the General Assembly "approved by the governor carries with it a strong presumption of constitutionality." Hammerschmidt v. Boone County , 877 S.W.2d 98, 102 (Mo. banc 1994). "A state legislative body has the power to enact any law not prohibited by the constitution, and the state constitution, unlike the federal constitution which is a grant of powers, is a limitation on legislative power." State ex inf. Danforth v. Merrell , 530 S.W.2d 209, 213 (Mo. banc 1975). "This Court will resolve doubts in favor of the procedural and substantive validity of an act of the legislature." Hammerschmidt , 877 S.W.2d at 102. "Attacks against legislative action founded on constitutionally imposed procedural limitations are not favored; [this Court] ascribe[s] to the General Assembly the same good and praiseworthy motivations as inform our decision-making processes." Id. The challenger bears the burden of establishing that an act of the General Assembly is unconstitutional. Calzone , 584 S.W.3d at 315. The Court will uphold the constitutional validity of an act passed by the General Assembly unless the act "clearly and undoubtedly" violates a constitutional limitation. Hammerschmidt , 877 S.W.2d at 102.

Article III, section 23 provides, "No bill shall contain more than one subject which shall be clearly expressed in its title, except bills enacted under the third exception in section 37 of this article and general appropriation bills, which may embrace the various subjects and accounts for which moneys are appropriated." In other words, section 23 prohibits bills with more than one subject but allows a narrow exception to that prohibition for appropriation bills because such bills necessarily include multiple subjects, i.e., appropriations of differing amounts from differing accounts for differing subjects.

But to keep the narrow exception for "general appropriation bills" from swallowing the broad prohibition against bills containing multiple subjects, this Court has long recognized that this exception in article III, section 23 "limits appropriation bills to appropriations only ." Rolla 31 Sch. Dist. v. State , 837 S.W.2d 1, 4 (Mo. banc 1992) (emphasis added). In other words, any bill that purports to combine appropriations with the enactment or amendment of general or substantive law necessarily contains more than one subject in violation of article III, section 23, and such a bill does not fall within the exception for "general appropriation bills." See State ex rel. Davis v. Smith , 335 Mo. 1069, 75 S.W.2d 828, 830 (Mo. banc 1934) ("There is no doubt but what the amendment of a general statute such as section 13525, and the mere appropriation of money are two entirely different and separate subjects.").

In State ex rel. Hueller v. Thompson , 316 Mo. 272, 289 S.W. 338, 340-41 (Mo. banc 1926), this Court explained:

An appropriation bill is just what the terminology imports, and no more. Its sole purpose is to set aside moneys for specified purposes, and the lawmaker is not directed to expect or look for anything else in an appropriation bill except appropriations. As to these he is charged by the Constitution to look and watch for two things: (a) The various subjects of the bill; and (b) the account or accounts for which the payment of the state's moneys are being set apart. The same section and article of the

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