Health Law Daily Wrap Up, SUPREME COURT NEWS—Court grapples with whether Medicaid beneficiary can sue over state’s decision to defund Planned Parenthood, (Apr 2, 2025)

By Sheila Lynch-Afryl, J.D., M.A.

South Carolina argued that the any-qualified-provider provision does not include clear, rights-creating language, as required by precedent.

The U.S. Supreme Court heard oral arguments in a case concerning South Carolina’s termination of Planned Parenthood South Atlantic from Medicaid because it provides abortions. In Medina v. Planned Parenthood South Atlantic (formerly Kerr v. Planned Parenthood South Atlantic), the Court must decide whether the Medicaid Act’s any-qualified-provider provision creates a private right for a Medicaid beneficiary to choose a specific provider. While the parties sparred over whether the provision creates a private right, the justices also delved into alternative remedies and the appropriate test, with Justice Kavanaugh saying that his goal is to provide clarity for lower courts.

In Medina, South Carolina terminated Planned Parenthood’s Medicaid agreement, finding it “unqualified to provide family planning services” because it provides abortions. A Medicaid beneficiary and Planned Parenthood sued under 42 U.S.C. §1983, arguing that it violated Soc. Sec. Act §1902(a)(23) (42 U.S.C. §1396a(a)(23)), which requires a Medicaid state plan to provide that any individual eligible for Medicaid “may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required…who undertakes to provide him such services.” The Fourth Circuit ultimately held that the any-qualified-provider provision “confers an individual right enforceable via § 1983.”

Before the Supreme Court, South Carolina argued that the any-qualified-provider provision does not include clear, rights-creating language because it does not use the word “right,” speaks of obtaining benefits from a third party, allows the regulated entity to define the scope of the right, and does not reside in a bill of rights. The state emphasized that it is unusual to find a right in a “substantial compliance regime where a sizable minority of beneficiaries may fail to receive the offered benefit.”

Justices Sotomayor and Kagan both discussed the difference between a right and a benefit or obligation. Kagan argued, “The obligation is to ensure that individuals can choose their doctor, and when we speak of that…there's a correlative right.”

The state noted that the remedy for violations of the any-qualified-provider provision includes administrative appeals for both the beneficiary and the provider. Sotomayor countered, however, that a Medicaid “recipient can only sue a denial for services that were actually rendered,” and if “a doctor can't render them, then they can't sue under that.” Justice Jackson also expressed concern that the state’s argument conflated the two steps by analyzing administrative remedies in step 1.

The U.S. government also participated in oral arguments as amicus supporting the state. Justice Sotomayor pointed out that “for 20 years, the government took the position that the free-choice-of-provider provision was enforceable via section 1983.” The government responded that “with the change in administration, the federal government re-evaluated its position in this case.” Upon questioning by Justice Jackson, counsel admitted that he did not know of any instances where HHS withheld funding due to a violation of this provision, but because this is a “substantial compliance regime,” HHS has been “concerned with compliance in the aggregate.”

The Medicaid beneficiary and Planned Parenthood emphasized that South Carolina violated the statute, and the only question is whether she can sue under section 1983. Counsel argued that Congress enacted the statute because states were artificially limiting the providers in Medicaid and noted the lack of an alternative remedy.

The respondents argued that if it this were “a real case about qualifications,” the state would deserve deference, but “it's absolutely wrong” under South Carolina’s scheme “to say that the state can just deem any requirement it wants,” for example, finding a provider unqualified because “too many people work at the provider have blue eyes or they support green energy.” Justice Kagan agreed, noting how “every state could split up the world by providers” that provide abortion, contraception, gender-affirming care vs. those who don’t.

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