Court decides against Planned Parenthood

The Supreme Court on Thursday ruled that a South Carolina woman and Planned Parenthood do not have a legal right, known as standing, to bring a lawsuit challenging South Carolina’s decision to exclude Planned Parenthood from the state’s Medicaid program on the basis that the organization provides abortions. 

By a vote of 6-3, the court, in an opinion written by Justice Neil Gorsuch, held that a provision of the Medicaid Act requiring states to ensure that Medicaid patients can obtain care from “any qualified provider” does not create the kind of clear and unambiguous right required under the Supreme Court’s cases to allow private lawsuits alleging violations of the provision. 

The decision means that the lawsuit by Julie Edwards, who had been treated by Planned Parenthood and sought “to shift all [her] gynecological and reproductive health care there,” cannot move forward – and she therefore cannot challenge the state’s decision to exclude Planned Parenthood from Medicaid. 

Justice Ketanji Brown Jackson dissented from the court’s ruling, in an opinion joined by the court’s two other Democratic appointees, Justices Sonia Sotomayor and Elena Kagan. She contended that with Thursday’s decision, “the project of stymying one of the country’s great civil rights laws continues.” 

Congress created the federal Medicaid program in 1965 to provide medical care, in cooperation with the states, to more than 72 million lower-income Americans. In enacting the program, Congress relied on its power under the Constitution’s spending clause, which allows Congress to attach conditions to federal funds. 

Federal law generally bars the use of Medicaid funds for abortions, but Planned Parenthood can receive the funds for other services. But in 2018 South Carolina’s governor, Henry McMaster, directed the state’s Department of Health and Human Services to exclude Planned Parenthood from the Medicaid program. He reasoned that because money is fungible, Planned Parenthood’s receipt of Medicaid funds effectively subsidized its abortion services.  

That prompted Edwards and Planned Parenthood to go to federal court, where they argued that the exclusion of Planned Parenthood from the Medicaid program violates a provision of the Medicaid Act that allows any patient who is eligible for Medicaid to seek health care from any “qualified” provider. 

The U.S. Court of Appeals for the 4th Circuit agreed that the Medicaid Act creates an individual right that can be enforced under federal civil rights laws, and it barred South Carolina from excluding Planned Parenthood from its Medicaid program. 

The state came to the Supreme Court, asking the justices to weigh in on whether Edwards and Planned Parenthood can sue to enforce the Medicaid Act. On Thursday, the court reversed the appeals court’s ruling. 

In an opinion by Gorsuch, the court emphasized that although federal civil rights laws allow private actors to sue government officials who violate their constitutional rights and their rights under federal law, federal laws “do not confer ‘rights’ enforceable” under civil rights laws “as a matter of course.” This is especially true, Gorsuch continued, for laws – such as the Medicaid Act – that Congress passes using its spending power, which “allows Congress to offer funds to States that agree to certain conditions.” 

When a state fails to comply with conditions that Congress has placed on the receipt of funds, Gorsuch noted, the remedy is usually the termination of the funds by the federal government, not a private lawsuit. 

To bring such a suit, Gorsuch wrote, a plaintiff must meet a “demanding bar” “that will be cleared only in the ‘atypical case’”: It must show that the law at issue clearly and unambiguously reflects Congress’ “intent to confer individual rights,” because only that kind of language will put the entity receiving the federal funds – here, South Carolina – on notice that it could face private lawsuits if it does not comply with the federal conditions. 

The ”any qualified provider” provision, Gorsuch said, fails to meet that high bar. He compared the text of the provision with provisions of the Federal Nursing Home Reform Act, which the Supreme Court in 2023 held created an individual right allowing private lawsuits under federal civil rights laws. The two provisions in that case, Gorsuch emphasized, explicitly refer to the rights of nursing-home residents, while the “any qualified provider” is not so explicit. 

Moreover, Gorsuch added, the nursing-home law specifically creates a “right to choose a personal attending physician” – which shows that “Congress knows how to give a grantee clear and unambiguous notice that, if it accepts federal funds, it may face private suits asserting an individual right to choose a Medicaid provider.” 

“Someday,” Gorsuch observed, “Congress might choose to revise” the “any qualified provider” provision to more closely resemble the nursing-home laws. “But that is not the law we have,” Gorsuch concluded. 

Gorsuch also pushed back against the suggestion that private plaintiffs must be allowed to sue under federal civil rights laws to “give the any-qualified provider provision the teeth it needs.” He noted that the federal government can cut off funding if a state does not comply with the provision. In fact, he continued, “this Court has called funding cutoffs ‘the typical remedy’ when a grant recipient violates the terms of spending-power legislation.”

And funding cut-offs are not necessarily the only means available to enforce the provision, Gorsuch posited. Under South Carolina law, he observed, Planned Parenthood can challenge its exclusion from the state’s Medicaid program – first through an administrative process and then, if necessary, in the state courts.

Justice Clarence Thomas filed a concurring opinion in which he agreed with the majority’s decision but also contended that the justices should take a more comprehensive look at the court’s cases involving the availability of federal civil rights claims. The law allowing private plaintiffs to bring federal civil rights claims “originated as a narrow, Reconstruction era statute,” he wrote. Thomas would hold that private plaintiffs cannot bring federal civil rights claims alleging violations of laws enacted under Congress’ spending power. Moreover, he added, the court “should revisit the threshold question of what constitutes a ‘right’ under” federal civil rights laws – particularly because “it seems more than likely that contemporaneous readers would have understood” the term “more narrowly than our current” cases do today.

In her dissent, Jackson agreed with the majority that the test to determine whether the “any qualified provider” provision creates an enforceable right is whether the provision “unambiguously confer[s] individual federal rights.” But if this test is properly applied, she argued, the lawsuit brought by Edwards and Planned Parenthood should be able to move forward.

In the “any qualified provider” provision, Jackson noted, Congress used language that focuses on the people whom it intended to benefit, by providing that Medicaid plans must allow “any individual eligible for medical assistance” to “obtain such assistance from” any qualified provider. Congress made clear that the provision conferred a right, she continued, given the provision’s title, which is “FREE CHOICE BY INDIVIDUALS ELIGIBLE FOR MEDICAL ASSISTANCE.” And the history backs this up as well, she suggested, because Congress enacted the provision “in direct response to efforts by some jurisdictions to steer Medicaid beneficiaries to specific providers.”

Jackson faulted the majority for focusing its analysis on “the simplistic premise that Medicaid’s free-choice-of-provider provision ‘looks nothing like th[e]’” nursing-home provisions that the court upheld in 2023. That opinion, Jackson stressed, did not “single out” the nursing-home laws “as the sole or definitive model for conferring individual rights.”

Jackson concluded that “Congress enacted the Medicaid Act’s free-choice-of-provider provision to ensure that Medicaid recipients have the right to choose their own doctors.” She continued, “The Court’s decision to foreclose Medicaid recipients from using” federal civil rights laws “to enforce that provision thwarts Congress’s will twice over: once, in dulling the tool Congress created for enforcing all federal rights, and again in vitiating one of those rights altogether.”