## Facts

- Connecticut participated in Medicaid and paid medical expenses incident to pregnancy and childbirth for eligible indigent women.
- After abortion was constitutionally protected in early pregnancy, Connecticut adopted a welfare regulation limiting Medicaid payments for first-trimester abortions to those certified as “medically necessary.”
- The regulation excluded coverage for nontherapeutic (elective) abortions while continuing to cover childbirth-related costs.
- Two indigent pregnant women unable to obtain the required medical-necessity certification, and a physician providing abortions, challenged the regulation under the Fourteenth Amendment.
- A three-judge federal district court ruled the regulation unconstitutional under the Equal Protection Clause and enjoined its enforcement.
- The state appealed directly to the U.S. Supreme Court.

## Issues

1. Whether the Equal Protection Clause requires a state Medicaid program that funds childbirth-related medical care to also fund nontherapeutic first-trimester abortions for indigent women.
2. Whether denying Medicaid payment for elective abortions, while funding childbirth, impermissibly burdens the constitutional right to choose abortion recognized in Roe.
3. What level of scrutiny applies to a funding classification affecting indigent women’s access to abortion services.
4. Whether procedural requirements for abortion funding (prior written request and prior authorization conditioned on medical necessity) are constitutionally permissible.

## Decision

- The Supreme Court reversed, upholding the Connecticut regulation.
- The Court held that the Equal Protection Clause does not require a state to fund nontherapeutic abortions merely because it funds childbirth-related care.
- The Court concluded the regulation did not impinge the abortion right recognized in Roe because it did not create a legal obstacle to obtaining an abortion; it reflected a choice not to subsidize that option.
- The Court applied rational basis review because indigency is not a suspect classification and there is no fundamental right to state funding of abortion.
- The Court held the medical-necessity limitation and related administrative requirements (prior written request and prior authorization) were reasonable mechanisms to ensure public funds were spent only for authorized purposes.

## Legal Principles

- A constitutional right to choose abortion is a right against unwarranted governmental intrusion, not a right to have the government finance the exercise of that choice.
- Indigency is not a suspect class for equal protection purposes; economic disadvantage alone does not trigger heightened scrutiny.
- A state may make a value judgment favoring childbirth over abortion and may implement that preference through selective public funding, so long as it does not directly restrict access to abortion.
- When no suspect class or fundamental right is burdened by the challenged classification, the regulation is assessed under rational basis review and upheld if rationally related to legitimate state interests.
- A state may condition Medicaid payment for abortions on a prior showing of medical necessity and may require prior written request and prior authorization to administer the funding program.

## Conclusion

The Court held that Connecticut could fund childbirth-related Medicaid services while declining to pay for elective first-trimester abortions, because equal protection does not obligate the state to subsidize abortion and the funding choice was subject to, and satisfied, rational basis review.


Maher v. Roe, 432 U.S. 464 (1977)