Rewritten Opinion: Does v. Gillespie

The question presented is whether to affirm an injunction prohibiting a state department of health from suspending Medicaid payments to Planned Parenthood of the Heartland (PPH) for health services rendered to Medicaid beneficiaries when the department based its suspension on PPH’s “values” and/or association with distinct entities. The injunction rests on beneficiaries’ 42 U.S.C. § 1983 claim that the Arkansas Department of Human Services (ADHS) violated the Medicaid Act’s free-choice-of-provider provision, 42 U.S.C. § 1396a(a)(23)(A) (Section 23(A)). Accordingly, we must first resolve whether beneficiaries have standing to bring such a claim. The free-choice-of-provider provision guarantees Medicaid beneficiaries the right to choose any willing and qualified provider. Congress included this provision in the Medicaid Act to ensure that beneficiaries have the freedom to choose among available providers, just as individuals with private insurance do. Ctrs. for Medicare and Medicaid Servs., CMS Manuals Pub. No. 45 The State Medicaid Manual, § 2100 (last modified Sept. 8, 2005). The Supreme Court has held that Section 23(A) gives beneficiaries the “absolute right” to choose among qualified providers “without governmental interference.” O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773, 785 (1980). Today, this Court joins the Fifth, Sixth, Seventh and Ninth Circuits in holding that, when a State abridges the free-choice-of-provider right, beneficiaries may challenge that State action under 42 U.S.C. § 1983. Recognizing a private right of enforcement for beneficiaries is essential to fulfill the purposes of the Medicaid Act. Congress enacted Medicaid to provide health care to individuals of limited means and “to help [such individuals] attain or retain capability for independence and self-care.” 42 U.S.C. § 1396-1. Unfortunately, this great country has a long and ignoble history of advancing laws and policies that relegate traditionally marginalized populations to inequitable health outcomes. See, e.g., Sec’y Advisory Comm. on Nat’l Health Promotion and Disease Prevention Objectives for 2020, U.S. Dept. of Health and Human Servs., Phase I Reports: Recommendations for the Framework and Format of Healthy People 2020, 28 (Oct. 28, 2008) (explaining that “[h]ealth disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics linked to discrimination and exclusion”); see also, Angela K. McGowan et. al, Civil Rights Laws as Tools to Advance Health in the Twenty-First Century, 37 Ann. Rev. Pub. Health 185, 188 (2016) (“[H]ealth disparities and discrimination are still pervasive in the United States”). ADHS’ politically motivated termination of PPH from its Medicaid program appears to fit within this inglorious tradition. PPH’s termination jeopardizes the health of low-income individuals by eliminating beneficiaries’ option to seek services from a unique, preferred provider in order to make a statement against abortion. ADHS contends that those sacrificed should not have access to the courts, that is, the power to vindicate their free-choice-of-provider rights. We disagree. Accountability offers an essential tool to counter marginalization and to combat health disparities. Denying beneficiaries a private right of action would perpetuate structural violence. In light of the Medicaid Act’s purposes and Section 23(A)’s unambiguous rights-conferring language, we affirm the district court’s determination that beneficiaries have standing to bring 42 U.S.C. § 1983 claims to enforce their free-choice-of-provider right. We likewise affirm the district court’s grant of a preliminary injunction enjoining ADHS from suspending Medicaid payments to PPH for covered services rendered to Medicaid beneficiaries. See Dataphase Sys. Inc. v. CL Sys., 640 F.2d 109, 114 (8th Cir. 1981) (providing the four-factor test for injunctive relief); Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 20 (2008) (same). Without such an injunction, Arkansas beneficiaries are likely to suffer irreparable harm. Eliminating PPH as a Medicaid provider will disrupt provider-patient relationships and unjustifiably decrease the quantity of available providers. It also would abolish beneficiary access to a unique provider that offers non-judgmental, culturally competent care as well as a wider range of services, significantly shorter wait times, and more patient-centered practices relative to other providers. Depriving Medicaid beneficiaries of provider choice undervalues these individuals and runs counter to Medicaid’s goal of available, accessible, acceptable, and quality health care. Beneficiaries also have established a likelihood of success on the merits. ADHS’ termination of PPH from Arkansas Medicaid for reasons unrelated to PPH’s competency to provide medical services constitutes unlawful governmental interference with beneficiaries’ free-choice-of-provider right. Under the circumstances, the balance of the equities and hardships favor the beneficiaries and the injunction is in the public interest. The district court properly granted an injunction, safeguarding Medicaid beneficiaries’ federally conferred free-choice-of-provider right.