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
- 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.
- Whether denying Medicaid payment for elective abortions, while funding childbirth, impermissibly burdens the constitutional right to choose abortion recognized in Roe.
- What level of scrutiny applies to a funding classification affecting indigent women’s access to abortion services.
- 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.