Medina v. Planned Parenthood South Atlantic, Docket No. 23-1275
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The Supreme Court took a close look at a part of Medicaid that says patients can see any approved doctor. But the justices said that nothing in the law clearly lets individual patients sue state officials if they don’t follow that rule.
Instead, the court reminded us that Medicaid works like a deal: states get federal money, and if they break the rules, the government can pull funding. That means people on Medicaid can’t bring private lawsuits when states limit which doctors they can see.
Justice Gorsuch wrote for a six-justice majority. They sent the case back to lower courts to figure out what comes next. Meanwhile, three justices, led by Justice Jackson, said they’d let patients have their day in court.
Summary of the Case
In July 2018, South Carolina excluded Planned Parenthood South Atlantic (PPSAT) from its Medicaid program, citing a state ban on public funding for facilities that perform abortions. PPSAT and patient Julie Edwards sued state health officials, alleging that the State's action violated the Medicaid Act's "free-choice-of-provider" mandate, which requires that Medicaid beneficiaries "may obtain" services "from any qualified" provider. The district court ruled in favor of PPSAT, and the Fourth Circuit affirmed. After a subsequent Supreme Court decision in a related case, the Fourth Circuit reaffirmed its judgment. The Supreme Court then considered whether the Medicaid provision clearly gives individuals an enforceable right to choose their providers.
Opinion of the Court
Justice Gorsuch, writing for a six-justice majority, held that the Medicaid provision does not clearly and unambiguously give individuals rights they can enforce through lawsuits. The Court emphasized that programs like Medicaid function like contracts between the federal government and states. When states don't comply with requirements, the typical remedy is cutting off federal funding, not individual lawsuits.
The Court found that the Medicaid provision is written as a requirement for state plans addressing overall compliance, not as language creating individual rights. Additionally, since states maintain control over provider qualifications, this undermines the interpretation that individuals have an absolute right to choose any provider. The Court concluded that funding termination, administrative appeals, and state judicial review remain the principal enforcement mechanisms, not individual lawsuits.
Separate Opinions
Justice Thomas agreed with the majority but wrote separately to question the Court's broader approach to these types of cases. He argued that spending programs like Medicaid, which operate as contracts between the federal government and states, fundamentally cannot create individual rights that people can enforce through lawsuits. He also suggested that the Court should reconsider its entire framework for determining when individuals can sue to enforce rights under federal programs.
Dissenting Opinions
Justice Jackson, joined by Justices Sotomayor and Kagan, dissented. She argued that the Medicaid provision clearly gives beneficiaries a right to choose their providers for three main reasons: (1) its text focuses on individuals—"any individual may obtain from any qualified provider"; (2) it uses mandatory language under a heading about "Free Choice by Individuals"; and (3) Congress knew how to create private enforcement rights and did so here. Jackson also pointed to previous Court decisions that described the provision as conferring a "right" and to later amendments that she believed confirmed Congress's intent to create enforceable rights.
Can Medicaid Patients Sue When States Limit Their Provider Choices?
The case hinges on how courts should interpret laws passed under Congress's spending power. Medicaid operates as a partnership: states receive federal funds if they follow certain rules, including the requirement that patients can choose any qualified provider. The majority viewed this as primarily a deal between governments, with the federal government's ability to withhold funding as the main enforcement mechanism.
For a provision to create rights that individuals can enforce through lawsuits, the Court requires "clear and unambiguous" evidence that Congress intended this result. The majority found that the Medicaid provision lacks the explicit "rights-creating language" found in other laws where Congress clearly intended to create individual rights. Instead, it appears in a list of requirements for state plans and focuses on state duties rather than individual entitlements.
The majority also emphasized that states maintain control over determining which providers are "qualified," which they saw as incompatible with an absolute individual right. They concluded that Congress intended enforcement through funding termination, administrative reviews, and state courts—not through individual lawsuits in federal court.
The dissent countered that the provision's focus on what "any individual may obtain" clearly creates individual rights, especially when compared to other provisions where Congress has recognized similar rights.