Case Name: Jane Hope et al., on Behalf of Themselves and All Others Similarly Situated, et al., Respondents, v. Cesar Perales, as Commissioner of the New York State Department of Social Services, et al., Appellants. Alma Poindexter, Intervenor-Respondent
Court: New York Court of Appeals
Jurisdiction: New York
Decision Date: 1994-05-05
Citations: 83 N.Y.2d 563
Docket Number: 
Parties: Jane Hope et al., on Behalf of Themselves and All Others Similarly Situated, et al., Respondents, v Cesar Perales, as Commissioner of the New York State Department of Social Services, et al., Appellants. Alma Poindexter, Intervenor-Respondent.
Judges: 
Reporter: New York Reports
Volume: 83
Pages: 563–578

Head Matter:
[634 NE2d 183, 611 NYS2d 811]
Jane Hope et al., on Behalf of Themselves and All Others Similarly Situated, et al., Respondents, v Cesar Perales, as Commissioner of the New York State Department of Social Services, et al., Appellants. Alma Poindexter, Intervenor-Respondent.
Argued January 13, 1994;
decided May 5, 1994
POINTS OF COUNSEL
G. Oliver Koppell, Attorney-General, New York City (Judy E. Nathan, Jerry Boone and Howard L. Zwickel of counsel), for appellants.
I. Prenatal Care Assistance Program (PCAP) satisfies the requirements of the New York State Constitution. (Planned Parenthood of Southeastern Pa. v Casey, 505 US —, 112 S Ct 2791; Harris v McRae, 448 US 297; Maher v Roe, 432 US 464; Cooper v Morin, 49 NY2d 69, cert denied sub nom. Lombard v Cooper, 446 US 984; Planned Parenthood Fedn. v Agency for Intl. Dev., 915 F2d 59; Klostermann v Cuomo, 61 NY2d 525; Pharmaceutical Mfrs. Assn. v Whalen, 54 NY2d 486; D’Angelo v Cole, 67 NY2d 65; Health Ins. Assn. v Hartnett, 44 NY2d 302; Hymowitz v Lilly & Co., 73 NY2d 487, 493 US 944.) II. The order, if otherwise affirmed, should be modified to provide the Legislature with a reasonable time to address the defect in the statute. (People v Liberta, 64 NY2d 152; Klostermann v Cuomo, 61 NY2d 525; State Div. of Human Rights [Geraci] v New York State Dept. of Correctional Servs., 90 AD2d 51.)
Catherine Weiss, New York City, Donna Lieberman, Yueh-ru Chu, Robert M. Levy, Louise Melling, Cleary, Gottlieb, Steen & Hamilton (Deborah M. Buell, Donna Costa, Ayala Deutsch, Stephanie Cotsirilos, Anne H. Erskine and Marcia L. Narine of counsel), Janet Benshoof, Catherine Albisa and Hollyer, Brady, Smith, Troxell, Barrett, Rockett, Hines & Mone (Laurie R. Rockett of counsel), for respondents. I.
The court below properly held that the New York Constitution provides broad and independent protection for reproductive choice as a fundamental right. (Matter of Doe v Coughlin, 71 NY2d 48, 488 US 879; People v Onofre, 51 NY2d 476, 451 US 987; Cooper v Morin, 49 NY2d 69, cert denied sub nom. Lombard v Cooper, 446 US 984; Rivers v Katz, 67 NY2d 485; Schloendorff v Society of N. Y. Hosp., 211 NY 125; Thornburgh v American Coll, of Obstetricians & Gynecologists, 476 US 747; Planned Parenthood of Southeastern Pa. v Casey, 505 US —, 112 S Ct 2791; Matter of Klein, 145 AD2d 145, 73 NY2d 705; Steinhoff v Steinhoff, 140 Misc 2d 397; Matter of Mary P., 111 Misc 2d 532.) II. The court below properly held that the exclusion of medically necessary abortions from coverage under chapter 584 violates the fundamental State constitutional right of reproductive choice. (Matter of City of New York v Wyman, 30 NY2d 537; People ex rel. Arcara v Cloud Books, 65 NY2d 324; Humphrey v State of New York, 60 NY2d 742; Zuckerman v City of New York, 49 NY2d 557; Indig v Finkelstein, 23 NY2d 728; Sable Communications of Cal. v Federal Communications Commn., 492 US 115; Rivers v Katz, 67 NY2d 485; Pharmaceutical Mfrs. Assn. v Whalen, 54 NY2d 486; Williamson v Lee Opt. Co., 348 US 483.) III. The court below properly held that the exclusion of medically necessary abortions from coverage under chapter 584 violates the Equal Protection Clause of the New York Constitution. (Phelan v City of Buffalo, 54 AD2d 262; Dorsey v Stuyvesant Town Corp., 299 NY 512, 339 US 981; Golden v Clark, 76 NY2d 618.) IV. The court below properly held that the exclusion of medically necessary abortions from coverage under chapter 584 violates article XVII of the New York Constitution. (Tucker v Toia, 43 NY2d 1; Matter of Jones v Blum, 101 AD2d 330, 64 NY2d 918; Matter of Bernstein v Toia, 43 NY2d 437; Co-Pilot Enters, v Suffolk County Dept. of Health, 38 Misc 2d 894; Matter of Conlon v Marshall, 185 Misc 638.) V. The court below properly held that extension is the appropriate remedy for chapter 584’s underinclusiveness. (People v Liberta, 64 NY2d 152; Matter of Jessie C., 164 AD2d 731, 78 NY2d 907; Soto-Lopez v New York City Civ. Serv. Commn., 755 F2d 266, affd sub nom. Attorney-Gen. of N. Y. v Soto-Lopez, 476 US 898; People ex rel. Alpha Portland Cement Co. v Knapp, 230 NY 48, cert denied sub nom. State Tax Commr. v People ex rel. Alpha Portland Cement Co., 256 US 702; People v Mancuso, 255 NY 463; Matter of Westinghouse Elec. Corp. v Tully, 63 NY2d 191; Doyle v Suffolk County, 786 F2d 523, 479 US 825; United States v Jackson, 390 US 570; Alliance of Am. Insurers v Chu, 77 NY2d 573; Flushing Natl. Bank v Municipal Assistance Corp., 40 NY2d 731.)
Michael P. Tierney, New York City, for intervenor-respondent.
I. No one has a greater stake in the outcome of this appeal than Ms. Alma Poindexter. (Matter of Ginsberg v Lomenzo, 23 NY2d 94; Loretto v Teleprompter Manhattan CATV Corp., 53 NY2d 124; Perl v Aspromonte Realty Corp., 143 AD2d 824; Matter of Village of Spring Val. v Village of Spring Val. Hous. Auth., 33 AD2d 1037; Matter of Norstar Apts. v Town of Clay, 112 AD2d 750; Vantage Petroleum v Board of Assessment Review, 61 NY2d 695; Matter of Dumbleton v Reed, 40 NY2d 586; Harrison v Bain Estates, 2 Misc 2d 52, 2 AD2d 670.) II. There is no fundamental right to abortion under the New York State Constitution. (Matter of City of New York v Wyman, 30 NY2d 537; Byrn v New York City Health & Hosps. Corp., 31 NY2d 194; Matter of Gloria C. v William C., 124 Misc 2d 313; Khan v Hip Hosp., 127 Misc 2d 1063; Planned Parenthood of Southeastern Pa. v Casey, 505 US —, 112 S Ct 2791; Webster v Reproductive Health Servs., 492 US 490; Harris v McRae, 448 US 297, 917; Matter of Bernstein v Toia, 43 NY2d 437; Matter of Barie v Lavine, 40 NY2d 565.) III. The lower courts exceeded their power in purporting to cure an alleged constitutional defect in PCAP by rewriting the act to provide funding for abortions. (People v Dietze, 75 NY2d 47; Matter of Smiley, 36 NY2d 433; Bright Homes v Wright, 8 NY2d 157; People v Liberta, 64 NY2d 152, 471 US 1020; People v Strassner, 299 NY 325; Matter of Tormey v La Guardia, 278 NY 450; Childs v Childs, 69 AD2d 406, 446 US 901.) IV. The decisions of the courts below directing funding of abortions under PCAP are barred by the Supremacy Clause of the United States Constitution. (Lewis v Grinker, 794 F Supp 1193, 965 F2d 1206; International Paper Co. v Ouellette, 479 US 481; Environmental Encapsulating Corp. v New York City, 855 F2d 48.)
John J. O’Brien, Menands, for New York State Right to Life Committee, Inc., amicus curiae.
I. The Due Process Clause of the New York State Constitution does not require the State to fund abortions. (Maher v Roe, 432 US 464; Harris v McRae, 448 US 297; State of New York v Bowen, 690 F Supp 1261, affd sub nom. State of New York v Sullivan, 889 F2d 401; Planned Parenthood Fedn. v Agency for Intl. Dev., 915 F2d 59; Maresca v Cuomo, 64 NY2d 242; Wiggins v Town of Somers, 4 NY2d 215; Byrn v New York City Health & Hosps. Corp., 31 NY2d 194.) II. PCAP does not violate the Equal Protection Clause of the New York State Constitution. (Dorsey v Stuyvesant Town Corp., 299 NY 512, 339 US 981; Matter of Doe v Coughlin, 71 NY2d 48, 488 US 879; Maresca v Cuomo, 64 NY2d 242; Golden v Clark, 76 NY2d 618.)
John D. Murnane, New York City, and Joseph W. Dellapenna, of the Pennsylvania Bar, admitted pro hac vice, for the
American Academy of Medical Ethics, amicus curiae.
I. New York’s constitutional guarantees of due process and equal protection embody values discoverable from the history and traditions of the people of New York. (Ginsberg v Purcell, 51 NY2d 272; New York Pub. Interest Research Group v Steingut, 40 NY2d 250; McCulloch v Maryland, 4 Wheat [17 US] 316; Bowers v Hardwick, 478 US 186; Michael H. v Gerald D., 491 US 110; Burnham v Superior Ct. of Cal., 495 US 604; Moore v City of E. Cleveland, 431 US 494; People v Molina, 121 Misc 2d 483; City of New York v Wyman, 66 Misc 2d 402, 37 AD2d 700, 30 NY2d 537; Byrn v New York City Health & Hosps. Corp., 38 AD2d 316, 31 NY2d 194.) II. Claims of a constitutionally protected right to abortion are based upon erroneous notions of the historical status of abortion under the common law and represent a sharp break with long-established traditions and values expressed in the common law and New York’s Constitution. (Evans v People, 49 NY 86; Byrn v New York City Health & Hosps. Corp., 38 AD2d 316, 31 NY2d 194.) III. The Legislature and the people are the proper fora for resolving the competing claims of mothers and their offspring. (Akron v Akron Ctr. for Reproductive Health, 462 US 416.)
Michael L. Costello, Albany, Richard E. Barnes, Clarke D. Forsythe, Paul Benjamin Linton, Alan J. Placa, Mildred A. Shanley, William J. Toohy and Eileen M. White for the New York State Catholic Conference, amicus curiae.
I. The PCAP meets the compelling need of New York’s low-income mothers and their children to receive adequate prenatal care, the unavailability of which has resulted in New York having one of the worst infant and maternal health records in the United States. II. The Due Process Clause of the New York Constitution (art I, § 6) does not encompass a right to a publicly funded abortion. (Byrn v New York City Health & Hosps. Corp., 31 NY2d 194; Matter of City of New York v Wyman, 30 NY2d 537; Cooper v Morin, 49 NY2d 69; People v Scott, 79 NY2d 474; Matter of Doe v Coughlin, 71 NY2d 48, 488 US 879; Turner v Safley, 482 US 78; Rivers v Katz, 67 NY2d 485.) III. PCAP does not violate the Equal Protection Clause of the New York Constitution (art I, § 11) because it does not burden a fundamental right or discriminate against a protected class of persons. (Under 21 v City of New York, 65 NY2d 344; Matter of Esler v Walters, 56 NY2d 306; Matter of Long Is. Light. Co. v Assessor of Town of Brookhaven, 154 AD2d 188; Golden v Clark, 76 NY2d 618; Matter of Davis, 57 NY2d 382; Dandridge v Williams, 397 US 471.) IV. PCAP is consistent with New York’s duty to care for the needy and to protect the public health under article XVII, §§ 1 and 3 of the New York Constitution. (Tucker v Toia, 43 NY2d 1; Matter of Lee v Smith, 43 NY2d 453; Matter of Bernstein v Toia, 43 NY2d 437; Jiggetts v Grinker, 148 AD2d 1, 75 NY2d 411; Boreali v Axelrod, 71 NY2d 1.) V. The lower courts exceeded their authority in rewriting PCAP to include abortion funding. (Childs v Childs, 69 AD2d 406, 446 US 901.)
Berle, Kass & Case, New York City (Jean M. McCarroll and Deborah Goldberg of counsel), for the American Ethical Union and others, amici curiae.
I. New York has a long tradition of commitment to religious liberty. (Matter of Engel v Vitale, 10 NY2d 174; Matter of Rivera v Smith, 63 NY2d 501; Holland v Alcock, 108 NY 312; Matter of O’Neill v Hubbard, 180 Misc 214; Matter of Brown v McGinnis, 10 NY2d 531; Smith v Donahue, 202 App Div 656; People v Lewis, 115 AD2d 597, 68 NY2d 923; Overton v Department of Correctional Servs., 131 Misc 2d 295, affd sub nom. Overton v Coughlin, 133 AD2d 744, 72 NY2d 838; Matter of Fosmire v Nicoleau, 75 NY2d 218.) II. New York’s tradition of religious liberty requires protection of the right of reproductive choice.
Vladeck, Waldman, Elias & Engelhard, P. C, New York City (Denny Chin and Anne L. Clark of counsel), for Amalgamated Clothing & Textile Workers Union and others, amici curiae.
I. Chapter 584 violates article XVII, § 1 of the New York State Constitution. (Tucker v Toia, 43 NY2d 1; Minino v Perales, 168 AD2d 289, 79 NY2d 883.) II. Chapter 584 violates article XVII, § 3 of the New York State Constitution. (Tucker v Toia, 43 NY2d 1; Matter of Conlon v Marshall, 185 Misc 638, 271 App Div 972; Co-Pilot Enters, v Suffolk County Dept. of Health, 38 Misc 2d 894; Matter of Levine v Whalen, 39 NY2d 510.)
Arnold & Porter, New York City (Peter G. Neiman of counsel), and Martha F. Davis for the NOW Legal Defense and Education Fund and others, amici curiae.
I. The Equal Protection Clause of the New York State Constitution is stronger than its Federal counterpart. (Hope v Perales, 150 Misc 2d 985, 189 AD2d 287; People v Scott, 79 NY2d 474; Cooper v Morin, 49 NY2d 69, cert denied sub nom. Lombard v Cooper, 446 US 984; People v Barber, 289 NY 378; People ex rel. Arcara v Cloud Books, 68 NY2d 553; Dorsey v Stuyvesant Town Corp., 299 NY 512, 339 US 981; People v Bing, 76 NY2d 331; Burnett v Coronada Oil & Gas Co., 285 US 393; People v Harris, 77 NY2d 434.) II. Chapter 584’s abortion exclusion violates the Equal Protection Clause of the New York Constitution. (Geduldig v Aiello, 417 US 484; General Elec. Co. v Gilbert, 429 US 125; Elaine W. v Joint Diseases N. Gen. Hosp., 81 NY2d 211; Brooklyn Union Gas Co. v New York State Human Rights Appeal Bd., 41 NY2d 84; Union Free School Dist. No. 6 v New York State Human Rights Appeal Bd., 35 NY2d 371; Board of Educ. v New York State Div. of Human Rights, 42 AD2d 49, 35 NY2d 673; People v Santorelli, 80 NY2d 875; Greschler v Greschler, 71 AD2d 322, 51 NY2d 368; Thaler v Thaler, 89 Misc 2d 315, 58 AD2d 890; People v Moss, 80 Misc 2d 633.)
Kramer, Levin, Naftalis, Nessen, Kamin & Frankel, New York City (Marvin E. Frankel and Jeffrey S. Trachtman of counsel), Haywood Bums, Janet Gallagher, George Wheeler Madison, Katherine Kennedy, Alesia Selby Regan, Sandra C. Katz and Bonnie S. Edwards for Association of the Bar of the
City of New York and others, amici curiae.
I. This Court should analyze the New York constitutional right of reproductive choice independently of Federal constitutional guarantees. (People v Kohl, 72 NY2d 191; Barron v Mayor & City Council of Baltimore, 7 Pet [32 US] 243; People v Scott, 79 NY2d 474; Ives v South Buffalo Ry. Co., 201 NY 271; People v West, 81 NY2d 370; People v Skinner, 52 NY2d 24; People v Alvarez, 70 NY2d 375; People ex rel. Arcara v Cloud Books, 68 NY2d 553; People v Barber, 289 NY 378; People v Harris, 77 NY2d 434.) II. The New York Constitution provides a right of reproductive choice more protective than the corresponding Federal right. (People v P. J. Video, 68 NY2d 296; People v Harris, 77 NY2d 434; Rivers v Katz, 67 NY2d 485; Immuno AG. v Moor-Jankowski, 11 NY2d 235; Matter of Doe v Coughlin, 71 NY2d 48, 488 US 879; Olmstead v United States, 277 US 438; Cooper v Morin, 49 NY2d 69, cert denied sub nom. Lombard v Cooper, 446 US 984; People v Hollman, 79 NY2d 181; People v Onofre, 51 NY2d 476; Thoreson v Penthouse Inti., 149 Misc 2d 150, 179 AD2d 29.) III. The funding exclusion of chapter 584 impermissibly burdens a woman’s fundamental State right of reproductive choice. (People v Harris, 11 NY2d 434; Rivers v Katz, 67 NY2d 485; Cooper v Morin, 49 NY2d 69; Brown v Board of Educ., 347 US 483; O’Neill v Oakgrove Constr., 71 NY2d 521.)
Paul A. Crotty, Corporation Counsel of New York City (Lama Bade Goodman and Meredith Anne Feinman of counsel), for the City of New York, amicus curiae.
I. Reproductive choice is a fundamental right which is protected in New York by State constitutional principles of privacy and bodily autonomy. (Rivers v Katz, 67 NY2d 485; Cooper v Morin, 49 NY2d 69; People v Onofre, 51 NY2d 476; Byrn v New York City Health & Hosps. Corp., 31 NY2d 194; Harris v McRae, 448 US 297.) II. Chapter 584’s abortion exclusion violates due process by unconstitutionally burdening a woman’s fundamental right to reproductive freedom. (Harris v McRae, 448 US 297; Cooper v Morin, 49 NY2d 69; Rivers v Katz, 67 NY2d 485; Tucker v Toia, 89 Misc 2d 116, 43 NY2d 1.) III. Chapter 584’s abortion exclusion violates the Equal Protection Clause of the New York State Constitution. (Memorial Hosp. v Maricopa County, 415 US 250; Phelan v City of Buffalo, 54 AD2d 262.)
Michelle Oberman, of the Illinois Bar, admitted pro hac vice, for AIDS Community Services of Western New York and others, amici curiae.
Chapter 584’s discriminatory abortion exclusion impermissibly pressures women eligible for PCAP’s services to carry to term even at the expense of their health and lives. (Harris v McRae, 448 US 297.)

Opinion:
OPINION OF THE COURT
Chief Judge Kaye.
At issue is the validity, under the State Constitution, of New York's Prenatal Care Assistance Program (PCAP) (Public Health Law § 2520 et seq.). Plaintiffs claim that the statute is facially unconstitutional by reason of underinclusiveness, for its failure to include medically necessary abortions in a prenatal care public funding scheme for women with incomes up to 85% over the Federal poverty level (meaning annual income for a single pregnant woman of between $9,840 and $18,204). We now reverse the Appellate Division order and declare the statute constitutional.
The Statute in Issue
New York's PCAP statute is best understood against the backdrop of related programs.
Medicaid was created by Congress in 1965 to provide Federal reimbursement to participating States for a portion of the cost of all medically necessary services for qualified individuals. Medicaid eligibility is determined by financial need, ultimately assessed by reference to the Federal poverty level— currently annual income below $9,840 for a single pregnant woman. Federal Medicaid reimbursement is available for abortion only in cases of rape or incest, or to save the life of the mother (see, Pub L 103-112, §509). States may, however, at their own option and expense, offer services additional to those reimbursed under Medicaid, and New York has consis tently included all medically necessary abortions in its State Medicaid program (Social Services Law § 365-a [2], [5] [b]; 18 NYCRR 505.2 [e]).
In 1987, Congress created PCAP to afford Federal reimbursement to States providing prenatal care and related services for needy pregnant women with household incomes exceeding the Medicaid eligibility standard (see, Omnibus Budget Reconciliation Act of 1987, Pub L 100-203, § 4101). Every State must offer PCAP to women with incomes at or below 133% of the poverty level, and may extend eligibility up to 185% of the poverty level, without regard to other resources these women may have (see, 42 USC § 1396a [l] [2] [A]).
Effective January 1, 1990, New York amended its Public Health and Social Services Laws to participate in PCAP, offering the maximum coverage for which Federal reimbursement is authorized (L 1989, ch 584). Thus, in New York, a single pregnant woman with annual income between $9,840 and $18,204 is eligible for PCAP, which covers enumerated pregnancy-related services: prenatal risk assessment, prenatal care visits, laboratory services, parental health education, referrals for pediatric care and nutrition services, mental health and related social services, transportation to and from appointments, labor and delivery, postpregnancy services such as family planning, inpatient care, dental services, emergency room services, home care and pharmaceuticals (Public Health Law § 2522 [1] [a]-[o]).
PCAP does not provide funding for an abortion, or transportation to or from an abortion. An eligible woman who elects to have an abortion, however, may receive all other covered pregnancy and postpregnancy services. PCAP coverage continues, without regard to a change in income, for 60 days after the month in which the pregnancy terminates, even if by abortion (see, Public Health Law § 2521 [3]).
While Medicaid eligibility generally depends upon verifica tian of the application (see, Social Services Law § 366-a [2]), a pregnant woman applying for PCAP is immediately presumed eligible upon a preliminary showing to a qualified provider that her household income falls below 185% of the poverty level (see, Public Health Law § 2529 [2]). Similarly, Medicaid applicants are required to exhaust certain household resources for eligibility (see, Social Services Law § 366 [2]), while PCAP applicants need only satisfy the income requirement (see, Public Health Law § 2521 [3]; Social Services Law § 366 [4] [o] [2]). These differences are rooted in the exigencies attendant upon the need for prenatal care.
As was made explicit at the time of New York's adoption of PCAP, the available benefits are tailored to the statutory objective of combatting the State's "unacceptably high rate of low birthweight and infant mortality" — reportedly higher than the national average — and increasing healthy births by ensuring adequate prenatal care to pregnant women who, although not indigent, are deemed less likely to spend their available resources to obtain good prenatal care (see, Mem of State Exec Dept, 1989 McKinney's Session Laws of NY, at 2218). Studies have documented the correlation between infant mortality and neurological abnormalities on the one hand, and low birthweight and premature birth on the other —conditions ameliorated by proper care throughout pregnancy, which can be costly (see, e.g., House Report No. 99-727 to Pub L 99-509, at 99, reprinted in 1986 US Code Cong & Admin News 3689). PCAP unquestionably is highly effective in meeting its objective.
Proceedings Below
In September 1990, plaintiffs, led by PCAP-eligible women Jane Hope and Jane Moe, commenced this action against the Commissioners of Social Services and Health seeking a preliminary injunction against implementation of the PCAP program to the extent it excludes funding for medically necessary abortions, and a declaration that PCAP-eligible women are entitled to such funding.
Citing evidence that abortions in New York cost between $200 and $3,500 (depending on the facility and the stage of pregnancy), plaintiffs alleged that PCAP-eligible women are otherwise unable to afford abortions. Jane Hope, age 19, was then a PCAP-eligible pregnant woman advised by her doctor that an abortion was medically necessary, and unable to afford the procedure on her earnings of $230 per week. Jane Moe was income eligible under PCAP and, although not pregnant at that time, is a carrier of a fatal genetic defect that would compel her to have an abortion if she were to become pregnant.
Defendants cross-moved for summary judgment declaring the constitutionality of chapter 584. Supreme Court granted the injunction, holding that PCAP violates the Due Process (NY Const, art I, § 6), Equal Protection (NY Const, art I, § 11), Aid to the Needy (NY Const, art XVII, § 1) and Public Health (NY Const, art XVII, § 3) Clauses of the State Constitution by affirmatively and impermissibly pressuring women to choose childbirth over abortion. The court considered and rejected plaintiffs' additional argument that PCAP impinges upon the free exercise of religion under the State Constitution (NY Const, art I, § 3), a holding not challenged on appeal. Instead of invalidating PCAP as underinclusive, Supreme Court enlarged the beneficial statute to include medically necessary abortions, staying its order pending appellate review. The Appellate Division affirmed (the Presiding Justice dissenting), agreeing with the trial court that the statute was unconstitutional because it coerced, steered or pressured low-income women into choosing childbirth, thus abridging their fundamental right to choose.
Because a substantial constitutional question is directly involved, defendants appeal as of right (see, CPLR 5601 [b] [1]). We granted leave to intervenor-respondent Alma Poindexter, a PCAP recipient.
Analysis
Analysis begins by articulating the common ground. Plainly, PCAP satisfies Federal constitutional standards (see, Harris v McRae, 448 US 297, 316-318, and n 19; Maher v Roe, 432 US 464, 474-475). Only the State Constitution is in issue. Moreover, no one disputes that, as every enactment of a coequal branch of government, PCAP is entitled to a strong presumption of constitutionality, and that plaintiffs bear the heavy burden of establishing the contrary beyond a reason able doubt (see, Matter of Klein [Hartnett], 78 NY2d 662, 666, cert denied — US —,. 112 S Ct 1945). It is not the role of the courts to pass upon the wisdom of the Legislature's policy choice, even though there may be differences of views about the decision to exclude a medically necessary service from an otherwise comprehensive prenatal care program.
Similarly, it is undisputed by defendants that the fundamental right of reproductive choice, inherent in the due process liberty right guaranteed by our State Constitution, is at least as extensive as the Federal constitutional right (see, Roe v Wade, 410 US 113, 153-154; Rivers v Katz, 67 NY2d 485, 493; see also, Planned Parenthood of Southeastern Pa. v Casey, 505 US —, —, 112 S Ct 2791, 2816-2817). Nor do defendants challenge New York's long-standing commitment to fund abortions for poor women under the Medicaid program (see, Social Services Law § 365-a [2], [5] [b]; see also, Matter of City of New York v Wyman, 30 NY2d 537, revg on dissent below 37 AD2d 700).
Finally, plaintiffs do not contend that the statute imposes any direct burden, that it makes abortions any less accessible or less affordable for PCAP-eligible women (see, Golden v Clark, 76 NY2d 618, 626; Matter of Schulman v New York City Health & Hosps. Corp., 38 NY2d 234, 240). PCAP-eligible women (who have income above the poverty level and need not exhaust other resources to establish eligibility) are presumptively able to afford abortion, a legislative premise not rebutted on the record before us. As defendants point out, PCAP may even make abortion more affordable for these women as — irrespective of pregnancy outcome — the statute offers free testing for fetal abnormalities that may early in pregnancy indicate the need for (and thereby reduce the cost of) an abortion, mental health and social services, family planning and 60-day postpartum care.
Instead, the heart of plaintiffs' challenge is that by funding certain childbirth services for these women, but not abortion, the Legislature has violated an obligation under the Due Process Clause not to influence the exercise of a fundamental right. Plaintiffs recognize that the fundamental right of reproductive choice does not carry with it an entitlement to sufficient public funds to exercise that right, and that the State is not required to remove burdens, such as indigence, not of its creation. They urge, however, that by failing to include abortions among PCAP entitlements, the statute creates an impermissible inducement for women to carry their pregnancies to term and relinquish their fundamental right of choice.
Plaintiffs have failed to establish their contention that PCAP even indirectly infringes the right of reproductive choice. There is no evidence that eligible women are coerced, pressured, steered or induced by PCAP to carry pregnancies to term. Thus, even if we were to recognize a governmental obligation to stand neutral — an issue we need not and do not reach in this case — no violation of such a requirement has been demonstrated here.
Plaintiffs' contention that a selective allocation of public funds in favor of childbirth over abortion can be an indirect burden on the fundamental abortion right arises from the dissenting opinions of the United States Supreme Court concerning Medicaid funding (see, Harris, 448 US, at 330 [Brennan, J., dissenting] [the "denial of funds for medically necessary abortions plainly intrudes upon this constitutionally protected (abortion) decision, for both by design and in effect it serves to coerce indigent pregnant women to bear children that they would otherwise elect not to have"]; see also, Maher, 432 US, at 484 [Brennan, J., dissenting]). Put succinctly, "[i]t matters not that the Government has used the carrot rather than the stick" (see, Harris, 448 US, at 334 [Brennan, J., dissenting]).
This principle has been embraced by several States as a matter of State constitutional law, invalidating Medicaid funding schemes that exclude medically necessary abortions from comprehensive medical care for the indigent (see, Moe v Secretary of Admin. & Fin., 382 Mass 629, 654-655, 417 NE2d 387, 402 [1981]; Committee to Defend Reproductive Rights v Myers, 29 Cal 3d 252, 270, 284-285, 172 Cal Rptr 866, 876, 885-886, 625 P2d 779, 789, 798-799 [1981]; Right to Choose v Byrne, 91 NJ 287, 307, n 5, 450 A2d 925, 935, n 5 [1982]; Women's Health Ctr. v Panepinto, 446 SE2d 658, 661 [W Va]).
The case before us is significantly different. Unlike an indigent woman, whose option to choose an abortion is arguably foreclosed by her lack of resources, the PCAP-eligible woman — not ordinarily a recipient of State assistance — presumptively has the financial means to exercise her fundamental right of choice. That the Legislature in these circumstances elects to subsidize certain prenatal services cannot, in and of itself, be deemed coercive, and no showing has been made that such a woman would be influenced by PCAP to carry a child to term.
Nor does the statute impermissibly penalize women for exercising their right to choose. In Regan v Taxation with Representation of Wash. (461 US 540, 545), for example, the Supreme Court upheld Congress' refusal to extend a tax deduction to charitable contributions made for lobbying activities, concluding that a mere failure to subsidize the exercise of plaintiffs' right of free speech, even though the deduction was available to those who did not lobby, was constitutionally permissible. Like the regulation in Regan, PCAP simply fails to subsidize abortion. Eligibility for the program does not terminate if a participant aborts her pregnancy, nor does the statute require reimbursement for any services received before abortion. PCAP does not penalize the exercise of the right of choice, as it does not deny eligibility for any benefit to which participants choosing to abort would otherwise be entitled.
We thus conclude that PCAP does not in any sense burden a fundamental right, and accordingly the statute is valid if it bears a rational relationship to the State's interest in providing much-needed prenatal care to low-income women (see, Golden v Clark, 76 NY2d, at 624, supra). Because plaintiffs concede the laudable goals and effectiveness of PCAP in ameliorating infant mortality and morbidity, we conclude that it does satisfy the rational relationship test.
We briefly address plaintiffs' remaining constitutional claims, which arise from the Aid to the Needy (NY Const, art XVII, § 1) and Public Health (NY Const, art XVII, § 3) Clauses of the State Constitution. Plaintiffs urge that PCAP violates those provisions by excluding coverage for medically necessary abortions without regard to the financial or medical need of the participants. This contention fails because, as discussed previously, we are bound to accept the legislative determination that PCAP-eligible women are not indigent or in need of public assistance to meet their medical needs. We cannot infer the contrary from the mere fact that PCAP — aimed neither at the protection of public health nor at the support of the needy —was enacted (see, Tucker v Toia, 43 NY2d 1, 8 [art XVII, § 1 imposes affirmative obligation on the Legislature to aid "those whom it has classified as needy"]).
Moreover, both clauses expressly accord to the Legislature discretion to promote the State's interest in aiding the needy and promoting public health "in such manner, and by such means as the legislature may from time to time determine" (NY Const, art XVII, § 1, 3). We cannot say beyond a reasonable doubt that, by not including abortion funding in PCAP, the Legislature has transgressed its powers.
Accordingly, the order of the Appellate Division should be reversed, with costs, and judgment granted declaring valid chapter 584 of the Laws of 1989.
Judges Simons, Titone, Bellacosa, Smith and Levine concur; Judge Ciparick taking no part.
Order reversed, etc.
. Used throughout are the 1994 Federal poverty figures (59 Fed Reg 6277). Monthly income for PCAP-eligible single women would thus range from $820 to $1,517.
. PCAP replaced New York's pilot Prenatal Care Assistance Program, created in 1987, which authorized the Commissioner of Health to provide grants of State funds to prenatal care service providers (see, L 1987, ch 822). PCAP is funded and administered through the Medicaid program (see, Social Services Law § 366 [4] [n], [o]; § 368-a [1] [,l]).
. In conjunction with PCAP, New York expanded its Medicaid program to provide Medicaid coverage for pregnant women with incomes at or below the Federal poverty level (see, Social Services Law § 366 [4] [m]).
. New York City, at its own expense, provides abortions free of charge to PCAP-eligible women.
. The other plaintiffs are four obstetricians/gynecologists, a nurse-midwife, seven health care clinics serving low-income women, four reproductive rights advocacy organizations and two members of the clergy. Supreme Court determined that Moe and the clergy members lacked standing to bring this action, a conclusion not challenged on appeal.
. [2] While plaintiffs also assert a denial of equal protection, equal protection is at the core of their due process argument, and both challenges fail for much the same reasons.
. This principle may be traced to Sherbert v Verner (374 US 398, 404), in which the Supreme Court invalidated a State provision denying unemployment benefits based on the refusal of a Seventh-day Adventist to accept Saturday work, holding that "the liberties of religion and expression may be infringed by the denial of or placing of conditions upon a benefit or privilege." The Supreme Court itself has limited the neutrality obligation recognized in Sherbert to regulations that infringe on rights arising under the Establishment and Freedom of Religion Clauses of the First Amendment (see, Maher v Roe, 432 US, at 475, n 8).