## Facts

- Indiana enacted HEA 1210, prohibiting state agencies from contracting with or providing state- or federally administered funds to entities that perform abortions or operate facilities where abortions are performed (with a limited hospital exception).
- Planned Parenthood of Indiana, Inc. (PPIN) provided abortion services using non-Medicaid funds and also provided non-abortion health services as an enrolled Indiana Medicaid provider.
- Two Medicaid beneficiaries received non-abortion services from PPIN, and two PPIN medical professionals treated Medicaid patients.
- PPIN also received federal public-health funding administered by Indiana to provide disease-intervention services related to sexually transmitted diseases under 42 U.S.C. § 247c.
- Plaintiffs sued state health and social-services officials, seeking to prevent enforcement of HEA 1210’s funding cutoff as applied to PPIN.
- The court addressed the matter on a motion for preliminary injunction.

## Issues

1. Whether Medicaid beneficiaries have an enforceable right under 42 U.S.C. § 1983 to the Medicaid Act’s “free choice of provider” requirement, 42 U.S.C. § 1396a(a)(23).
2. Whether HEA 1210 likely conflicts with, and is preempted by, the Medicaid Act by disqualifying an otherwise qualified provider based solely on the provider’s performance of abortions with non-Medicaid funds.
3. Whether federal law governing STD-related grants under 42 U.S.C. § 247c likely preempts Indiana’s categorical exclusion of PPIN from receiving those funds based on abortion-related activities.
4. Whether plaintiffs satisfied the requirements for preliminary injunctive relief (likelihood of success, irreparable harm, balance of harms, and public interest).

## Decision

- The court granted a preliminary injunction in part.
- The court enjoined Indiana from enforcing HEA 1210 to terminate PPIN’s Medicaid reimbursement for covered, non-abortion services provided to Medicaid recipients.
- The court enjoined Indiana from enforcing HEA 1210 to exclude PPIN from receiving certain federal STD disease-intervention funding administered by the state under 42 U.S.C. § 247c.
- The court found plaintiffs were likely to succeed on the merits of the Medicaid “free choice of provider” claim and the § 247c preemption claim (as presented at the preliminary-injunction stage).
- The court found irreparable harm to PPIN and its patients, and concluded the balance of harms and public interest favored maintaining access to covered care while the case proceeded.
- The court did not resolve the unconstitutional-conditions theory at this stage because statutory grounds supported interim relief.

## Legal Principles

- The Medicaid Act’s “free choice of provider” provision, 42 U.S.C. § 1396a(a)(23), is framed in mandatory terms and can confer an individually enforceable right on beneficiaries, actionable under 42 U.S.C. § 1983.
- A state may not disqualify a Medicaid provider in a manner that conflicts with federal Medicaid requirements by excluding a provider for reasons unrelated to the provider’s medical competence or legal qualifications to furnish covered services.
- State laws that condition participation in federally funded programs on criteria that conflict with federal program requirements may be preempted under the Supremacy Clause.
- Preliminary injunctive relief requires a showing of likely success on the merits, irreparable harm absent an injunction, and that the balance of harms and the public interest favor relief.

## Conclusion

The court preliminarily barred Indiana from applying HEA 1210 to cut off PPIN’s Medicaid reimbursements and certain federal STD grant funding because plaintiffs were likely to show that the defunding scheme conflicted with federal Medicaid’s free-choice-of-provider requirement and was preempted as applied to the identified federal public-health grant program, and because immediate enforcement threatened irreparable harm to provider operations and patient access to care.


Planned Parenthood of Ind., Inc. v. Comm'r of the Ind. State Dep't of Health, 794 F. Supp. 2d 892 (S.D. Ind. 2011)