Dive Brief:
- The Supreme Court ruled on Thursday that individual Medicaid patients cannot sue to choose their health provider, allowing states to block Medicaid funding for abortion providers. The judgment was 6-3, split on ideological lines, with conservative justices in the majority.
- The ruling in Medina v. Planned Parenthood ends a legal dispute over a 2018 South Carolina policy that sought to block clinics that provide abortions from receiving Medicaid reimbursements. Plaintiffs argued the executive order violated a federal “free choice of provider clause” that guarantees Medicaid beneficiaries the right to choose their doctor, so long as they are qualified and accept the insurance.
- Justice Neil Gorsuch, writing the majority opinion, said the law provided no such explicit guarantee. Experts worry the case could have ripple effects beyond a family-planning context and provides a precedent for states to cut Medicaid funding for other providers, including those who offer gender-affirming care.
Dive Insight:
Thursday’s ruling pitted patients’ ability to choice their provider against states’ right to allocate funds as they see fit.
Although federal law generally bans the use of Medicaid funds for abortions, South Carolina Gov. Henry McMaster banned any Medicaid funds from flowing to clinics that offer abortions in a 2018 executive order, reasoning the funding was indirectly subsidizing abortion services.
Planned Parenthood argued the ban violated patients’ right to choose their provider, but the Supreme Court found they had no such enforceable right.
Gorsuch wrote that if Congress wished to clarify that patients have an enforceable right to choose their doctor, lawmakers could re-pass Medicaid legislation to include that exact verbiage. However, currently, “that is not the law we have.”
The justice added, “deciding whether to permit private enforcement poses delicate policy questions involving competing costs and benefits — decisions for elected representatives, not judges.”
The decision marks a sharp reversal from lower courts’ judgments. A district court first sided with Planned Parenthood on the matter, and the Fourth Circuit Court of Appeals reaffirmed the court’s decision in 2019, 2022 and 2024, finding Medicaid law did create an individual right that can be enforced under federal civil rights law, according to a press release from the plaintiffs.
McMaster cheered the ruling in a statement on Thursday.
“Seven years ago, we took a stand to protect the sanctity of life and defend South Carolina’s authority and values – and today, we are finally victorious,” said McMaster.
The ruling is likely to have widespread implications.
Eighteen states backed South Carolina in the case and could seek to implement similar restrictions on Medicaid dollars. Texas, Arkansas and Missouri have already tried to cut Medicaid funds for Planned Parenthood.
“States should be free to fund real, comprehensive care and exclude organizations like Planned Parenthood that profit off abortion,” John Bursch, a lawyer at the conservative Christian group Alliance Defending Freedom, who argued before the court on behalf of South Carolina, said in a statement Thursday. “The American people don’t want their tax dollars propping up the abortion industry.”
However, liberal justices decried the ruling. Justices Ketanji Brown Jackson, Elena Kagan and Sonia Sotomayor dissented.
Jackson wrote in her dissent that the decision ran afoul of the 1871 Civil Rights Act that protected Americans’ right to sue for civil rights violations.
“Today’s decision is likely to result in tangible harm to real people,” she wrote. “At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians – and countless other Medicaid recipients around the country – of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable’.”
Planned Parenthood condemned the decision, warning it jeopardized patients’ access to services like birth control and cancer screenings. Twenty percent of South Carolinians receive healthcare services through the Medicaid program, the organization said.
Approximately 5% of those people have sought sexual and reproductive healthcare services at Planned Parenthood this year.
“Medina on its own will likely [make it] harder for plaintiffs to enforce other civil rights in federal court,” Mary Ziegler, a professor of law at University of California, Davis, wrote on X Thursday. “And as far as Planned Parenthood and comparable providers are concerned, this case could be part of a one-two punch if Trump’s Big Beautiful Bill passes.”
