SCOTUS Rejects Challenge to South Carolina’s Exclusion of Planned Parenthood from State Medicaid Program

In Medina v. Planned Parenthood South Atlantic, 606 U.S. ____ (2025), the U.S. Supreme Court held that individual Medicaid beneficiaries can’t sue state officials under 42 U.S.C. §1983 for failing to comply with the Medicaid Act’s any-qualified-provider provision. The suit challenged South Carolina’s decision to exclude Planned Parenthood from the state’s Medicaid program because it provides abortions.

Facts of the Case

Congress created Medicaid in 1965 to subsidize state healthcare for families and individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” Medicaid offers States “a bargain”: federal funds in exchange for compliance with congressionally imposed conditions. To participate in Medicaid, States must submit a “plan for medical assistance” satisfying over 80 conditions in the Medicaid Act (42 U.S. Code §1396a(a)). If a State fails “to comply substantially” with any condition, the Secretary of Health and Human Services can withhold federal funding. 

The case before the Court involves the Medicaid Act’s any-qualified-provider provision in §1396a(a)(23)(A), which requires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. The provision does not define “qualified,” leaving that to States’ traditional authority over health and safety matters. The question is whether individual Medicaid beneficiaries may sue state officials under 42 U.S.C. §1983 for failing to comply with the any-qualified-provider provision.

Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medicaid patients. It also performs abortions. Citing state law prohibiting public funds for abortion, South Carolina in July 2018 determined that

Planned Parenthood could no longer participate in the State’s Medicaid program. At the same time, the State took steps that, it said, would help ensure that other providers would continue offering necessary medical care and family planning services.

Planned Parenthood and patient Julie Edwards sued, claiming the exclusion of Planned Parenthood violated the any-qualified-provider provision. They brought a class action “to vindicate rights secured by the federal Medicaid statutes” pursuant to Section 1983, which allows private parties to sue state actors who violate their “rights” under the federal “Constitution and laws.”

The district court granted summary judgment for plaintiffs and enjoined the exclusion. The Fourth Circuit affirmed. This Court then granted certiorari, vacated, and remanded in light of Health and Hospital Corporation of Marion Cty. v. Talevski, 599 U.S. 166 (2023), which addressed whether another spending-power statute created §1983-enforceable rights. On remand, the Fourth Circuit reaffirmed.

Supreme Court’s Decision

By a vote of 6-3, the Court reversed. It held that Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under §1983. Justice Neil Gorsuch wrote on behalf of the majority.

In writing for the majority, Justice Neil Gorsuch emphasized that federal statutes do not automatically confer Section 1983-enforceable “rights.” Citing Gonzaga Univ. v. Doe, 536 U.S. 273 (2002), he further noted that Section 1983 provides causes of action for deprivation of “rights,” not mere “benefits” or “interests.” 

To prove an enforceable right, plaintiffs must show the statute “clear[ly] and unambiguous[ly]” uses “rights-creating terms” with “an unmistakable focus” on individuals, which Justice Gorsuch characterized as a “stringent” and “demanding” test.According to the majority, this is especially true of spending-power statutes like Medicaid, where “the typical remedy” for violations is federal funding termination, not private suits.

The majority went on to find that Section 1396a(a)(23)(A) lacks the required clear rights-creating language to satisfy the high bar. In reaching this conclusion, Justice Gorsuch distinguished it from provisions of the Federal Nursing Home Reform Act (FNHRA), which the Supreme Court held created an individual right allowing private lawsuits under federal civil rights laws in Talevski.

In support, the majority cited that FNHRA specifically creates a “right to choose a personal attending physician” – which shows that “Congress knows how to give a grantee clear and unambiguous notice that, if it accepts federal funds, it may face private suits asserting an individual right to choose a Medicaid provider.”

“Someday, Congress might choose to revise §1396a(a)(23) to resemble FNHRA,” Justice Gorsuch wrote. “But that is not the law we have.”

Dissent

Justice Ketanji Brown Jackson authored a dissent, which was joined by Justices Sonia Sotomayor and Elena Kagan.

“Congress enacted the Medicaid Act’s free-choice-of-provider provision to ensure that Medicaid recipients have the right to choose their own doctors,” Justice Jackson wrote “The Court’s decision to foreclose Medicaid recipients from using” federal civil rights laws “to enforce that provision thwarts Congress’s will twice over: once, in dulling the tool Congress created for enforcing all federal rights, and again in vitiating one of those rights altogether.”