June 27, 2024 — The U.S. Supreme Court ruled on Thursday that Planned Parenthood and one of its patients cannot sue South Carolina over the state’s attempt to block Medicaid funding for the organization. The decision, split 6-3 along ideological lines, reinforces states’ authority to restrict funding to providers affiliated with abortion services—even if those providers offer non-abortion healthcare.
Background of the Case
In 2018, South Carolina’s Republican Governor Henry McMaster issued an executive order directing state officials to deny Medicaid reimbursements to Planned Parenthood clinics. McMaster argued that taxpayer dollars should not indirectly subsidize abortion, stating:
“Payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life.”
While abortion is banned in South Carolina after six weeks of pregnancy, and federal law already prohibits Medicaid funds from being used for abortions (except in cases of rape, incest, or life-threatening circumstances), Planned Parenthood’s clinics in Charleston and Columbia provide other critical services, including:
- Contraception counseling
- Cancer screenings
- STD testing
- Physical exams
Legal Battle and Lower Court Rulings
Planned Parenthood and a Medicaid patient who relied on its services sued under 42 U.S.C. § 1983, a federal civil rights law, arguing that South Carolina’s policy violated Medicaid’s “free choice of provider” requirement. This rule ensures Medicaid recipients can seek care from any qualified provider.
A federal district judge sided with Planned Parenthood, blocking the state’s order. The case then moved to the U.S. Court of Appeals for the Fourth Circuit, where a unanimous three-judge panel upheld the ruling in 2023. Judge J. Harvie Wilkinson III wrote:
“This case is, and always has been, about whether Congress conferred an individually enforceable right for Medicaid beneficiaries to freely choose their health care provider. Preserving access to Planned Parenthood means preserving affordable choice and quality care for mothers and infants in South Carolina.”
Supreme Court’s Decision
The central question before the Supreme Court in Medina v. Planned Parenthood South Atlantic (23-1275) was whether Medicaid’s “free choice” provision creates a private right enforceable by individuals—or if only the federal government can challenge state violations.
The conservative majority (6-3) ruled that the law does not unambiguously grant such a right, echoing its strict test for private lawsuits under federal spending clauses. Justice Amy Coney Barrett, writing for the majority, emphasized that Medicaid’s wording—allowing patients to “obtain assistance from any qualified institution”—lacks the explicit “rights-creating” language found in other statutes.
The Court distinguished this case from its 2023 decision in Health and Hospital Corporation of Marion County v. Talevski, where it allowed nursing home residents to sue over Medicaid violations because that law repeatedly referenced “rights.”
Dissenting Opinion
The Court’s liberal justices (Sotomayor, Kagan, Jackson) dissented, arguing that the ruling undermines Medicaid patients’ access to care. Justice Sonia Sotomayor wrote:
“Today’s decision greenlights states’ efforts to politicize healthcare by excluding providers for reasons unrelated to medical competency. Low-income patients will bear the brunt.”
Implications of the Ruling
- State Power Over Medicaid Funds: States may now have broader discretion to defund Planned Parenthood and similar providers, even for non-abortion services.
- Limited Recourse for Patients: Medicaid recipients cannot sue if a state excludes their preferred provider—only the federal government can enforce violations.
- Broader Impact: The decision could embolden other conservative states to expand funding restrictions on clinics affiliated with abortion services.
Planned Parenthood’s Response
Planned Parenthood South Atlantic CEO Jenny Black called the ruling “devastating,” warning that it would disproportionately harm low-income patients reliant on their clinics for preventive care.
What’s Next?
- The Biden administration could intervene by withholding federal Medicaid funds from South Carolina, though such action is unlikely before the 2024 election.
- Congress could amend Medicaid’s language to explicitly protect patient choice, but partisan divides make this improbable.
The ruling solidifies the Court’s trend of narrowing private enforcement of federal spending programs, leaving vulnerable populations with fewer avenues to challenge state policies.
Key Takeaways
- 6-3 Decision: Conservative justices ruled Medicaid does not guarantee patients a right to sue over provider exclusions.
- Impact: States can now deny Medicaid funds to Planned Parenthood even for non-abortion services.
- Dissent: Liberals warn the decision harms healthcare access for low-income patients.
This ruling marks another milestone in the decades-long battle over abortion and federal funding, with significant consequences for reproductive healthcare access nationwide.
