Justices question states’ discretion and the definition of “rights” in South Carolina’s attempt to bar Planned Parenthood from Medicaid program.
On April 2, 2025, the U.S. Supreme Court heard nearly two hours of oral argument in Medina v. Planned Parenthood South Atlantic, probing whether Medicaid recipients can sue under federal law when a state removes a provider, such as Planned Parenthood, from the Medicaid program. The case turns on the interpretation of the Medicaid Act’s “free choice of provider” provision and whether it confers an enforceable right on beneficiaries.
South Carolina’s Department of Health and Human Services, led by Eunice Medina, sought to exclude Planned Parenthood South Atlantic (PPSAT) from the state’s Medicaid program. The Fourth Circuit ruled in favor of PPSAT and a Medicaid recipient, Julie Edwards, who challenged the exclusion under 42 U.S.C. § 1983. South Carolina petitioned the Supreme Court, arguing that the relevant Medicaid provision does not create a privately enforceable right.
During oral arguments, the Justices focused intensely on whether the statutory language—specifically the phrase allowing individuals to “obtain such assistance from any qualified provider”—creates an enforceable right or is merely a policy preference. John Bursch, arguing for South Carolina, claimed that the statute lacks “rights-creating language” required under precedents like Gonzaga v. Doe and Talevski. He emphasized the absence of words like “right,” “entitlement,” or “privilege,” which he argued are necessary to put states on notice of potential litigation exposure under Section 1983.
Justice Sotomayor challenged this reasoning, suggesting that Congress aimed to prevent states from restricting provider choice and that the historical context supports reading the provision as conferring enforceable rights. Justice Kagan appeared especially skeptical, stating: “The state has an obligation to ensure that individuals have a right to choose their doctor. That’s what this provision is.”
The government, represented by Kyle Hawkins, aligned with South Carolina, reversing its prior position and arguing that the statute’s structure and placement within a compliance regime undercut its interpretation as creating enforceable rights. Justice Jackson noted this reversal and questioned whether the Court was being asked to overrule existing precedents, such as Wilder v. Virginia Hospital Assn., without clear cause.
Nicole Saharsky, arguing on behalf of PPSAT and the Medicaid recipient, contended that Congress used mandatory and beneficiary-focused language sufficient to create an enforceable right. She emphasized that the provision was designed to prevent precisely the kind of state restrictions now being challenged and that there is no viable alternative remedy for affected individuals.
Multiple justices, including Kavanaugh and Barrett, expressed concern over the broader implications, such as whether a broad ruling could allow countless lawsuits under other Medicaid provisions. However, they also questioned the fairness of denying enforcement when no other remedies exist for beneficiaries.
The Court is expected to issue its ruling by June 2025.