Just days after the 3-year anniversary of the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the court has issued another decision that will exacerbate disparities in access to critical healthcare, including reproductive healthcare, contraception, preventive care, mental health care, and cancer screening.
On June 26, the Court ruled (6-3) in Medina v. Planned Parenthood South Atlantic that Medicaid beneficiaries have no right to enforce Medicaid’s “free choice of provider” provision, and therefore, no right to challenge South Carolina’s decision to disqualify Planned Parenthood from the state’s Medicaid program. This decision is not the only threat to patients and Planned Parenthood — Congress also is poised to prohibit federal Medicaid funds from flowing towards Planned Parenthood for 1 year under the One Big Beautiful Bill Act.
The Medina Ruling
The Medina case stemmed from a 2018 executive order by South Carolina’s Governor, Henry McMaster (R), that categorically barred all health facilities and providers that perform abortions from Medicaid reimbursement. Governor McMaster took this step even though a long-standing federal requirement known as the Hyde Amendment prohibits the use of federal Medicaid funds for abortion services except in narrow circumstances.
Two Planned Parenthood clinics and one patient brought a lawsuit arguing that the order violated the Medicaid Act’s “free choice of provider” provision, which allows Medicaid beneficiaries to receive care from any qualified and willing provider of their choice. The Supreme Court did not address whether South Carolina violated this provision by disqualifying Planned Parenthood. Rather, the court focused on whether Medicaid beneficiaries have the right to sue government officials who violate this provision under a prominent civil rights law known as Section 1983.
The majority ruled that the “free choice of provider” provision does not confer a federal right to Medicaid beneficiaries to sue over South Carolina’s exclusion of Planned Parenthood from the Medicaid program. The court determined that Congress did not use sufficiently “clear and unambiguous rights-creating language” in the “free choice of provider” provision, emphasizing that the word “right” does not appear at all. As a result, patients do not have the right to sue the state under Section 1983. Finding no individual right, the majority noted that Medicaid functions as a contract between the federal and state governments, and the proper remedy for a state’s violation of the “free choice of provider” provision is thus for the federal government to withhold the state’s Medicaid funding.
Justice Ketanji Brown Jackson, joined by justices Sonia Sotomayor and Elena Kagan, dissented and argued that the “free choice of provider” provision did, in fact, include sufficiently clear rights-creating language to allow patients to sue. The dissent would have affirmed that low-income individuals could sue under Section 1983. The dissent thus describes the majority’s decision as part of “the project of stymieing one of the country’s great civil rights laws.”
What Happens Next?
While dismantling a patient’s right to sue a state under the “free choice of provider” provision, the majority pointed to other remedies. The court asserted that the federal government, via the Health and Human Services secretary, has the discretion to enforce the “free choice of provider” provision by withholding Medicaid funding from states in violation of the provision. This enforcement mechanism seems unlikely, especially from the Trump administration.
Planned Parenthood is also able to challenge South Carolina’s decision to exclude it from the Medicaid program under state administrative processes as well as in the courts. However, this can be a long, arduous process. And in the meantime, affected Medicaid beneficiaries would lack access to the provider of their choice and the care they need.
How Will Medina Impact Care Nationwide?
The Medina decision will prevent Medicaid beneficiaries in South Carolina — and other states that are likely to do the same — from accessing Planned Parenthood as their provider of choice. As was made clear in many amicus briefs, Planned Parenthood provides a range of critical healthcare services. This includes services to improve maternal and child health through contraception and family planning, sexually transmitted infection testing and treatment, cancer screening, and screening for conditions that could ultimately cause infertility and cancer. Under Medina, Medicaid beneficiaries in South Carolina will no longer be able to seek this care at Planned Parenthood — or, if they do, they will have to pay out of pocket, which many cannot afford.
Finding another trusted provider will not be easy for low-income patients in South Carolina and beyond. As we’ve noted previously, South Carolina Medicaid beneficiaries already face limited choices of providers, with 41 of the state’s 46 counties federally designated as Health Professional Shortage Areas. Under Medina, Planned Parenthood’s primary care providers may no longer be able to help fill these access gaps for Medicaid beneficiaries — not because they are unqualified or unwilling, but because South Carolina can exclude them from Medicaid on ideological grounds.
As noted, Medina will pave the way for similar action in other states, likely impacting access to healthcare for millions of Medicaid beneficiaries. Over the past decade, at least 14 states have attempted to disqualify Planned Parenthood from their state Medicaid program.
What will the future hold for Planned Parenthood? Nationwide, nearly half of Planned Parenthood’s 2 million patients are covered through publicly funded programs like Medicaid, making Medicaid a major revenue source for the organization. Without additional funding to support Planned Parenthood’s services, the court’s decision will likely result in significant revenue losses, potentially leading Planned Parenthood to reduce its service areas or close clinics. These risks are even greater if Republicans in Congress succeed in blocking federal Medicaid funding to Planned Parenthood for 1 year.
Ultimately, the court’s ruling in Medina puts at risk access to a wide range of care, including reproductive healthcare for low-income women and their families — especially in states where access to this care is already limited because of abortion bans. As Justice Jackson noted in her dissent, this ruling 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.'”
Suhasini Ravi, JD, MPH, is a senior associate at the Center for Health Policy and the Law at the O’Neill Institute in Washington, D.C. Sarah Wetter, JD, MPH, is a senior associate with the O’Neill Institute.
