Beal v. Doe

Background

Women who were eligible for Medicaid in Pennsylvania applied for state help to pay for abortions and were denied because Pennsylvania’s Medicaid rules limited payment to abortions certified as medically necessary and required two other physicians to concur in writing. The women sued, claiming the state plan violated the federal Medicaid statute and equal protection. A three-judge district court and then the Third Circuit split on the statutory question, prompting the Supreme Court to decide the issue.

Reasoning

The Court addressed only whether Title XIX (the federal Medicaid law) requires States to pay for all abortions allowed by state law. It found the statute does not mention specific procedures and instead gives States discretion to set "reasonable standards" consistent with the statute’s objectives. The Court relied on the legislative context (most States had banned elective abortions when Medicaid began) and the administering agency’s view that funding is permitted but not required. The Court therefore held that Title XIX does not force a State to fund nontherapeutic (elective) abortions and reversed the Court of Appeals, while remanding for further review of Pennsylvania’s two-physician concurrence rule.

Real world impact

The decision leaves it up to each State and the Federal Government whether Medicaid will cover elective abortions. States may continue policies like Pennsylvania’s that deny funding except for certified medical necessity. Dissenting Justices warned that the practical effect will fall hardest on poor and minority women by making access to safe, legal abortions more difficult.

Dissents or concurrances

Three Justices dissented, arguing the statute and prior abortion decisions require funding as part of necessary medical services and that the ruling will coerce poor women to carry pregnancies and deepen racial and economic disparities.