5th Circuit: Texas Statute Giving Parents Right to Consent to Teens' Contraceptives Is Consistent with Title X

 In Deanda v. Becerra, (5th Cir., March 12, 2024), the U.S. 5th Circuit Court of Appeals held that a Texas statute giving parents the right to consent to their teenagers' receiving contraceptives is consistent with Title X of the federal Public Health Service Act under which clinics are given grants to distribute contraceptives and other family planning services. HHS had given informal guidance to grantees that they could not require parental consent or notify parents before prescribing contraceptives to minors. The court's opinion describes the lawsuit:

In 2020, Alexander Deanda filed a federal lawsuit challenging the Secretary’s administration of the Title X program. He alleged that he is the father of three minor daughters1; that he is raising his daughters according to his Christian beliefs to abstain from pre-marital sex; and that he wants to be informed if any of his children access or try to access contraceptives. He further alleged that Texas law gives him a right to consent before his children obtain contraceptives. See Tex. Fam. Code § 151.001(a)(6); § 102.003(a)(1). Finally, he alleged that the Secretary administers Title X unlawfully by funding grantees who provide contraceptives to minors without notifying parents or obtaining parental consent. Accordingly, Deanda sought declaratory and injunctive relief on behalf of himself and a putative class, claiming that the Title X program violates (and does not preempt) Texas law and that it violates his constitutional right to direct his children’s upbringing as well as his rights under the Religious Freedom Restoration Act (“RFRA”).

The court concluded that Title X and the Texas statute reinforce each other because Title X calls for grantees to encourage family participation to the extent practicable.  The court however reversed the trial court's invalidation of a formal HHS Rule promulgated in 2021 forbidding grantees from notifying parents or requiring parental consent because the Rule was adopted after this lawsuit was filed and was not specifically challenged by the lawsuit. 

Houston Chronicle reports on the decision.

Tennessee Sues to Restore Title X Grant Without Making Abortion Referrals

Tennessee's Attorney General this week filed suit against the U.S. Department of Health and Human Services seeking to restore Tennessee's $7 million annual Title X family planning grant which had been cancelled because of the state's abortion referral policy.  The complaint (full text) in State of Tennessee v. Becerra, (ED TN, filed 10/24/2023), challenges the HHS rule that requires Title X grantees to furnish information and nondirective counseling on abortion if pregnant clients request it.  Tennessee was only willing to make referrals and provide counseling as to procedures that are legal in Tennessee,  HHS takes the position that where, as in Tennessee, abortion is outlawed, out-of-state referrals would be required. the suit contends that the HHS rule violates various provisions of the Administrative Procedure Act. It asks the court, among other things, to:

Enjoin Defendants from withholding Title X funds from Tennessee for refusing to offer counseling and referrals (including out-of-state) for abortions that are otherwise illegal under Tennessee law.

Catholic World Report reports on the lawsuit.

HHS Must Assure Parental Consent in Grantee Programs That Distribute Contraceptives to Minors

In Deanda v. Becerra, (ND TX, Dec, 8, 20222), a Texas federal district court held that a Texas statute which protects parental rights to consent to a minor's medical care applies to all Title X grantees in Texas.  Title X of the Public Health Service Act provides for grants to entities offering family planning services.  Plaintiff, a Christian raising his daughters in accordance with Christian teachings that require unmarried children to refrain from sexual intercourse until marriage, contends that the Department of Health and Human Services is not monitoring grantees to ensure that they obtain parental consent to providing contraceptives to minors. The court rejected defendant's claim that Title X pre-empts Texas law on parental rights. It went on to hold that parents have a federal constitutional right to control the medical care of their minor children, and this includes the right to consent to contraception.  The court said in part:

Contraception is a serious matter - both medically and for parents' rights to control the upbringing and education of their children. Several popular methods of birth control carry serious side effects. The courts that have denied parental consent rights apparently presume contraceptive drugs are "no big deal." ... 

[O]mitting parental consent gives insufficient weight to the undesirability of teenage promiscuity.

HHS Proposes Reversal of Trump Administration Title X Family Planning Grant Rules

Yesterday the U.S. Department of Health and Human Services published a proposed rule that would reverse the Trump Administration rules on federally funded family planning services and return, with a few modifications, to the rules in effect before 2019.  As summarized by NPR News:

The [Trump Administration] rules ... forbid any provider who provides or refers patients for abortions from receiving federal funding through Title X to cover services such as contraception and STD screenings for low-income people....

The Trump administration implemented the current rules in an effort to "defund Planned Parenthood," as he had promised supporters during both his campaign and his presidency. That prompted more than 1,000 health clinics in dozens of states, including but not limited to Planned Parenthood, to leave the program.

The HHS Release (full text) titled Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services says in part:

For five decades, Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and related preventive health services for millions of low-income or uninsured individuals and others.... Title X providers offered clients a broad range of effective and medically safe contraceptive methods approved by the U.S. Food and Drug Administration. Title X-funded sexually transmitted infection (STI) and human immunodeficiency virus (HIV) screening services prevented transmission and adverse health consequences....

Given the previous success of the program, the large negative public health consequences of maintaining the 2019 rules, the substantial compliance costs for grantees, and the lack of tangible benefits, the Department proposes revoking the 2019 Title X regulations. As has been clearly borne out by case law and history, the Department has the discretion to make this determination and it is in the interest of public health....

Supreme Court Grants Review of Title X Rule Restricting Abortion Counseling

The U.S. Supreme Court today granted certiorari (Order List, 2/22/2021) in three related cases challenging a Final Rule promulgated by the Department of Health and Human Services in March 2019. (See prior posting.) The rule imposes new restrictions on health care providers receiving Title X family planning funds.  As described in the AMA's petition for certiorari:

The Rule both prohibits and compels certain pregnancy-related speech between a Title X provider and her patient, proscribing abortion related information but requiring information about non-abortion options—regardless of what the patient wants. The Rule also imposes burdensome physical separation requirements on any Title X provider engaging in abortion-related activities outside the Title X program.

The cases (with links to their SCOTUSblog case pages) are American Medical Association v. Cochran (Docket No. 20-429),  Cochran v. Mayor and City Council of Baltimore (Docket No. 20-454), and Oregon v. Cochran (Docket No. 20-539). The Hill reports on the Court's action.

9th Circuit: New Title X Limits Remain In Effect For Now

Earlier this month, the U.S. 9th Circuit Court of Appeals voted to vacate the 3-judge panel's decision in State of California v. Azar, and to grant en banc review of whether the Trump Administration's new regulations on family planning grants may go into effect. The new rules bar recipients of family planning grants under Title X from referring clients for abortions. They also ban clinics that receive Title X funds from sharing office space with abortion providers. Three district courts had enjoined implementation of the new rules, but a 3-judge panel of the 9th Circuit had granted a stay of the injunctions, allowing the new rules to go into effect. (See prior posting.) While it was widely reported that the court's action earlier this month granting en banc review had reinstated the district court injunctions, apparently that was not so because a week later in State of  California v. Azar, (9th Cir., July 11, 2019), the en banc court, in a 7-4 opinion, said:

Pursuant to prior order of the Court upon granting reconsideration en banc, the three-judge panel Order on Motions for Stay Pending Appeal in these cases was ordered not be cited as precedent by or to any court of the Ninth Circuit. However, the order granting reconsideration en banc did not vacate the stay order itself, so it remains in effect. Thus, the motions for administrative stay remain pending and were not mooted by the grant of reconsideration en banc.

After due consideration of the emergency motions, the motions for administrative stay of the three-judge panel order are DENIED.

Liberty Counsel, reporting on the decision, says that the new Title X rules will block $50 to $60 million in grants to Planned Parenthood that would have been used for birth control, testing for sexually transmitted diseases, and cancer screenings.