South Carolina had argued that no one’s rights were violated when it decided to exclude Planned Parenthood from its Medicaid program.

 

South Carolina Gov. Henry McMaster (C) speaks at a press conference outside the U.S. Supreme Court as justices hear oral arguments in Medina v. Planned Parenthood South Atlantic in Washington on April 2, 2025. Kayla Bartkowski/Getty Images

 

Matthew Vadum

 

The U.S. Supreme Court on June 26 ruled that South Carolina may stop abortion provider Planned Parenthood from taking part in the state’s Medicaid program.

The majority opinion in the 6–3 decision in Medina v. Planned Parenthood South Atlantic was written by Justice Neil Gorsuch. The new ruling reverses a federal appeals court decision that blocked South Carolina from excluding Planned Parenthood.

The court majority held that federal law does not permit health care providers or patients to sue a state if it runs afoul of a federal law requiring that Medicaid patients be allowed to use their preferred provider.

Although the case does not center on abortion, it was being closely watched because a ruling in favor of South Carolina could encourage more states to boot the organization from their Medicaid networks. Missouri, Arkansas, Mississippi, and Texas have already removed Planned Parenthood from state Medicaid networks, the organization reported.

Medicaid is a joint federal–state program that offers health insurance coverage to low-income Americans. The program is governed by the federal Medicaid Act.

South Carolina bans abortion after six weeks of pregnancy. Federal law forbids the use of Medicaid funds for abortion except in cases of rape, incest, or when the mother’s life is deemed to be endangered by the pregnancy.

The petitioner in the case, Eunice Medina, is director of the South Carolina Department of Health and Human Services. The respondent, Planned Parenthood, a major provider of abortion services, also offers services such as birth control and pregnancy testing.

The case goes back to July 2018, when South Carolina Gov. Henry McMaster signed Executive Order 2018-21, directing state health officials to “deem abortion clinics unqualified to provide family planning services.” The order also required officials to terminate clinics’ enrollment agreements and deny their enrollment applications in the future.

The issue was whether “the Medicaid Act’s any-qualified-provider provision unambiguously confers a private right upon a Medicaid beneficiary to choose a specific provider,” according to the June 2024 petition.

Federal courts of appeals disagree on how the provision should be interpreted. In March 2024, the U.S. Court of Appeals for the Fourth Circuit ruled against the state.

In 2018, Planned Parenthood South Atlantic and Julie Edwards, one of the organization’s Medicaid clients, filed a lawsuit in federal district court over South Carolina’s policy, according to the petition.

They argued that the state had violated clients’ right to select a “qualified provider” under federal law.

South Carolina countered by saying that the any-qualified-provider provision “does not unambiguously create a federal right enforceable by providers and individual patients under 42 U.S.C. [Section] 1983,” a federal law that allows individuals to sue the government for civil rights violations.

The district court upheld Edwards’s right to sue South Carolina over the state’s decision not to cover medical treatment that Planned Parenthood might provide to her. That court also granted Edwards’s request for a preliminary injunction blocking the state policy.

The Fourth Circuit affirmed the decision, finding that Congress intended “to create an individual right enforceable under [Section] 1983 in the free-choice-of-provider provision” and that the provision “bars states from excluding providers for reasons unrelated to professional competency.”

In the new majority opinion, Gorsuch wrote that Section 1983 allows “private plaintiffs to sue for violations of federal spending-power statutes [such as the Medicaid Act] only in ‘atypical situations’ where the provision in question ‘clear[ly]’ and ‘unambiguous[ly]’ confers an individual right.”

The spending law at issue in this case “is not such a statute,” he added.

Whether to allow private plaintiffs “to enforce a new statutory right poses delicate questions.”

“New rights for some mean new duties for others,” and private enforcement actions can force governments to spend money on litigation instead of public services.

“The job of resolving how best to weigh those competing costs and benefits belongs to the people’s elected representatives, not unelected judges charged with applying the law as they find it,” Gorsuch wrote.

Gorsuch’s opinion was joined by Chief Justice John Roberts, along with Justices Clarence Thomas, Samuel Alito, Brett Kavanaugh, and Amy Coney Barrett.

The Supreme Court reversed the decision of the Fourth Circuit and sent the case back to that court “for further proceedings consistent with this opinion.”

Thomas filed a separate concurring opinion, stating that the Supreme Court correctly held that the Section 1983 lawsuit under the Medicaid Act may not proceed.

Thomas wrote that past Supreme Court rulings on Section 1983, which was originally enacted as part of the Civil Rights Act of 1871, today bear “little resemblance to the statute as originally understood.”

“In appropriate cases, we should reassess [Section] 1983’s bounds, including its application in the spending context and our understanding of the ‘rights’ enforceable under [Section] 1983.”

The Supreme Court has broadened the application of Section 1983 over the years, and it has been interpreted to mean that litigants may now invoke the statute “to challenge myriad ‘state actions that have little or nothing to do with’ civil rights,” Thomas wrote, citing Maine v. Thiboutot (1980).

Justice Ketanji Brown Jackson filed a dissenting opinion, which Justices Sonia Sotomayor and Elena Kagan, joined.

Jackson wrote that Section 1983 grew out of the Civil Rights Act of 1871, which was “an exercise in grand ambition” aimed at confronting “a wave of terrorist violence [in the South] designed to disenfranchise and intimidate the country’s newly freed citizens and their allies.”

South Carolina “vehemently” opposed the legislation at the time, and today “the project of stymying one of the great civil rights laws continues,” Jackson wrote.

In this case, the state asked the court “to hollow out” Section 1983 so South Carolina can “evade liability for violating the rights of its Medicaid recipients to choose their own doctors.”

“Today’s decision is likely to result in tangible harm to real people” who will be deprived “of their only meaningful way of enforcing a right that Congress has expressly granted them,” Jackson added.

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