Medina v. Planned Parenthood South Atlantic
The Supreme Court ruled that Medicaid patients cannot use the Civil Rights Act of 1871 to sue their state for kicking out a preferred healthcare provider, because the Medicaid rule requiring free choice of provider does not clearly grant individual patients an enforceable legal right.
The decision significantly narrows a widely used enforcement tool for Medicaid beneficiaries and leaves enforcement of provider-choice rules primarily to the federal government, which can withhold funding from noncompliant states.
“Someday, Congress might choose to revise §1396a(a)(23) to resemble FNHRA. But that is not the law we have.”
The majority explaining that Congress knows how to write explicit rights into law — it just didn't do so here.
How it got here: A federal district court blocked South Carolina's exclusion of Planned Parenthood and the Fourth Circuit affirmed; after a Supreme Court GVR in light of Talevski, the Fourth Circuit reaffirmed, and the Supreme Court granted certiorari again.
The Case in Depth
What happened
South Carolina excluded Planned Parenthood from its Medicaid program in 2018, citing a state law against using public funds for abortion. Julie Edwards, a diabetic Medicaid patient who relied on Planned Parenthood for gynecological care, sued the state alongside Planned Parenthood. They argued that the exclusion violated a federal Medicaid rule requiring that eligible patients be able to obtain care from any qualified provider of their choosing.
The question before the Court
Can individual Medicaid patients sue their state in federal court when the state excludes a healthcare provider — like Planned Parenthood — from the Medicaid program?
The Court's answer
No — the Court ruled that Medicaid patients cannot use the Civil Rights Act of 1871 (42 U.S.C. §1983) to sue state officials for excluding their preferred healthcare provider. The Medicaid provision at issue — which says states must let eligible patients obtain care from any qualified provider — does not use the explicit "rights-creating" language required before individuals can bring such lawsuits.
The Court held that Medicaid and similar federal spending programs operate more like contracts between Congress and the states than direct legal commands, so the standard remedy for violations is the federal government cutting off funding — not private suits. To allow individual lawsuits, the law must clearly and unambiguously warn states that accepting federal money also means accepting the risk of being sued by beneficiaries. The Medicaid provider-choice rule, written as a state obligation and buried among 87 undifferentiated plan requirements, does not meet that demanding standard.
Curious how the Court got there? See the step-by-step legal reasoning →
Why it matters
Medicaid patients who want to see a provider their state has excluded — including Planned Parenthood — can no longer go to federal court under the Civil Rights Act to force reinstatement. States gain greater practical freedom to exclude providers without facing individual lawsuits, and patients in South Carolina and potentially other states lose their most direct way to challenge such decisions.
What changes now
The case returns to the Fourth Circuit, which must dismiss the §1983 claims. South Carolina may proceed with excluding Planned Parenthood from its Medicaid program unless the federal government acts to withhold funding. Patients seeking to challenge provider exclusions must use state administrative processes and courts, or press federal officials to enforce the provider-choice rule through funding mechanisms. Congress could amend the Medicaid Act to create explicit individual rights if it chooses to restore private enforcement.
What this does not decide
The ruling does not determine whether South Carolina's exclusion of Planned Parenthood is otherwise lawful, nor does it prevent the federal government from withholding Medicaid funding to enforce provider-choice rules. The Court also expressly did not address whether Congress's alternative remedy structure displaces §1983 or whether the provision has the required "unmistakable focus" on individuals.
Concurrences and dissents
Concurrence — Justice Thomas
Justice Thomas joined the majority in full but wrote separately to argue that §1983 has far exceeded its original 1871 scope through decades of judicial expansion. He contends spending-power statutes cannot 'secure' rights within §1983's meaning because they operate as contractual offers, not legal commands — a view he advanced in his Talevski dissent. He also questions whether the modern expansive conception of 'rights' under §1983 reflects the statute's original meaning, calling for a fundamental reexamination of §1983 jurisprudence in an appropriate future case.
Dissent — Justice Jackson
Justice Jackson argued the Medicaid provider-choice provision plainly creates enforceable individual rights: it uses individual-centric mandatory language ('any individual…may obtain'), its original session-law heading read 'Free Choice by Individuals Eligible for Medical Assistance,' and the Court's own O'Bannon decision explicitly described the provision as giving recipients 'the right to choose' their providers. She criticized the majority for replacing the Gonzaga test with an impermissible 'imitate FNHRA' requirement, called the decision part of a historical pattern of weakening Reconstruction-era civil rights protections, and warned it will strip Medicaid recipients of their only meaningful enforcement tool.
How the Court got there
The legal reasoning, step by step
- The Court applied its established test from Gonzaga Univ. v. Doe (2002): for a federal statute to create rights enforceable by individuals under §1983 (the Civil War-era law allowing suits against state officials), the statute must 'clearly and unambiguously' use rights-creating language with an unmistakable focus on individuals — a 'stringent' and 'demanding' bar met only in rare, 'atypical' cases. The Court reaffirmed in Talevski (2023) that this is the definitive method.
- Medicaid is a spending-power statute — Congress offers states money in exchange for following conditions, like a contract, rather than directly commanding them. Because federal-state funding deals resemble agreements between sovereigns rather than regulations, the ordinary remedy when states violate the terms is the federal government withholding funds, not private litigation. Private suits require that Congress clearly warned states upfront that accepting money meant accepting the risk of being sued.
- Using the Federal Nursing Home Reform Act (FNHRA) provisions upheld in Talevski as the reliable benchmark, the Court noted that those provisions explicitly used the word 'right' (e.g., 'protect and promote the right to be free from' restraints) and appeared in a subpart titled 'requirements relating to residents' rights.' Congress knows how to create clear rights — FNHRA also gives nursing-home residents 'the right to choose a personal attending physician.'
- The Medicaid any-qualified-provider provision (§1396a(a)(23)(A)) says states must 'provide that any individual eligible for medical assistance may obtain such assistance from any…qualified' provider. The Court found this addresses what states must do to receive federal funds, not what rights patients hold — it lacks FNHRA's explicit rights-creating language, and Congress enacted both provisions in the same legislation yet wrote them very differently.
- Surrounding context reinforced the conclusion: Medicaid requires only 'substantial' state compliance — language focusing on aggregate obligations rather than the rights of any particular person. The provision appears unlabeled among 87 plan requirements directed at the Secretary of HHS with no discernible order. And the provision's exceptions letting states control which felony convictions disqualify providers would be incoherent if the provision simultaneously granted patients enforceable individual rights.
- The Court rejected four counterarguments: legislative history (for spending statutes, what matters is what Congress clearly told states, not what members may have intended); the Medicare analogy (the parallel Medicare provision uses 'guarantee' and 'free choice' — language Congress deliberately omitted from the Medicaid version); the dissent's proposed looser test (would obliterate the line between benefits and rights, making rights the rule rather than the exception); and policy concerns about enforcement gaps (funding cutoffs remain available and state administrative appeals exist; if those prove inadequate, Congress can create new remedies).
Doctrinal impact
Cases affected by this decision
Reaffirms Gonzaga Univ. v. Doe (536 U.S. 273)
Reaffirmed as the controlling test requiring clear, unambiguous rights-creating language in spending statutes before private suits can proceed.
Reaffirms Health and Hospital Corporation of Marion Cty. v. Talevski (599 U.S. 166)
Reaffirmed as the definitive modern application of Gonzaga and the reliable benchmark for what rights-creating language looks like.
Limits Wilder v. Virginia Hospital Assn. (496 U.S. 498)
Lower courts told not to rely on Wilder's more permissive reasoning, which Gonzaga and Armstrong repudiated.
Limits Blessing v. Freestone (520 U.S. 329)
Lower courts told not to rely on Blessing's three-factor test, which was superseded by Gonzaga's more demanding standard.
Reaffirms Pennhurst State School and Hospital v. Halderman (451 U.S. 1)
Reaffirmed that spending-power legislation is contract-like and the typical remedy for violations is funding termination, not private suits.