Maher v. Roe

Background

Connecticut limited Medicaid payment for first-trimester abortions to cases the attending physician certified as "medically necessary," a term that included psychiatric necessity, and required prior authorization. Two low-income women who could not obtain the required physician certification sued. Lower courts disagreed on whether the federal Medicaid law required funding; a three-judge District Court later struck down Connecticut’s rules as violating equal protection because the State funded childbirth but not elective abortions.

Reasoning

The Supreme Court considered whether the Constitution forces a state that pays for childbirth to also pay for nontherapeutic abortions. The majority said no. The Court explained that the Constitution does not obligate states to fund medical care and that Roe protects against undue burdens on the right to choose an abortion but does not create a right to state funding. Because indigency is not a suspect classification and the regulation did not place a direct legal barrier to abortion, the Court applied a rational-basis review. It found a legitimate state interest in encouraging childbirth and protecting potential life, and concluded that subsidizing childbirth costs is a rational way to further that interest. The Court also upheld the State’s requirements for medical-necessity certification and prior authorization as reasonable procedural safeguards.

Real world impact

States may lawfully choose not to cover elective first-trimester abortions under Medicaid while covering childbirth. States can require medical-necessity findings and prior authorizations for Medicaid abortion payments. Congress or state legislatures, however, may change funding rules by passing laws.

Dissents or concurrances

Justice Brennan (joined by Marshall and Blackmun) dissented, arguing the funding gap coerces poor women and unduly burdens the fundamental right to choose, and that strict scrutiny should apply.