## Facts

- New Mexico’s Medicaid program historically funded abortions deemed “medically necessary” under the same general medical-necessity standard used for other covered services.
- The Human Services Department adopted a revised regulation (“Rule 766”) restricting state Medicaid abortion funding to cases of life endangerment, rape, incest, or ectopic pregnancy.
- The rule eliminated funding for abortions physicians determined were medically necessary to protect a woman’s health when the pregnancy did not fall within those narrow categories.
- Medicaid continued to fund medically necessary procedures for men, including procedures unique to male anatomy or reproductive function.
- Reproductive-rights organizations and physicians sued the Secretary of the Human Services Department, seeking declaratory and injunctive relief under the New Mexico Constitution.
- The district court enjoined enforcement of the revised rule and later granted summary judgment for plaintiffs, permanently requiring a nondiscriminatory medical-necessity standard.
- The Secretary appealed; the case was reviewed by the New Mexico Supreme Court.

## Issues

1. Whether restricting Medicaid funding for medically necessary abortions, while funding medically necessary procedures for men under the ordinary standard, constitutes sex discrimination under the New Mexico Equal Rights Amendment.
2. What level of scrutiny applies under the New Mexico Equal Rights Amendment to a governmental classification affecting pregnancy and abortion-related care.
3. Whether the permanent injunction improperly compelled funding decisions beyond the judiciary’s remedial authority.

## Decision

- The New Mexico Supreme Court affirmed summary judgment for plaintiffs and upheld the permanent injunction.
- The Court held the revised rule violated the New Mexico Equal Rights Amendment because it applied a more restrictive medical-necessity standard to women’s pregnancy-related needs than to men’s medical needs.
- The Court applied strict scrutiny to the sex-based classification and concluded the State failed to show a compelling interest for the differential treatment.
- The Court rejected arguments that fiscal concerns or alignment with federal abortion-funding limits justified the discrimination.
- The Court held the injunction was a proper remedy for a constitutional violation and did not exceed the trial court’s authority.

## Legal Principles

- Under the New Mexico Equal Rights Amendment, governmental classifications that treat women differently from men, including classifications tied to pregnancy, are subject to strict scrutiny.
- A Medicaid program violates the state Equal Rights Amendment if it funds “medically necessary” care under one standard for men while using a narrower abortion-specific standard for women, absent a compelling justification.
- Cost containment, standing alone, is not a compelling interest sufficient to justify sex-based discrimination in access to medically necessary care.
- Federal limits on the use of federal Medicaid funds for abortions do not, by themselves, justify state rules withholding state funds in a manner that violates the state constitution.
- Courts may enjoin unconstitutional agency rules and may require nondiscriminatory administration of an existing medical-necessity standard as remedial relief.

## Conclusion

The court held that New Mexico’s restriction on Medicaid funding for medically necessary abortions imposed sex-based unequal treatment under the state Equal Rights Amendment, failed strict scrutiny, and was properly enjoined to require equal application of the medical-necessity standard.


N.M. Right to Choose/NARAL v. Johnson, 975 P.2d 841 (N.M. 1998)