Case: Mabel Wadsworth Women's Health Center v. Mayhew

On November 24, 2015, the American Civil Liberties Union, ACLU of Maine, and Planned Parenthood Federation of America filed a lawsuit in the Superior Court of Maine (Maine's only trial-level court), Cumberland County, seeking to restore abortion coverage for women receiving free and low-cost Maine Medicaid ("MaineCare") as health insurance. These nonprofit organizations filed on behalf of Mable Wadsworth Women's Health Center, Maine Family Planning, and Planned Parenthood of New England, each a reproductive and sexual health care provider that provides abortions. Together, the plaintiff-providers served 21,500 Maine residents per year, more than half of whom were low-income. The providers themselves brought the suit on behalf of their MaineCare patients. 

The plaintiffs sued the Maine Department of Health and Human Services (MDHHS), because one of their policies banned abortion coverage under MaineCare except in the limited circumstances of threat to the patient's life, rape, or incest. On the other hand, the policy covered all pregnancy care for patients choosing to bring their pregnancies to term and covered other alternative procedures like sterilization. Under federal law, state funds may be used for abortions at states' discretion. The providers brought their complaint under the Maine Administrative Procedure Act (APA), which prevents agencies like MDHHS from rule-making that either exceeds their authority or is not in accordance with the law, and Article 1, Sections 1 and 6-A of the Maine Constitution. The complaint alleged that the MDHHS policy interfered with a woman's fundamental right to choose; discriminated against women who decided on abortions; violated the Maine Constitution's "Liberty and Safety" Clause, its Equal Protection Clause (EPC), and its substantive due process right to privacy; and had a negative effect of forcing women to delay or never receive abortions, even at the expense of the women's health, or skip necessary household expenses in order to fully fund their abortions themselves. 

The plaintiffs requested declaratory relief, an injunction against enforcement of the MDHHS policy, and costs. Justice Andrew M. Horton was ultimately assigned to the case. After several extensions of time, on June 16, 2017, the MDHHS submitted a consolidated statement of material facts—with both parties agreeing on everything material—and motioned for summary judgment. The plaintiffs replied and submitted their own request for summary judgment on July 21, 2017.

On October 24, 2017, Judge Horton granted summary judgment in favor of MDHHS, along with recoverable costs, and denied it to the plaintiffs. Judge Horton concluded that, despite MDHHS's argument to the contrary, the providers themselves had standing because of lost income, and could also assert the third-party constitutional rights of their would-be clients. The Court also found the plaintiff's claim ripe and justiciable. Past these threshold procedural issues, however, the Court found that MDHHS had not exceeded its rule-making authority under the Maine APA because the government may subsidize one constitutionally protected choice (birth) and not another (abortion) without impermissibly restricting the unsubsidized choice. The Court used this "no funding" vs. "denial of a right" distinction to support multiple holdings: this is also why MDHHS's policy did not fail at its own mission of helping all Maine persons maintain their optimal level of health, economic independence, and personal development; and why MDHHS had not denied any women substantive due process or their constitutional right to privacy. Further, the Court found that MDHHS did not need to explain its rationale in order for the policy to be valid. Additionally, the Court held that there was no EPC issue given that the Maine Constitution's Equal Protection Clause parallels its federal equivalent and that under both, economic status is not a suspect class. Therefore, under the highly deferential rational basis standard used for non-suspect classes, the Court concluded that MDHHS's policy passed review. 2017 WL 6513589.

On November 8, 2017, the plaintiffs appealed in the Maine Supreme Judicial Court, which heard oral arguments in May 2018, and again in June 2019. However, expecting that legislative and regulatory action may resolve the case, the parties agreed to stay the appeal until September 23, 2019. On September 19, 2019, Maine Governor Janet Mills enacted L.D. 820, which required the Department to provide abortion coverage for MaineCare recipients. Separately on that same day, MDHHS promulgated an emergency rule providing for state abortion coverage for anyone eligible for MaineCare through December 18, 2019. On December 17, 2018, MDHHS enacted a final rule to this effect, effectively mooting the appeal.

The health centers argued that they qualified for exceptions to the mootness doctrine because the case was of great public interest and the issues may later be repeated. Plaintiffs therefore still requested the case be heard and that the Supreme Court vacate the lower court decision. Chief Justice Leigh I. Saufley wrote for the Court on January 14, 2020 to say that any public interest questions or issue repetition was too uncertain, and therefore, the Court dismissed the case and refused vacatur.