Planned Parenthood of St. Louis Region v. Department of Social Services, Division of Medical Services, 602 S.W.3d 201 (Mo. 2020) (en banc)
By Lucy Downing
I. Introduction
In a six-one decision, the Missouri
Supreme Court affirmed a circuit court’s decision declaring a provision of an
appropriation bill purporting to deny Medicaid reimbursement to Planned
Parenthood of the St. Louis Region (“Planned Parenthood”) for medical services
rendered unconstitutional and severing it from the remainder of the bill. The Court reversed the portion of the circuit
court’s judgment taxing costs against the state as statutorily
unauthorized. Judge Paul C. Wilson wrote
the majority opinion with Judge Zel M. Fischer dissenting.
II. Background
Missouri’s
Medicaid program is administered by the MO HealthNet Division of the Missouri
Department of Social Services.[1] RSMo section 208.152.1 provides that the MO
HealthNet Division “shall make payments to authorized providers on
behalf of Medicaid-eligible individuals for physicians’ services and
family planning.”[2] The General Assembly appropriated funds for
the fiscal year of 2019 to pay for these services, and Planned Parenthood was
an authorized provider of these services due to a statutorily-authorized
agreement with MO HealthNet.[3] However, MO HealthNet refused to reimburse
Planned Parenthood for services rendered in 2019 due to section 11.800 of a new
Missouri appropriation bill.[4] The section provided: “No funds shall be
expended to any abortion facility as defined in Section 188.015, RSMo, or any
affiliate thereof.”[5]
III. Legal Background
Planned Parenthood filed a complaint
with the Administrative Hearing Commission, which ruled in the state’s favor
without addressing Planned Parenthood’s constitutional claim due to its lack of
authority to make such a determination.[6] Planned Parenthood then sought consolidated
review in the circuit court, arguing it is impermissible to use an
appropriation bill to amend substantive law because such behavior violates
article III, section 23 of the Missouri Constitution.[7] The circuit court agreed with Planned
Parenthood and therefore declared Section 11.800 unconstitutional, severed the
section from the rest of the bill, and taxed costs against the state.[8] MO HealthNet appealed to the Missouri Supreme
Court.[9]
IV. Instant Decision
A. Majority
Writing for the majority, Judge
Wilson first discussed the constitutionality of Section 11.800 of the
appropriation bill.[10] Article III, section 23 of the Missouri
Constitution provides, “No bill shall contain more than one subject which shall
be clearly expressed in its title, except bills enacted under the third
exception in section 37 of this article and general appropriation bills, which
may embrace the various subjects and accounts for which moneys are
appropriated.”[11] Thus, while section 23 prohibits bills with
more than one subject, it does contain a “narrow exception” for appropriation
bills “because such bills necessarily include multiple subjects, i.e.,
appropriations of differing amounts from differing accounts for differing
subjects.”[12]
However,
the majority explained that the Court has long recognized that the exception is
limited, and “section 23 [still] limits appropriation bills to
appropriations only.”[13] To clarify, “any bill that purports to
combine appropriations with the enactment or amendment of general or
substantive law necessarily contains more than one subject in violation of
article III, section 23, and such a bill does not fall within the exception for
general appropriation bills.”[14] The majority clarified, however, that an
appropriation bill must be in direct conflict with a general law in order for
it to be considered more than solely an appropriation in this context.[15]
Accordingly,
the majority examined whether Section 11.800 directly conflicts with general
law, specifically RSMo Sections 208.153.1 and 208.152.1.[16] Section 208.152.1 “provides that MO HealthNet
payments shall be made on behalf of Medicaid-eligible individuals for physicians’
services and family planning,” while section 208.153.1 provides that
“these individuals can obtain those services from any authorized health care
provider, i.e., any provider that has an agreement with MO HealthNet
Division to provide those services.”[17] Because these statutes “specify clearly and
unambiguously what MO HealthNet payments will cover and two whom those payments
must be made, . . . the language in section 11.800 seeking to disqualify
certain authorized providers based on services they provide, separately and
apart from the MO HealthNet program, – and for which no MO HealthNet payments
can be made – is a naked attempt to use HB2011 both to appropriate funds for
various purposes and to amend sections 208.153.1 and 208.152.1.”[18] Therefore, the majority found this to be “a
clear and unmistakable violation of the proscription in article III, section 23
of the Missouri Constitution against bills with multiple subjects.”[19]
Judge
Wilson then analyzed whether the circuit court was correct in severing section
11.800 from the remainder of the appropriation bill.[20] While he agreed with the circuit court that
the bill should be severed, he took issue with how the lower court reached its
conclusion on the issue, specifically its reliance on RSMo Section 1.140 during
its severance analysis.[21] He explained that the Court uses a different
severance analysis for procedurally unconstitutional provisions versus
substantively unconstitutional provisions.[22] For substantive violations, the Court applies
section 1.140 to analyze the propriety of severance.[23] “On the other hand, when evaluating a procedural
constitutional violation, the doctrine of judicial severance is applied and
severance is only appropriate when this Court is convinced beyond a reasonable
doubt that the legislature would have passed the bill without the additional
provisions and that the provisions in question are not essential to the
efficacy of the bill.”[24] While the circuit court was incorrect in
applying section 1.140 in its severance analysis because this case involves a
procedural violation, the majority nonetheless agreed that severance is
appropriate under the analysis for procedural violations.[25] Judge Wilson noted that the General Assembly
intentionally segregated section 11.800 from the appropriations in the rest of
the bill and it expressly noted that the other sections shall not be severed
from each other but provided no similar prohibition against severing section
11.800.[26] Thus, the majority affirmed the circuit
court’s determination regarding severance because it was satisfied “beyond a
reasonable doubt that the appropriation bill would have passed without section
11.800, and that nothing in 11.800 is essential to the efficacy of the
appropriations made elsewhere in [the appropriation bill].”[27]
Lastly,
the majority reversed the lower court’s determination to tax costs to MO
HealthNet because it found no statutory authorization for such a decision.[28]
B. Dissent
In his dissent, Judge Fischer argues
that section 11.800 is constitutional.[29] He posits that the language of article III,
section 23 plainly and unambiguously exempts appropriation bills from its
purview, and therefore it does not control the resolution of this case.[30] He further argues that, “even if [section] 23
does apply to appropriation bills, the challenged language in HB2011 is
constitutional because it embraces one of the various subjects for which money
is appropriated.”[31]
V. Comment
[1] See
Planned Parenthood of St. Louis Region v. Dep’t of Soc. Services, Division
of Medical Services, 602 S.W.3d 201 (Mo. banc 2020).
[2] Id.
at 204.
[3] Id.
[4] Id.
[5]
House Bill No. 2011, § 11.800 (2018).
[6] See
Planned Parenthood, 602 S.W.3d at 206.
[7] Id.
[8] Id. The Supreme Court vacated the circuit court’s
decision to tax costs against the state, holding such a tax to be without
statutory authorization.
[9] Id.
[10] Id.
[11] Mo. Const. art. III, § 23.
[12] Planned
Parenthood, 602 S.W.3d at 206.
[13] Id.
(internal quotations omitted).
[14] Id.
(internal quotations omitted).
[15] Id.
at 208.
[16] Id.
[17] Id.
[18] Id.
at 208–09.
[19] Id.
at 209.
[20] Id.
[21] Id.
[22] Id.
at 210.
[23] Id.
at 211.
[24] Id.
at 211–12. (internal quotations omitted).
[25] Id.
at 212.
[26] Id.
[27] Id.
[28] Id.
[29] Id.
at 213.
[30] Id.
[31] Id.
[32] Joe
Harris, Missouri Court Shuts Down Effort to Defund Planned Parenthood, Courthouse News Service (June 30, 2020),
https://www.courthousenews.com/missouri-court-shuts-down-effort-to-defund-planned-parenthood/.
[33] Id.
[34] Id.
[35] Id.
