Missouri’s new strategy to remove Planned Parenthood from Medicaid: health inspections
Missouri Gov. Mike Parson’s administration has signaled it will use the inspections arm of the state health department in what abortion advocates are calling the latest effort to shutter Planned Parenthood, which operates the state’s only abortion facility.
In emergency administrative rules the Department of Health and Senior Services (DHSS) issued last week, the state said it will more closely inspect abortion facilities and share the results with the Department of Social Services (DSS). That agency could use the findings to block the organization from receiving funding through Medicaid.
The rules are set to go into effect Oct. 13.
Medicaid does not pay for abortions, except in cases where the mother’s life is at risk. The objective of Republican lawmakers and the administration is to remove Planned Parenthood’s 11 other clinics across the state — which do not provide abortions — from the Medicaid program.
The new rule comes two years after Parson’s health department failed in an attempt to revoke the license of the St. Louis Planned Parenthood clinic. It declined to renew the license after an inspection turned up complications in four surgical abortions, which the clinic said were “cherry-picked” out of more than 3,000 otherwise successful procedures.
An administrative law judge, Sreenivasa Rao Dandamudi, ruled last year the denial was improper. Parson replaced him this year.
BEHIND THE STORY
MOREThe Bigger Picture: Missouri
Since the U.S. Supreme Court’s 1973 Roe v. Wade decision, which established a constitutional right to abortion, Missouri lawmakers have steadily tightened access to the procedure. There is just one clinic in the state — a Planned Parenthood clinic in St. Louis — that performs abortions. In 2019, Missouri revoked the clinic’s license following an inspection that turned up complications in four surgical abortions. An administrative law judge ruled that the clinic was wrongfully denied the license.
In 2019, Gov. Mike Parson signed a law criminalizing abortions after eight weeks of pregnancy, with no exceptions for rape or incest. A federal judge blocked the measure pending resolution of a lawsuit filed by Planned Parenthood. A three-judge panel from the 8th Circuit Court of Appeals affirmed that decision but the full court has decided to reconsider the case. It could lift the injunction against all or part of the law.
In the Missouri General Assembly, clashes over abortion cross a range of issues. While Planned Parenthood is prohibited from using Medicaid funds for abortions except when the life of the mother is at risk, Republicans attempted earlier this year to bar the organization from receiving Medicaid dollars for all non-abortion services it provides to low-income clients.
Some Missouri lawmakers have expressed interest in a new Texas law that bans abortion after six weeks of pregnancy and authorizes private citizens to sue abortion providers who break the law and others who aid women seeking to terminate their pregnancies. Rep. Mary Elizabeth Coleman, an Arnold Republican, has promised to introduce a version of the legislation next year. Read more by clicking the arrow in the upper right.
The Bigger Picture: Kansas
Kansas has long been an epicenter of anti-abortion activism. In July 1991, Operation Rescue brought thousands of protesters to Wichita for the “Summer of Mercy,” a campaign of daily civil disobedience. It focused heavily on a clinic run by Dr. George Tiller, one of a handful of physicians who performed late-term abortions. In June 2009, he was murdered by an anti-abortion extremist.
In 2015, then-Gov. Sam Brownback signed a law banning dilation and evacuation, a second-trimester procedure described by anti- abortion activists as “dismemberment abortion.”
Challenges to the law reached the Kansas Supreme Court, which ruled in 2019 that the state constitution gave women “a fundamental right” to make decisions about their own bodies, including whether to terminate a pregnancy.
The Kansas Legislature, controlled by a Republican supermajority, responded by placing a proposed constitutional amendment on the Aug. 2022 ballot. The “Value Them Both” amendment would eliminate the state constitutional right to an abortion but not impose an outright ban.
If approved, however, it would allow the Legislature to pass abortion restrictions to the extent permitted by the U.S. Constitution, and lay the groundwork for a future ban if Roe v. Wade is overturned.
Joplin Republican Sen. Bill White who released a report last week endorsing the proposed rules, said sharing health department inspections with DSS would give the latter agency additional grounds to disqualify Planned Parenthood as a Medicaid-funded provider.
“We’re asking them to be more vigilant and to review and intensify, if you will, what they’re looking at,” he said. “We’re saying, we want you to have more criteria you’re analyzing with … We want it to be more diligent.”
But Planned Parenthood said health inspection reports are already public and the impact of the rule is unclear.
The new rule adds to the inspection requirements for abortion facilities, such as ensuring there are annual fire drills and that surgical equipment is sterilized. Many of the requirements are already mandated by state law or existing regulations. They include a controversial pelvic exam to be administered within 72 hours of the procedure, maintenance of drug logs and physician counseling for patients on non-abortion options.
DHSS spokeswoman Lisa Cox said the department already conducts inspections for all the provisions in the new rule.
Planned Parenthood said the rule targets a single provider in Medicaid, which the federal government has not allowed.
“This ‘defund’ attempt could also risk Missouri’s entire Medicaid program,” said M’Evie Mead, director of Planned Parenthood Advocates in Missouri.
This story was originally published October 4, 2021 at 2:54 PM.