The U.S. Supreme Court ruled Thursday that individuals cannot sue state officials under federal civil rights law to challenge state decisions about which healthcare providers participate in Medicaid, even when those decisions may violate federal Medicaid requirements.

The 6-3 ruling in Medina v. Planned Parenthood South Atlantic reverses a lower court decision and marks a significant shift in the enforcement of Medicaid’s “any qualified provider” provision, which Congress designed to ensure that Medicaid recipients can obtain care from any provider qualified and willing to serve them.

The dispute began in South Carolina, where state officials in 2018 excluded Planned Parenthood from the state’s Medicaid program, citing a state law barring public funds for abortion. Planned Parenthood, which provides a wide range of health services, and a patient who relied on its clinics, sued the state under 42 U.S.C. §1983, arguing that the exclusion violated federal Medicaid law guaranteeing patient choice of provider.

Lower courts sided with Planned Parenthood, holding that the Medicaid Act’s “any qualified provider” provision gave individual patients a right enforceable through lawsuits under §1983. The Supreme Court’s decision overturns those rulings.

Writing for the majority, Justice Neil Gorsuch held that the Medicaid Act does not “clearly and unambiguously confer individual rights enforceable under §1983” in its provision guaranteeing patient choice of provider. The majority believes that:

• Spending-power statutes like Medicaid are akin to contracts between the federal government and states. If a state fails to comply with the terms, the federal government’s typical remedy is to withhold funding, not to permit private lawsuits.
• Congress must use explicit, rights-creating language to allow individuals to sue under §1983, and the Medicaid provision at issue lacks such language. The law “addresses state duties and may benefit providers and patients, but lacks [the] clear ‘rights-creating language’” found in other statutes where private enforcement is allowed.
• Congress knows how to create enforceable rights—as it did in the Federal Nursing Home Reform Act, which expressly gives residents the “right to choose a personal attending physician”—but did not do so in the Medicaid statute at issue.

The majority also rejected arguments based on legislative history and policy concerns, stating that only Congress, not the courts, can decide whether to allow private enforcement of such federal requirements.

Justice Ketanji Brown Jackson, joined by Justices Sotomayor and Kagan, issued a forceful dissent. She accused the majority of “hollow[ing] out” a central federal civil rights law and undermining the ability of Medicaid recipients to protect their rights in court. The dissent argued that the Medicaid statute’s language and legislative history make clear that Congress intended to protect patient choice, and that the Court’s decision “stymies one of the country’s great civil rights laws” by closing the courthouse doors to vulnerable beneficiaries.

States now have clear authority to block Medicaid funding to Planned Parenthood and potentially other providers for non-abortion services such as contraception, cancer screenings, STI testing, and general reproductive health care. Nearly half of Planned Parenthood’s patients rely on Medicaid. In states that act on this ruling, low-income individuals could lose access to one of the few providers offering affordable, comprehensive reproductive health services.

Rural and underserved communities are likely to be disproportionately affected, as alternatives to Planned Parenthood are often scarce in these areas.

The ruling is expected to embolden other Republican-led states to exclude Planned Parenthood and possibly other disfavored providers (for example, those offering gender-affirming care) from Medicaid programs.