Filing Date: November 25, 1998
Docket No. 23,239
NEW MEXICO RIGHT TO CHOOSE/NARAL,
ABORTION AND REPRODUCTIVE HEALTH SERVICES,
PLANNED PARENTHOOD OF THE RIO GRANDE,
CURTIS BOYD, M.D., LUCIA CIES, M.D.,
BRUCE FERGUSON, M.D., and LEWIS KOPLIK, M.D.,
Plaintiffs-Appellees
and Cross-Appellants,
v.
WILLIAM JOHNSON, Secretary of the New Mexico
Human Services Department,
Defendant-Appellant
and Cross-Appellee,
and
EUGENE E. KLECAN and DONALD SCHAURETE,
Defendants-in-Intervention and
Appellants and Cross-Appellees.
CERTIFICATION FROM THE NEW MEXICO COURT OF APPEALS
Steve Herrera, District Judge
Crider, Calvert & Bingham, P.C.
Stevan Douglas Looney, Special Assistant Attorney General
Albuquerque, NM
White, Koch, Kelly & McCarthy, P.A.
M. Karen Kilgore
Santa Fe, NM
Charles J. Milligan, General Counsel
New Mexico Human Services Department
Santa Fe, NM
for Appellant and Cross-Appellee,
William Johnson, Secretary of Human Services Department
Eugene E. Klecan
Albuquerque, NM
for Appellants and Cross-Appellees
Eugene E. Klecan and Donald Schaurete
Freedman, Boyd, Daniels, Peifer,
Hollander, Guttman & Goldberg
J. Michele Guttmann
Albuquerque, NM
Louise Melling
Catherine Weiss
Reproductive Freedom Project
American Civil Liberties Union Foundation
New York, NY
Cynthia A. Fry
Albuquerque, NM
Priscilla Smith
Catherine Albisa
Center for Reproductive Law & Policy
New York, NY
Ann Scales
Albuquerque, NM
Maureen Sanders
Albuquerque, NM
Philip B. Davis
ACLU of New Mexico
Albuquerque, NM
Roger Evans
Legal Action for Reproductive Rights
Planned Parenthood Federation of America
New York, NY
Carpenter & Chavez, Ltd.
David J. Stout
Albuquerque, NM
for Appellees and Cross-Appellants
Paul Benjamin Linton, Acting General Counsel
Americans United for Life
Chicago, IL
for Amici Curiae
Senator Duncan Scott, Representative Frank Bird, and
Other Members of the New Mexico Legislature
Bopp, Coleson & Bostrom
James Bopp, Jr.
John K. Abegg
Terre Haute, IN
for Amicus Curiae
Right to Life Committee of New Mexico
Hon. Tom Udall, Attorney General
Martha A. Daly
Elizabeth A. Glenn, Assistant Attorneys General
Santa Fe, NM
for Amicus Curiae
New Mexico Attorney General
Michael B. Browde
Christian G. Fritz
Albuquerque, NM
for Amici Curiae
New Mexico League of Women Voters and
New Mexico Legislators
Martha F. Davis
Deborah A. Ellis
NOW Legal Defense and Education Fund
New York, New York
Rondolyn R. O'Brien
Albuquerque, NM
for Amici Curiae
New Mexico Women's Bar Association and
New Mexico Public Health Association
MINZNER, Justice.
{1} This case concerns the authority of the Secretary of
the New Mexico Human Services Department to restrict funding
for medically necessary abortions under the State's Medicaid
program. The Secretary appeals the district court's order
permanently enjoining the Department from enforcing a rule
that prohibits the use of state funds to pay for abortions
for Medicaid-eligible women except when necessary to save
the life of the mother, to end an ectopic pregnancy, or when
the pregnancy resulted from rape or incest. Under the
district court's order, the Department must allow the use of
state funds to pay for abortions for Medicaid-eligible women
when they are medically necessary. Under the court's order,
an abortion is "medically necessary" when a pregnancy
aggravates a pre-existing condition, makes treatment of a
condition impossible, interferes with or hampers a diagnosis, or has a profound negative impact upon the
physical or mental health of an individual.
{2} The Court of Appeals certified the appeal to this Court
because it presented a significant question of law under the
New Mexico Constitution. Based on the independent grounds
provided by the Equal Rights Amendment to Article II,
Section 18 of our state constitution, we affirm the district
court's order. New Mexico's Equal Rights Amendment requires
a searching judicial inquiry to determine whether the
Department's rule prohibiting state funding for certain
medically necessary abortions denies Medicaid-eligible women
equality of rights under law. We conclude from this inquiry
that the Department's rule violates New Mexico's Equal
Rights Amendment because it results in a program that does
not apply the same standard of medical necessity to both men
and women, and there is no compelling justification for
treating men and women differently with respect to their
medical needs in this instance. The district court did not
exceed its authority in providing a remedy for this
constitutional violation by enjoining the Department from
enforcing its rule and requiring the Department to apply the
standard of medical necessity in a nondiscriminatory manner
in this case.
{3} As an alternative basis for affirming the district
court's order, Plaintiffs argue that a woman's right to
reproductive choice is among the inherent rights guaranteed
by Article II, Section 4 of the New Mexico Constitution, and
that the Department's rule unlawfully infringes upon this
right because it favors childbirth over abortion. It is
unnecessary for us to reach the broader questions raised by
this argument, however, because we decide this appeal based
upon the Department's violation of the Equal Rights
Amendment to Article II, Section 18 of our state
constitution. Thus, our discussion is limited to the
protection afforded by New Mexico's Equal Rights Amendment
in the situation where the Department has elected to provide
medical assistance to needy persons in this state.
{4} We begin with a review of the factual and legal
developments that led to this appeal. For many years, both
federal and state law have provided funding for persons to
obtain medical assistance when they meet certain criteria
based on financial and medical need. At the federal level,
Title XIX of the Social Security Amendments of 1965, 42
U.S.C. §§ 1396 to 1396v (1994 & Supp. II 1996), establishes
a program, commonly known as "Medicaid," for the purpose of
providing federal financial assistance to states that choose
to participate. Under the program, the federal government
pays a percentage of the total cost that a participating
state incurs in providing certain categories of medical care
and services to needy persons. See 42 U.S.C. § 1396b(a), 1396d(b)(1). While a state's medical assistance plan must
contain a number of required elements in order to qualify
for federal funding, see Hern v. Beye, 57 F.3d 906, 910
(10th Cir. 1995), "Title XIX does not obligate a
participating State to pay for those medical services for
which federal reimbursement is unavailable," Harris v.
McRae, 448 U.S. 297, 309 (1980).
{5} Except in cases of rape or incest, or when necessary to
save the life of the mother, abortions are among the medical
services for which federal funding is unavailable under a
provision of federal law known as "the Hyde Amendment." See
Departments of Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Act of 1995,
Pub. L. No. 103-333, § 509, 108 Stat. 2539, 2573 (1994).See footnote 1
However, "[a] participating State is free, if it so chooses,
to include in its Medicaid plan those medically necessary
abortions for which federal reimbursement is unavailable."
Harris, 448 U.S. at 311 n.16.
{6} Section 27-2-12 of New Mexico's Public Assistance Act,
NMSA 1978, § 27-2-12 (1993), authorizes the Medical
Assistance Division of the Human Services Department to
issue regulations regarding the provision of medical
assistance to persons eligible for public assistance
programs under the federal Social Security Act. Pursuant to
Section 27-2-12, the Department issued a rule, known as
"Rule 766," that restricted the availability of abortions
under the State's medical assistance plan. In response to
concerns about its constitutionality, the Department revised
Rule 766 in 1994 to expand the availability of abortions
under the State's medical assistance plan. The revised rule
allowed the use of state funds to provide abortions for
Medicaid-eligible women when they are medically necessary.
See Pregnancy Termination Procedures, N.M. Human Servs.
Dep't, Med. Assistance Div. Reg. 766, 5 N.M. Reg. 1632 (Dec.
15, 1994, prior to 1995 amendment). The 1994 rule defined
an abortion as "medically necessary" when a pregnancy
"aggravates a pre-existing condition, makes treatment of a
condition impossible, interferes with or hampers a
diagnosis, or has a profound negative impact upon the
physical or mental health of an individual." Id. Under
the 1994 rule, abortions for Medicaid recipients that met this definition of "medically necessary" but did not fit
into the exceptions of the Hyde Amendment were paid for
exclusively with state funds.
{7} After a new Secretary was appointed, the Department
made another revision of Rule 766 that was scheduled to take
effect in May 1995. The 1995 rule restricted state funding
of abortions under the Department's medical assistance
program to those certified by a physician as necessary to
save the life of the mother or to end an ectopic pregnancy,
or when the pregnancy resulted from rape or incest. See
Pregnancy Termination Procedures, N.M. Human Serv. Dep't,
Med. Assistance Div. Reg., 6 N.M. Reg. 684 (Apr. 29, 1995)
(codified at 8 NMAC 4.MAD.766 (May 1,1995)).See footnote 2 On April 21,
1995, however, Plaintiffs brought suit in the district court
to prevent the 1995 revision of Rule 766 from taking effect.
{8} Plaintiffs' complaint alleged that Rule 766 violates
the rights of Medicaid-eligible women under Article II,
Sections 4 and 18 of the New Mexico Constitution. The
Department denied these allegations. Eugene E. Klecan filed
a motion, in which Donald Schaurete later joined, to
intervene as of right as a taxpayer and representative of
the potential life of the unborn. The district court
granted the motion to intervene. The Attorney General
declined to represent the Department and was later allowed
to present arguments as an amicus curiae.
{9} On May 1, 1995, the district court granted a
preliminary injunction to keep the 1995 revision of Rule 766
from taking effect. Both Plaintiffs and the Department
subsequently filed motions for summary judgment and entered
stipulations of fact. On July 3, 1995, the district court
issued a memorandum opinion concluding that the 1995
revision of Rule 766 violates Article II, Section 18 of the
New Mexico Constitution. On this basis, the district court
granted Plaintiffs' motion for summary judgment and made the
injunction permanent. The Department appealed this ruling.
Klecan and Schaurete also appealed. Plaintiffs cross-appealed the orders allowing Klecan and Schaurete to
intervene.See footnote 3 On October 13, 1995, the Court of Appeals
certified the appeals to this Court.
{10} The parties raise several threshold questions that we must answer before turning to the merits of the district
court's ruling. First, the Department challenges
Plaintiffs' standing to assert a claim on behalf of pregnant
women who seek medically necessary abortions under the
State's medical assistance program. Second, Plaintiffs
challenge the district court rulings that allowed Klecan and
Schaurete to intervene as of right in this case. Third,
Klecan and Schaurete assert that Plaintiffs' claims must be
dismissed because the doctrine of sovereign immunity bars
them from bringing suit against the Department. Finally,
the Department asserts that the district court's order
granting Plaintiff's motion for summary judgment was
improper because there are disputed issues of material fact.
{11} Plaintiffs Curtis Boyd, M.D., Lucia Cies, M.D., Bruce
Ferguson, M.D., and Lewis H. Koplik, M.D., are individual
physicians who provide reproductive health care services,
including abortions, to Medicaid-eligible women. Plaintiff
Abortion and Reproductive Health Services is a non-profit
organization that also provides such services. Plaintiff
Planned Parenthood of the Rio Grande is a non-profit
organization that provides counseling and referral on
pregnancy options, including abortion, and loans funds for
abortions to Medicaid-eligible women. Plaintiff New Mexico
Right to Choose/NARAL is a non-profit advocacy organization
with members who are Medicaid-eligible women. The
Department contends that Plaintiffs do not have standing to
bring this lawsuit because none of them are Medicaid-eligible women who seek a medically necessary abortion and
were denied it due to Rule 766.
{12} In order to obtain standing for judicial review in New
Mexico, litigants generally must allege that they are
directly injured as a result of the action they seek to
challenge in court. See De Vargas Sav. & Loan Ass'n v.
Campbell, 87 N.M. 469, 472, 535 P.2d 1320, 1323 (1975);
Ramirez v. City of Santa Fe, 115 N.M. 417, 420, 852 P.2d
690, 693 (Ct. App. 1993); cf. City of Las Cruces v. El Paso
Elec. Co., 1998-NMSC-006, ¶ 16, 124 N.M. 640, 954 P.2d 72
(noting prerequisites of "actual controversy" in declaratory
judgment actions). Following the trend in federal standing
law articulated in Sierra Club v. Morton, 405 U.S. 727
(1972), and United States v. SCRAP, 412 U.S. 669 (1973),
however, this requirement is met even when the extent of the
alleged injury is slight, see Ramirez, 115 N.M. at 420, 852
P.2d at 693, or the allegation is made by an organization on
behalf of its members, see National Trust for Historic
Preservation v. City of Albuquerque, 117 N.M. 590, 594, 874
P.2d 798, 802 (Ct. App. 1994). Moreover, New Mexico state
courts are not subject to the jurisdictional limitations
imposed on federal courts by Article III, Section 2 of the
United States Constitution. See John Does I Through III v.
Roman Catholic Church of the Archdiocese of Santa Fe, Inc.,
1996-NMCA-094, ¶¶ 25-26, 122 N.M. 307, 924 P.2d 273; cf. State ex rel. Clark v. Johnson, 120 N.M. 562, 569, 904 P.2d
11, 18 (1995) (concluding that it is within this Court's
discretion to confer standing "'on the basis of the
importance of the public issues involved.'" (quoting State
ex rel. Sego v. Kirkpatrick, 86 N.M. 359, 363, 524 P.2d 975,
979 (1974))).
{13} Nevertheless, the exercise of this Court's discretion
to confer standing should be guided by prudential
considerations, particularly when litigants seek to assert
claims on behalf of third parties. Cf. John Does I Through
III, 1996-NMCA-094, ¶ 25 ("The requirements for standing
derive from constitutional provisions, enacted statutes and
rules, and prudential considerations."). Under federal
standing law, courts consider the following three criteria
in determining the right of litigants to bring actions on
behalf of third parties:
The litigant must have suffered an
"injury in fact," thus giving him or her
a "sufficiently concrete interest" in
the outcome of the issue in dispute; the
litigant must have a close relation to
the third party; and there must exist
some hindrance to the third party's
ability to protect his or her own
interests.
Powers v. Ohio, 499 U.S. 400, 411 (1991) (citations
omitted); see also Singleton v. Wulff, 428 U.S. 106, 112-16
(1976) (plurality opinion); Craig v. Boren, 429 U.S. 190,
192-97 (1976). These three criteria, as applied by the
plurality in Singleton, 428 U.S. at 112-18, warrant our
consideration in this case.
{14} Insofar as they are providers of abortion services to
Medicaid-eligible women, Plaintiffs have both a direct
financial interest in obtaining state funding to reimburse
them for the cost of these services, see id. at 112-13, and
a close relation to the Medicaid-eligible women whose rights
they seek to assert in court, see id. at 117. Insofar as
Plaintiff New Mexico Right to Choose/NARAL seeks to assert
the rights of its members who are Medicaid-eligible women,
this organization also has a sufficiently direct interest
and a sufficiently close relationship. Cf. National Trust
for Historic Preservation, 117 N.M. at 594, 874 P.2d at 802
(organization may assert claim on behalf of its members).
Further, we agree with the plurality in Singleton, 428 U.S.
at 117-18, that privacy concerns and time constraints impose
a significant hindrance on the ability of Medicaid-eligible
women to protect their own interest in obtaining medically
necessary abortions. For all of these reasons, we
determine that Plaintiffs have standing to challenge the
constitutionality of Rule 766 in this case.
{16} Under Rule 1-024(A)(2), anyone who makes a timely
application shall be permitted to intervene
when the applicant claims an interest
relating to the property or transaction
which is the subject of the action and
the applicant is so situated that the
disposition of the action may as a
practical matter impair or impede the
applicant's ability to protect that
interest, unless the applicant's
interest is adequately represented by
existing parties.
Plaintiffs contend that Klecan and Schaurete's asserted
interest as taxpayers and protectors of the potential life
of the unborn is not sufficient to meet this standard. We
agree with Plaintiffs that Klecan and Schaurete fail to meet
the requirements of Rule 1-024(A)(2).
{17} Rule 1-024(A)(2) requires a person claiming a right of
intervention to demonstrate an interest in the action "that
is significant, direct rather than contingent, and based on
a right belonging to the proposed intervenor rather than
[to] an existing party to the suit." Cordova v. State ex
rel. Human Servs. Dep't (In re Marcia L.), 109 N.M. 420,
421, 785 P.2d 1039, 1040 (Ct. App. 1989). In this respect,
the requirements for intervention as of right seem to accord
with the general requirements for standing. Cf. Rule 1-082
NMRA 1998 (rules of civil procedure shall not be construed
to extend court's jurisdiction); In re Marcia L., 109 N.M.
at 421, 785 P.2d at 1040 (noting that Rule 1-024(A) "is
almost identical to [Fed. R. Civ. P.] 24(a)"); 6 James Wm.
Moore et al., Moore's Federal Practice § 24.03[2][d], at 24-37 (3d ed. 1998) (advocating the view that a party who lacks
standing cannot intervene under Fed. R. Civ. P. 24(a)).
However, while we may confer standing to decide an issue of
great public importance, see State ex rel. Clark, 120 N.M.
at 569, 904 P.2d at 18, this power to confer standing "'does
not equate with rights of indiscriminate intervention.'
The bounds of [Rule 1-024] are to be observed." Dominguez
v. Rogers, 100 N.M. 605, 608, 673 P.2d 1338, 1341 (Ct. App.
1983) (quoting Peterson v. United States, 41 F.R.D. 131, 135
(D. Minn. 1966) (mem.)).
{18} In this case, Klecan and Schaurete assert that their
interests as taxpayers will be harmed by the expenditure of
state funds for medically necessary abortions. However,
they have not alleged that such an expenditure will change
their tax liability in any way, or that any of their tax
payments are earmarked for the purpose of paying for
abortions. Thus, we conclude that Klecan and Schaurete's
interest as taxpayers is not sufficiently direct to meet the
requirements of Rule 1-024(A)(2). See In re Marcia L., 109
N.M. at 421, 785 P.2d at 1040; cf. Eastham v. Public
Employees' Retirement Ass'n Bd., 89 N.M. 399, 405, 553 P.2d
679, 685 (1976) (concluding that taxpayers lack standing
when they fail to demonstrate that they "'will be affected
by the acts sought to be enjoined in any other manner than
any other taxpayer of the state'" (quoting Asplund v
Hannett, 31 N.M. 641, 645, 249 P. 1074, 1075 (1926))). As
such, Klecan and Schaurete's asserted interest as taxpayers
does not entitle them to intervene as a matter of right in
this case.
{19} With regard to Klecan and Schaurete's alleged interest
as representatives of the potential life of the unborn, we
conclude that interest is adequately protected by the
Department in this case. "Where the State . . . is named as
a party to an action and the interest the applicant seeks to
protect is represented by a governmental entity, a
presumption of adequate representation exists." Chino Mines
Co. v. Del Curto, 114 N.M. 521, 524, 842 P.2d 738, 741 (Ct.
App. 1992); see also Planned Parenthood League of Mass.,
Inc. v. Attorney General, 677 N.E.2d 101, 109 (Mass. 1997);
6 Moore et al., supra, § 24.03[4][a][iv][A], at 24-46.1 to
24-46.2; cf. In re Marcia L., 109 N.M. at 421, 785 P.2d at
1040 (intervention under Rule 1-024(A) must be "based on a
right belonging to the proposed intervenor rather than [to]
an existing party to the suit"). Thus, to the extent that
the interest in the potential life of the unborn requires
legal representation in this case, the Department is
presumed to represent that interest adequately.
{20} To overcome this presumption, the proposed intervenors
must demonstrate that the representation is inadequate by
showing, for example, an adversity of interest, collusion,
or nonfeasance on the part of the Department. See Chino
Mines Co., 114 N.M. at 524, 842 P.2d at 741; 6 Moore et al.,
supra, § 24.03[4][a][ii], at 24-45. In this case, Klecan,
Schaurete, and the Department share the same ultimate
objective_-upholding the constitutionality of Rule 766.
While the record indicates that there may have been some
difference of opinion about the tactics used to accomplish
this objective, such differences are insufficient to
establish an adversity of interest. See Planned Parenthood
League, 677 N.E.2d at 109; 6 Moore et al., supra, §
24.03[4][a][iii], at 24-45. Further, the fact that the
Attorney General chose to support the Plaintiffs' position
as an amicus curiae does not show collusion or nonfeasance
on the part of the Department. The record shows that the Department was provided with independent and adequate
representation notwithstanding the Attorney General's
position in this case.
{21} For these reasons, the proposed intervenor's "assertion
of an interest in the protection of 'unborn' children is
also insufficient to justify intervention as of right."
Keith v. Daley, 764 F.2d 1265, 1271 (7th Cir. 1985); cf.
Dominguez, 100 N.M. at 608, 673 P.2d at 1341 (rejecting a
father's application to intervene as of right in an action
for wrongful death of his daughter where the father's
interest was represented by a duly appointed personal
representative and the father failed to show that
representation was inadequate). We conclude that the
district court's decision to grant the motion to intervene
as of right requires reversal "because it was premised on a
misapprehension of the law." Elinski, 1997-NMCA-117, ¶ 8.
{22} Because we reverse on this issue, we need not reach the
question of whether Klecan and Schaurete were denied due
process after the district court erroneously granted their
motion to intervene. In light of the public importance of
the other constitutional issues presented in this case,
however, we consider Klecan and Schaurete's other arguments
as if they were presented by an amicus curiae. Cf. 6 Moore
et al., supra, § 24.03[2][b], at 24-29 ("[A]pplicants
concerned only about the legal principles that apply to an
action may appear as amici curiae, but they are not entitled
to intervene as of right.").
{23} Klecan and Schaurete assert that Plaintiffs' complaint
must be dismissed because the Department is not subject to
suit in this matter. Section 44-6-13 of the Declaratory
Judgment Act, NMSA 1978, § 44-6-13 (1975), however, plainly
states that "the state of New Mexico, or any official
thereof, may be sued and declaratory judgment entered when
the rights . . . of the parties call for a construction of
the constitution of the state of New Mexico." Further, we
have heard other claims against the Department that
challenge the constitutionality of its public assistance
programs, see, e.g., Howell v. Heim, 118 N.M. 500, 882 P.2d
541 (1994); cf. Katz v. New Mexico Dep't of Human Servs.,
Income Support Div., 95 N.M. 530, 624 P.2d 39 (1981) (appeal
of administrative ruling), and in this case, the Department
admitted the jurisdictional allegations in Plaintiffs'
complaint. Therefore, sovereign immunity does not shield
the Department from appearing in court as a defendant in
this case.
{24} "Summary judgment is proper if there are no genuine
issues of material fact and the movant is entitled to
judgment as a matter of law." Roth v. Thompson, 113 N.M. 331, 334, 825 P.2d 1241, 1244 (1992); see also Rule 1-056(C)
NMRA 1998. On appeal, the Department contends that the
district court erred in entering summary judgment in
Plaintiff's favor because there are genuine issues of
material fact. In the district court, however, the
Department filed its own motion for summary judgment, and
also stipulated that "the[] parties agree that based upon
this record, this case is ripe for determination by summary
judgment." In addition, the parties filed a lengthy set of
stipulated facts. While some disputed facts not covered by
these stipulations may remain, they do not preclude summary
judgment without a showing that they are material. See
Tapia v. Springer Transfer Co., 106 N.M. 461, 463, 744 P.2d
1264, 1266 (Ct. App. 1987). The Department made no such
showing here. Cf. Spectron Dev. Lab. v. American Hollow
Boring Co., 1997-NMCA-025, ¶ 32, 123 N.M. 170, 936 P.2d 852
(concluding that normal rules of preservation of error apply
to appeals from summary judgments). Therefore, this issue
does not provide a basis for reversal of the district
court's order, and none of the threshold issues raised by
the parties preclude this Court from ruling on the
constitutionality of Rule 766.
{25} We next address the merits of Plaintiffs'
constitutional claims. Plaintiffs concede that the United
States Constitution does not require the State to provide
funding to Medicaid-eligible women for medically necessary
abortions that fall outside the restrictions of the Hyde
Amendment. See Harris, 448 U.S. at 316. Plaintiffs'
arguments in the district court and on appeal are directed
to the issue of whether the New Mexico Constitution affords
greater protection than federal law. This issue was
preserved below. See State v. Gomez, 1997-NMSC-006, ¶¶ 22,
23, 122 N.M. 777, 932 P.2d 1 (requirements for preserving
state constitutional issue when parallel provision of
federal constitution is involved); cf. State v. Sarracino,
1998-NMSC-022, ¶ 11, 125 N.M. 511, 964 P.2d 72 (discussing
preservation when there is no federal constitutional scheme
from which to depart).
{26} At least twelve other states court have published
opinions addressing the question of whether state law
requires funding for abortions for indigent women in
situations where federal reimbursement is unavailable. In
six of these states, the courts have determined that such
funding is required under their state constitutions. See
Committee to Defend Reprod. Rights v. Myers, 625 P.2d 779,
798-99 (Cal. 1981); Doe v. Maher, 515 A.2d 134, 162 (Conn.
Super. Ct. 1986); Moe v. Secretary of Admin. and Fin., 417
N.E.2d 387, 404 (Mass. 1981); Women of Minn. v. Gomez, 542
N.W.2d 17, 32 (Minn.1995); Right to Choose v. Byrne, 450
A.2d 925, 941 (N.J. 1982); Women's Health Ctr. of W. Va.,
Inc. v. Panepinto, 446 S.E.2d 658, 667 (W. Va. 1993). One
court found that a state agency exceeded its statutory authority in restricting state funding for abortions. See
Planned Parenthood Ass'n, Inc. v. Department of Human
Resources, 687 P.2d 785, 792-93 (Or. 1984). Another court
expressed disapproval of an agency rule restricting state
funding for abortions in an opinion holding that a trial
court abused its discretion in denying an award of attorney
fees to plaintiffs who prevailed in their challenge to such
restrictions. See Roe v. Harris, 917 P.2d 403, 407 (Idaho
1996). In four of the twelve states that have published
opinions on the issue, however, the courts have not found
provisions in their state constitutions that require state
funding for abortions in situations where federal
reimbursement is unavailable. See Doe v. Department of
Social Servs., 487 N.W.2d 166, 179-80 (Mich. 1992); Hope v.
Perales, 634 N.E.2d 183, 188 (N.Y. 1994); Rosie J. v. North
Carolina Dep't of Human Resources, 491 S.E.2d 535, 538 (N.C.
1997); Fischer v. Department of Pub. Welfare, 502 A.2d 114,
126 (Pa. 1985). Only two of the published opinions
addressing the issue have analyzed whether state funding for
abortions is required by a state's equal rights amendment,
with conflicting results. Compare Doe, 515 A.2d at 162
(concluding that funding restrictions violate Connecticut's
equal rights amendment) with Fischer, 502 A.2d at 126
(concluding that funding restrictions do not violate
Pennsylvania's equal rights amendment).
{27} Our analysis focuses on the protection afforded by the
Equal Rights Amendment to Article II, Section 18 of the New
Mexico Constitution in the situation where the Department
has elected to provide medical assistance to needy persons.
We first examine whether this provision of our state
constitution establishes a basis for affording Medicaid-eligible women greater protection against gender
discrimination than they receive under federal law. We
conclude that it does. Next, we address the Department's
claim that Rule 766 does not warrant heightened judicial
scrutiny because it is based on a physical characteristic
unique to one sex, namely the ability to become pregnant and
bear children. We conclude that this unique physical
characteristic does not exempt Rule 766 from a searching
judicial inquiry under New Mexico's Equal Rights Amendment.
We then examine whether Rule 766 operates to the
disadvantage of women in the context of the State's Medicaid
program, and we determine that Rule 766 is presumptively
unconstitutional because it results in a program that does
not apply the same standard of medical necessity to both men
and women. Finally, we examine whether there is a
compelling justification for treating men and women
differently with respect to their eligibility for medical
assistance in this instance. Because such a compelling
justification is lacking in this case, we conclude that Rule
766 violates the New Mexico Constitution.
{28} Neither the Hyde Amendment nor the federal authorities upholding the constitutionality of that amendment bar this
Court from affording greater protection of the rights of
Medicaid-eligible women under our state constitution in this
instance. See Gomez, 1997-NMSC-006, ¶ 17; Harris, 448 U.S.
at 311 n.16. Under this Court's "interstitial approach" to
state constitutional interpretation, we "may diverge from
federal precedent for three reasons: a flawed federal
analysis, structural differences between state and federal
government, or distinctive state characteristics." Gomez,
1997-NMSC-006, ¶ 19; see also State v. Gutierrez, 116 N.M.
431, 440, 863 P.2d 1052, 1061 (1993) (describing this
Court's "willingness to undertake independent analysis of
our state constitutional guarantees when federal law begins
to encroach on the sanctity of those guarantees"). In this
case, we find distinctive state characteristics that render
the federal equal-protection analysis inapposite with
respect to Plaintiffs' claim of gender discrimination.
{29} Article II, Section 18 of the New Mexico Constitution
guarantees that "[e]quality of rights under law shall not be
denied on account of the sex of any person." This guarantee
became part of our state constitution in 1973, after the
people of New Mexico passed the Equal Rights Amendment by an
overwhelming margin. See Richard H. Folmar, Piecemeal
Amendment of the New Mexico Constitution: 1911 to 1990, at
28 tbl.I, 34 tbl.IV (13th rev., New Mexico Legis. Council
Serv., 1991). There is no counterpart to New Mexico's Equal
Rights Amendment in the United States Constitution. Indeed,
the absence of such an amendment to the United States
Constitution appears to have been a significant factor in
the development of federal law applying the Equal Protection
Clause to gender discrimination claims. See Frontiero v.
Richardson, 411 U.S. 677, 692 (1973) (Powell, J., concurring
in the judgment) (pending ratification process for federal
equal rights amendment provides "reason for deferring a
general categorizing of sex classifications as invoking the
strictest test of judicial scrutiny"); People v. Ellis, 311
N.E.2d 98, 101 (Ill. 1974) (noting relationship between
Frontiero and equal rights amendment). This lack of a
federal counterpart to New Mexico's Equal Rights Amendment
renders the federal equal protection analysis inapposite in
this case.
{30} Prior to 1973, Article II, Section 18 of the New Mexico
Constitution contained only the following sentence: "No
person shall be deprived of life, liberty or property
without due process of law; nor shall any person be denied
equal protection of the laws." The Equal Rights Amendment
added a new sentence to this provision of our state
constitution: "Equality of rights under law shall not be
denied on account of the sex of any person." We construe
the intent of this amendment as providing something beyond
that already afforded by the general language of the Equal
Protection Clause. See Doe, 515 A.2d at 160-61 ("To equate
our [equal rights amendment] with the equal protection
clause of the federal constitution would negate its meaning given that our state adopted an [equal rights amendment]
while the federal government failed to do so."); Ellis, 311
N.E.2d at 101 ("[W]e find inescapable the conclusion that
[our equal rights amendment] was intended to supplement and
expand the guaranties of the equal protection provision of
the Bill of Rights[.]"); Darrin v. Gould, 540 P.2d 882, 889
(Wash. 1975) (en banc) ("Any other view would mean the
people intended to accomplish no change in the existing
constitutional law governing sex discrimination" when they
enacted an equal rights amendment); cf. Hannett v. Jones,
104 N.M. 392, 395, 722 P.2d 643, 646 (1986)
("[C]onstitutions must be construed so that no part is
rendered surplusage or superfluous[.]").
{31} We do not base our analysis on a mere textual
difference between the federal and state constitutions. Cf.
Gomez, 1997-NMSC-006, ¶ 17 (indicating that textual
differences are not necessary prerequisites to affording
broader protection under the New Mexico Constitution (citing
State ex rel. Serna v. Hodges, 89 N.M. 351, 356, 552 P.2d
787, 792 (1976))). Rather, we view New Mexico's Equal
Rights Amendment as the culmination of a series of state
constitutional amendments that reflect an evolving concept
of gender equality in this state. A review of the history
of these amendments informs our analysis.
{32} From its inception, our state constitution has
recognized that "[a]ll persons are born equally free." N.M.
Const. art. II, § 4. The provisions in our state
constitution prohibiting discrimination on account of sex,
however, have developed in a piecemeal fashion. At the time
the New Mexico Constitution was drafted in 1910, the rights
of women to vote and participate in public life were a topic
of debate and compromise. See Reuben W. Heflin, New Mexico
Constitutional Convention, 21 N.M. Hist. Rev. 60, 67 (1946);
Edward D. Tittmann, New Mexico Constitutional Convention:
Recollections, 27 N.M. Hist. Rev. 177, 182 (1952). While
Congress only extended the right to vote and hold public
office to "every free white male inhabitant" when it
established the Territory of New Mexico in 1850, see Organic
Act Establishing the Territory of New Mexico, ch. 49, § 6, 9
Stat. 446, 449 (1850) (compiled in NMSA 1978, vol. 1,
Territorial Laws and Treaties), in 1914 this Court noted
that the territorial government had appointed women to hold
various public offices, see State v. Chaves de Armijo, 18
N.M. 646, 663-64, 140 P. 1123, 1129 (1914). In addition,
"[t]he Supreme Court of the Territory, in 1908, admitted a
woman to practice law in the Territory, and [circa 1889] a
woman was admitted to the bar at Las Vegas." Id. at 663,
140 P. at 1129.
{33} The original state constitution that became law in
1912, however, only gave women the right to vote in school
elections and to hold the office of county school
superintendent, school director, board of education member,
notary public, and "such other appointive offices as may be provided by law." N.M. Const. art. XX, § 11; id. art. VII,
§ 2 (prior to 1921 amendment). In 1913, the Legislature
provided that "women may hold any appointive office in the
State of New Mexico." 1913 N.M. Laws, ch. 60. Following
the passage of the Nineteenth Amendment to the United States
Constitution, which gave women the unconditional right to
vote in federal and state elections, Article VII, Section 2
of the New Mexico Constitution was amended in 1921 to state
that "[t]he right to hold public office in New Mexico shall
not be denied or abridged on account of sex, and wherever
the masculine gender is used in this constitution, in
defining the qualifications for specific offices, it shall
be construed to include the feminine gender." See Folmar,
supra, at 22 tbl. I.
{34} Despite these developments, many of the State's early
laws continued to reflect the common-law view "that women
were incapable mentally of exercising judgment and
discretion and were classed with children, lunatics, idiots,
and aliens insofar as their political rights were
concerned." Chaves de Armijo, 18 N.M. at 659, 140 P. at
1127; see also Anne K. Bingaman, The Effects of an Equal
Rights Amendment on the New Mexico System of Community
Property: Problems of Characterization, Management and
Control, 3 N.M. L. Rev. 11, 56 (1973) (noting early
community property laws that "reflect[ed] the attitudes of
an era when married women were expected to rear children,
care for home and husband, and do nothing else"). For
example, the State's early marriage laws provided that
"[t]he husband is the head of the family. He may choose any
reasonable place or mode of living, and the wife must
conform thereto." NMSA 1953, § 57-2-2 (1907) (repealed
1973); see also NMSA 1953, § 57-4-3 (1927) (repealed 1973)
(granting husbands the exclusive right to manage and control
personal property shared by their wives under the state's
community property laws).
{35} Many of these early laws were repealed or amended in
direct response to the passage of the Equal Rights Amendment
in 1972. See, e.g., 1973 N.M. Laws, ch. 58, § 1 (revising
the definition of "unlawful discriminatory practice" under
the New Mexico Human Rights Act, NMSA 1978, § 28-1-7 (1995),
to expand prohibitions on sex discrimination); Anne K.
Bingaman, The Community Property Act of 1973: A Commentary
and Quasi-Legislative History, 5 N.M. L. Rev. 1 (1974)
(reviewing changes in community property law occasioned by
passage of the Equal Rights Amendment); Folmar, supra, at 28
tbl.I (noting that Article VIII, Section 5 of the New Mexico
Constitution was amended in 1973 to remove gender-based
restrictions on veterans' property tax exemptions); Lisa
Dawgert Waggoner, New Mexico Joins the Twentieth Century:
The Repeal of the Marital Rape Exemption, 22 N.M. L. Rev.
551, 561 (1992) (describing changes to the definition of
criminal sexual offenses in response to the Equal Rights
Amendment). New Mexico courts also have relied upon the
Equal Rights Amendment and the statutory changes that followed in its wake. See, e.g., State v. Gonzales, 111
N.M. 590, 599, 808 P.2d 40, 49 (Ct. App. 1991) (Equal Rights
Amendment makes it "clear beyond cavil that discrimination
on the basis of gender in the use of peremptory challenges
[to strike jurors in a criminal case] is prohibited in New
Mexico"); Behrmann v. Phototron Corp., 110 N.M. 323, 328,
795 P.2d 1015, 1020 (1990) (affirming a jury verdict in
favor of an employee who claimed that termination of her
employment because of her pregnancy was an unlawful
discriminatory practice under Section 28-1-7).
{36} Based on our review of the text and history of our
state constitution, we conclude that New Mexico's Equal
Rights Amendment is a specific prohibition that provides a
legal remedy for the invidious consequences of the gender-based discrimination that prevailed under the common law and
civil law traditions that preceded it. As such, the Equal
Rights Amendment requires a searching judicial inquiry
concerning state laws that employ gender-based
classifications. This inquiry must begin from the premise
that such classifications are presumptively
unconstitutional, and it is the State's burden to rebut this
presumption.
{37} Although we recognize that federal courts currently
apply an intermediate level of scrutiny to gender-based
classifications, see United States v. Virginia, 518 U.S.
515, 532-34 (1996), our rationale for conducting a searching
judicial inquiry regarding such classifications under the
New Mexico Constitution may accord with the criteria for
invoking more stringent judicial scrutiny under federal law,
see United States v. Carolene Prods. Co., 304 U.S. 144, 152-53 n.4 (1938) (noting that heightened scrutiny may be
appropriate "when legislation appears on its face to be
within a specific prohibition of the Constitution"); San
Antonio Indep. Sch. Dist. v. Rodriguez, 411 U.S. 1, 28
(1973) ("history of purposeful unequal treatment" is one of
"traditional indicia" of suspect classification requiring
strict scrutiny under federal law); Marrujo v. New Mexico
State Highway Transp. Dep't, 118 N.M. 753, 757, 887 P.2d
747, 751 (1994) (noting circumstances in which strict
scrutiny applies); cf. Opinion of the Justices to the House
of Representatives, 371 N.E.2d 426, 428 (Mass. 1977) ("To
use a standard . . . which requires any less than the strict
scrutiny test would negate the purpose of the equal rights
amendment and the intention of the people in adopting it.").
Thus, as we explain below, our analysis is not inextricably
tied to the standard of review employed by the federal
courts. Cf. Gutierrez, 116 N.M. at 435-36, 863 P.2d at
1056-57 (in interpreting state constitutional guarantees,
New Mexico courts may seek guidance from decisions of
federal courts without being bound by those decisions).
{38} The Department asserts that heightened scrutiny is not warranted in this case because Rule 766 employs a
classification based on a "physical condition" with respect
to which men and women are not similarly situated. See
Geduldig v. Aiello, 417 U.S. 484, 496-97 n.20 (1974);
Fischer, 502 A.2d at 125-26. We agree that not all
classifications based on physical characteristics unique to
one sex are instances of invidious discrimination. A flat
prohibition of such classifications may lead to "absurd
results." See generally Barbara A. Brown et al., The Equal
Rights Amendment: A Constitutional Basis for Equal Rights
for Women, 80 Yale L.J. 871, 893-94 (1971); Ruth Bader
Ginsburg, Gender and the Constitution, 44 Univ. Cin. L. Rev.
1, 37 (1975). For this reason, the presumption that gender-based classifications violate New Mexico's Equal Rights
Amendment is not irrebuttable, and our heightened scrutiny
need not be "fatal in fact." Cf. Virginia, 518 U.S. at 533
n.6 (observing that "strict scrutiny of [classifications
based on race or national origin] is not inevitably 'fatal
in fact'").
{39} It would be error, however, to conclude that men and
women are not similarly situated with respect to a
classification simply because the classifying trait is a
physical condition unique to one sex. In this context,
"'similarly situated' cannot mean simply 'similar in the
possession of the classifying trait.' All members of any
class are similarly situated in this respect and
consequently, any classification whatsoever would be
reasonable by this test." Joseph Tussman & Jacobus
tenBroek, The Equal Protection of the Laws, 37 Cal. L. Rev.
341, 345 (1949). It is equally erroneous to rely on the
notion that a classification based on a unique physical
characteristic is reasonable simply because it corresponds
to some "natural" grouping. See id. at 346. We find this
error present in an analysis which reasons that laws
affecting only the members of one sex may be justified by
"certain immutable facts of life which no amount of
legislation may change." Fischer, 502 A.2d at 125.
{40} To determine whether men and women are similarly
situated with respect to a classification, "we must look
beyond the classification to the purpose of the law."
Tussman & tenBroek, supra, at 346. Further, to determine
whether a classification based on a physical characteristic
unique to one sex results in the denial of "equality of
rights under law" within the meaning of New Mexico's Equal
Rights Amendment, we must ascertain whether the
classification "operates to the disadvantage of persons so
classified." Ginsburg, supra, at 37-38; see also Brown et
al., supra, at 894 (noting danger that rule based on unique
physical characteristic "could be used to justify laws that
in overall effect seriously discriminate against one sex");
Cass R. Sunstein, Neutrality in Constitutional Law (with
Special Reference to Pornography, Abortion, and Surrogacy),
92 Colum. L. Rev. 1, 33 (1992) ("The question at hand is
whether government has the power to turn th[e] capacity [to bear children], limited as it is to one gender, into a
source of social disadvantage."); Laurence H. Tribe,
American Constitutional Law § 16-29, at 1584 (2d ed. 1988)
("[T]he fundamental problem is [the] willingness to
transmute woman's 'real' biological difference to woman's
disadvantage.").
{41} In making these determinations, we cannot ignore the
fact that "[s]ince time immemorial, women's biology and
ability to bear children have been used as a basis for
discrimination against them." Doe, 515 A.2d at 159.
Further, history teaches that lawmakers often have attempted
to justify gender-based discrimination on the grounds that
it is "benign" or "protective" of women. See generally
Ginsburg, supra, at 2-7; cf. Frontiero, 411 U.S. at 684
(plurality opinion) (discussing "attitude of 'romantic
paternalism'"). For example, as a basis for imposing
restrictions on women's ability to work and participate in
public life, courts have accepted at face value a desire of
lawmakers to protect women from "ugliness and depravity,"
J.E.B. v. Alabama ex rel. T.B., 511 U.S. 127, 132 (1994), "a
legislative solicitude for the moral and physical well-being
of women," Goesaert v. Cleary, 335 U.S. 464, 468 (1948)
(Rutledge, J., dissenting), overruling recognized by Payne
v. Tennessee, 501 U.S. 808, 828 n.1 (1991), including the
need to protect a woman's "physical structure and a proper
discharge of her maternal functions," Muller v. Oregon, 208
U.S. 412, 422 (1908), and the rationale that "woman is still
regarded as the center of home and family life," Hoyt v.
Florida, 368 U.S. 57, 62 (1961), overruling recognized by
Payne, 501 U.S. at 829 n.1.
{42} We also note that some physical characteristics, such
as the ability to become pregnant, may have profound health
consequences. For example, there is undisputed evidence in
the record that carrying a pregnancy to term may aggravate
pre-existing conditions such as heart disease, epilepsy,
diabetes, hypertension, anemia, cancer, and various
psychiatric disorders. According to these sources,
pregnancy also can hamper the diagnosis or treatment of a
serious medical condition, as when a pregnant woman cannot
receive chemotherapy to treat her cancer, or cannot take
psychotropic medication to control symptoms of her mental
illness, because such treatment will damage the fetus. The
evidence presented in this case concerning the health
consequences of pregnancy accords with the expert medical
testimony presented in other cases. See, e.g., Doe, 515
A.2d at 142; Moe, 417 N.E.2d 387, 393 n.10.
{43} In light of these factors, we conclude that
classifications based on the unique ability of women to
become pregnant and bear children are not exempt from a
searching judicial inquiry under the Equal Rights Amendment
to Article II, Section 18 of the New Mexico Constitution.
New Mexico's state constitution requires the State to
provide a compelling justification for using such classifications to the disadvantage of the persons they
classify.
{44} Looking "beyond the classification to the purpose of
the law," Tussman & tenBroek, supra, at 346, it is apparent
that men and women who meet the Department's general
criteria regarding financial and medical need are similarly
situated with respect to their eligibility for medical
assistance in this case. The basic objective of Title XIX
of the federal Social Security Act is to provide qualified
individuals with necessary medical care. See 42 U.S.C. §
1396; Hern, 57 F.3d at 910-11. Likewise, "[t]he mission of
the New Mexico Medical Assistance Division is to maximize
the health status of Medicaid-eligible individuals by
furnishing payment for quality health services at levels
comparable to private health plans." 8 NMAC 4.MAD.002.
{45} While Title XIX gives the State some flexibility to
determine the extent of coverage for the required categories
of medical services, several federal courts, including the
Tenth Circuit, have "interpreted Title XIX and its
accompanying regulations as imposing a general obligation on
[participating] states to fund those mandatory coverage
services that are medically necessary." Hern, 57 F.3d at
911.See footnote 4 Apart from the restrictions on federal funding
imposed by the Hyde Amendment, "[a]bortion falls under
several of these 'mandatory coverage' categories." Id. at
910. Further, the mandatory coverage services available
under state law generally rely on the standard of medical
necessity. See 8 NMAC 4.MAD.601 (providing for services
"which are medically necessary for the diagnosis and/or
treatment of illnesses, injuries, or conditions of
recipients").
{46} Except in the cases of rape or incest, or when
necessary to save the life of the mother, Rule 766 denies
state funding for abortions even when they are medically
necessary. Under the Department's regulations, there is no
comparable restriction on medically necessary services
relating to physical characteristics or conditions that are
unique to men. Indeed, we can find no provision in the
Department's regulations that disfavors any comparable,
medically necessary procedure unique to the male anatomy.
For example, the Department does not explicitly condition
reimbursement for any covered health service for income-eligible men on a physician's certification that the care is
necessary to save the life of the patient.
{47} Thus, Rule 766 undoubtedly singles out for less
favorable treatment a gender-linked condition that is unique
to women. See Geduldig, 417 U.S. at 501 (Brennan, J.,
dissenting); Sunstein, supra, at 32-33. "Since only women
become pregnant, discrimination against pregnancy by not
funding abortion when it is medically necessary and when all
other medical[ly necessary] expenses are paid by the state
for both men and women is sex oriented discrimination."
Doe, 515 A.2d at 159. We determine that Rule 766 employs a
gender-based classification that operates to the
disadvantage of women and is therefore presumptively
unconstitutional. In order to survive the heightened
scrutiny that we apply to such classifications, the State
must meet its burden of showing that Rule 766 is supported
by a compelling justification.
{48} The Department asserts that the restriction on
medically necessary abortions imposed by Rule 766 serves the
State's interests in two ways. First, the Department claims
that Rule 766 is a legitimate cost-saving measure. In this
regard, we acknowledge that courts very rarely require the
government to fund its citizens' exercise of their
constitutional rights. See Harris, 448 U.S. at 316-18
(federal government is not required to fund a woman's
exercise of her constitutional right to abortion); Howell,
118 N.M. at 506, 882 P.2d at 547 (concluding that there is
no fundamental right to receive public assistance). But
that is not to say that when the Department elects to
provide medically necessary services to indigent persons, it
can do so in a way that discriminates against some
recipients on account of their gender.
{49} The Department fails to offer a sufficiently compelling
justification for such discrimination in this case. To be
sure, Rule 766 may prevent the State from incurring the cost
of funding medically necessary abortions not covered by the
Hyde Amendment. But the Department's assertion "that it
saves money when it declines to pay the cost of a [Medicaid-eligible woman's medically necessary] abortion is simply
contrary to undisputed facts." Maher v. Roe, 432 U.S. 464,
490 (1977) (Brennan, J., dissenting) (citation omitted).
{50} Pregnant women who qualify for medical assistance from
the Department are, by definition, unable to pay for their
own medical expenses. Such women have only a limited
period of time to obtain a safe, relatively inexpensive
abortion after discovering that they are pregnant. The
expense of obtaining an abortion increases two to six times
in the second trimester. Further, it is not unreasonable to
infer that the conditions which make an abortion medically
necessary also may have a disabling effect on a pregnant woman's earning capacity. For these reasons, we cannot
assume that Medicaid-eligible women are likely to obtain
medically necessary abortions with private funds when they
are denied state funding under Rule 766.
{51} Indeed, such a result would be incompatible with the
second interest asserted by the Department_protecting the
potential life of the unborn. If Rule 766 only succeeded in
shifting the burden of paying for abortion services to the
private sector, then it would lose its effect of preserving
potential life. Thus, in order to account for the second
interest asserted by the Department, we must assume that the
Department stands ready to accept an increase in the cost of
other forms of medical assistance to which Medicaid-eligible
pregnant women are entitled when they are denied medically
necessary abortions.
{52} Under this scenario, for every woman who is denied
state funding for a medically necessary abortion, we must
assume the Department will be obligated to contribute a
significant portion of the funds used to pay for medical
expenses associated with bringing a pregnancy to term.See footnote 5
These expenses may include the cost of providing midwife
services, see 8 NMAC 4.MAD.718.1, case management services
for pregnant women and their infants, see 8 NMAC 4.MAD.772
(May 15, 1996), coverage for newborn infants, see 8 NMAC
4.NBN.400, and other pregnancy-related services, see 8 NMAC
4.PSO.400; 8 NMAC 4.PWN.400. In addition, the Department in
some cases may have to cover medical treatment necessary to
control the aggravation of pre-existing conditions that,
according to Plaintiffs' allegations, would render an
abortion medically necessary. See 42 C.F.R. § 440.210(a)(2)
(1997) (mandatory coverage for "other conditions that might
complicate the pregnancy"). It is undisputed that the
State's expenses associated with bringing a pregnancy to
term generally are much greater than its expenses associated
with providing a medically necessary abortion.See footnote 6 For these
reasons, we cannot conclude that Rule 766 serves as the
least restrictive means of reducing the State's costs of providing medical assistance.
{53} We next consider whether, apart from its financial
impact, Rule 766 serves as the least restrictive means of
advancing the State's interest in the potential life of the
unborn. Under federal law, the State's interest in the
potential life of the unborn is never compelling enough to
outweigh the interest in the life and health of the mother.
See Roe v. Wade, 410 U.S. 113, 164-65 (1973); Planned
Parenthood v. Casey, 505 U.S. 833, 879 (1992) (plurality
opinion); Doe, 515 A.2d at 157. Assuming, however, that at
some late stage of a woman's pregnancy the State's interest
becomes sufficiently compelling to support the denial of
public funding, Rule 766 is not the least restrictive means
of advancing this interest because it prohibits state
funding for most medically necessary abortions at all stages
of a woman's pregnancy and without regard to her health
except in life-threatening situations. Further, according
to the parties' stipulated facts, Rule 766 also may deny
coverage for an abortion even when it is determined that the
fetus will not be viable because it suffers from a fatal
physical or mental impairment.
{54} For these reasons, we conclude that Rule 766 is not the
least restrictive means to advance the State's interest in
the potential life of the unborn at a point when that
interest may become compelling. Further, because the State
fails to provide a compelling justification for treating men
and women differently with respect to their medical needs in
this instance, we conclude that Rule 766 violates the Equal
Rights Amendment to Article II, Section 18 of the New Mexico
Constitution.
{55} We next address the Department's claim that the
district court lacks the authority to remedy this
constitutional violation by ordering the State to pay for
medically necessary abortions for Medicaid-eligible women.
According to the Department, the district court's order is
inconsistent with the requirements of Section 27-2-12 of the
Public Assistance Act and the provisions in the New Mexico
Constitution regarding the separation of powers.
{56} Section 27-2-12 provides that:
Consistent with the federal act and
subject to the appropriation and
availability of federal and state funds,
the medical assistance division of the
human services department may by
regulation provide medical assistance,
including the services of licensed
doctors of oriental medicine and
licensed chiropractors, to persons
eligible for public assistance programs under the federal act.
The Department claims this language means that it cannot
provide any medical assistance for which federal
reimbursement is unavailable. Thus, according to the
Department, the district court violated the Public
Assistance Act and exceeded its constitutional powers by
enacting law and appropriating state funds for such medical
assistance in the case of medically necessary abortions that
fall outside the restrictions in the Hyde Amendment. See
N.M. Const. art. III, § 1 (providing for separation of
powers); id. art. IV, § 1 (vesting legislative power in the
Senate and the House of Representatives); id. art. IV, § 30
(limiting payments from the treasury to appropriations by
the Legislature).
{57} We do not agree with the Department's proposed
construction of Section 27-2-12 of the Public Assistance
Act. Section 27-2-12 does not expressly prohibit funding
medically necessary abortions for Medicaid-eligible women,
nor does it explicitly state that funding for this
particular medical procedure is contingent on federal
reimbursement. Indeed, the Legislature has considered and
rejected such language. See S. 52, 42d Leg., 1st Sess.
(N.M. 1995); H.R. 76, 42d Leg., 1st Sess. (N.M. 1995).
Unlike the specific restriction on the availability of
federal funds for abortions imposed by Congress in the Hyde
Amendment, New Mexico's Public Assistance Act only contains
general language delegating rulemaking authority to the
Department and setting limits on that authority with respect
to the State's medical assistance program. Thus, we cannot
say the funding restrictions in Rule 766 are compelled by
the plain meaning of Section 27-2-12. See State ex rel.
Helman v. Gallegos, 117 N.M. 346, 353, 871 P.2d 1352, 1359
(1994) (noting circumstances under which the plain-meaning
rule does not apply).
{58} In this case, the Department's power to adjust the
distribution of state funds under the medical assistance
provisions of the Public Assistance Act in order to comply
with the Bill of Rights guaranteed by the New Mexico
Constitution "arise[s] from the statutory language by fair
and necessary implication." Howell, 118 N.M. at 504, 882
P.2d at 545. The basic purpose of Section 27-2-12 is to
ensure that, if New Mexico is going to participate in the
federal Medicaid program, the State's plan must provide for
the categories of medical assistance and the level of state
funding that are required to remain eligible for federal
financial assistance under Title XIX of the Social Security
Act. Cf. 42 U.S.C. § 1396a(a)(10) (requiring state plan to
provide categories of medical assistance listed under 42
U.S.C. §§ 1396d(a)(1) to (5), (17), (21)); id. § 1396a(a)(2)
(requiring state plan to provide for financial participation
by the State); id. § 1396c (providing for discontinuation of
federal payments if state plan does not comply with these
federal requirements). But this linkage to "[f]ederal law cannot enlarge state executive power beyond that conferred
by the state constitution." State ex rel. Taylor v.
Johnson, 1998-NMSC-015, ¶ 42, 125 N.M. 343, 961 P.2d 768.
Where, as here, state funds within the Department's control
are used in a manner that does not conflict with federal law
in order to fulfill the fundamental guarantees of our state
constitution, we cannot say that Section 27-2-12 has been
violated. Cf. Boley v. Miller, 418 S.E.2d 352, 358 (W. Va.
1992) (refusing to construe state medical assistance statute
as prohibiting use of state funds to pay for abortions that
did not qualify for federal matching funds); Dodge v.
Department of Soc. Servs., 657 P.2d 969, 975-76 (Colo. Ct.
App. 1982) (same).
{59} Our conclusion that the district court's order does not
violate Section 27-2-12 also disposes of the Department's
claim that the district court violated the provisions in our
state constitution requiring separation of powers. In
requiring the Department to disburse state funds
appropriated by the Legislature in a manner consistent with
the Equal Rights Amendment to Article II, Section 18 of the
New Mexico Constitution, the district court did not usurp
the Legislature's power to enact new laws or appropriate
funds. See Moe, 417 N.E.2d at 395; Dodge, 657 P.2d at 973-75; Georgia by Dep't of Med. Assistance v. Heckler, 768
F.2d 1293, 1296 (11th Cir. 1985). "'It is a function of the
judiciary when its jurisdiction is properly invoked to
measure the acts of the executive and the legislative branch
solely by the yardstick of the constitution.'" State ex
rel. Clark, 120 N.M. at 570, 904 P.2d at 19 (quoting State
ex rel. Hovey Concrete Prods. Co. v. Mechem, 63 N.M. 250,
252, 316 P.2d 1069, 1070 (1957)). The district court did
not exceed its power in performing that function here.
{60} The Department's final contention is that a permanent
injunction is not warranted because Plaintiffs have not
established that they will suffer irreparable injury if Rule
766 is implemented or that granting an injunction is not
adverse to the public interest. See National Trust for
Historic Preservation, 117 N.M. at 595, 874 P.2d at 803
(listing requirements for preliminary injunction). These
assertions, however, rely on the Department's arguments
regarding standing and separation of powers, which we have
rejected earlier in this opinion. Therefore, we conclude
that the district court did not err in permanently enjoining
the Department from enforcing Rule 766. Cf. Doe, 515 A.2d
at 162 (finding that enforcement of abortion regulation
would cause irreparable injury and granting injunctive
relief).
{61} Based on the independent grounds provided by the Equal
Rights Amendment to Article II, Section 18 of the New Mexico
Constitution, we affirm the district court's orders granting
Plaintiffs' motion for summary judgment, permanently enjoining the Department from enforcing its May 1995
revision of Rule 766, and awarding costs to Plaintiffs. We
reverse the district court's orders granting Klecan and
Schaurete's motion to intervene for failure to comply with
the requirements of Rule 1-024(A)(2). Because we have
previously granted a stay of Plaintiffs' cross-appeal with
respect to the issue of attorney fees, we defer ruling on
that issue or the award of costs on appeal until further
order of this Court.
{62} IT IS SO ORDERED.
__________________________________
PAMELA B. MINZNER, Justice
WE CONCUR:
______________________________________
GENE E. FRANCHINI, Chief Justice
______________________________________
JOSEPH F. BACA, Justice
______________________________________
DAN A. McKINNON, III, Justice
______________________________________
M. CHRISTINA ARMIJO, Judge,
New Mexico Court of Appeals
(sitting by designation)