(THE FEDERALIST SOCIETY) — Does an individual Medicaid beneficiary have a legal right, enforceable in civil litigation against the State, to take her taxpayer-funded Medicaid dollars to a provider whom the State has prohibited from participating in Medicaid reimbursement?
In Medina v. Planned Parenthood South Atlantic, the Supreme Court answered “No” to that question. In a 6-3 opinion by Justice Neil Gorsuch, the Court held that Medicaid’s so-called “any-qualified-provider” provision, 42 U.S.C. §1396a(a)(23)(A), does not clearly and unambiguously confer an individually enforceable right under 42 U.S.C. §1983. This decision not only resolves the dispute at hand, but also provides a detailed primer on when spending-power legislation creates an individually-enforceable right. This otherwise highly technical opinion, which barely references abortion, also implicates the ongoing debates regarding whether Planned Parenthood ought to continue to be supported by taxpayer dollars.
South Carolina law prohibits the use of public funds for abortions. Reasoning that Medicaid payments to abortion providers for any services would indirectly subsidize abortion, Governor Henry McMaster directed the South Carolina Department of Health and Human Services to deem abortion providers “unqualified” to provide services to Medicaid beneficiaries. By extension, this made abortion providers ineligible to receive reimbursements from the state’s Medicaid program. Julie Edwards, a Planned Parenthood client and Medicaid beneficiary, joined the organization in suing South Carolina under § 1983 of the Civil Rights Act, claiming that Planned Parenthood’s disqualification violated the §1396a “any-qualified-provider” provision of the Medicaid statute.
The two statutory provisions implicated by this claim bear a closer look. First, §1983 allows individuals to sue state actors who deprive them of “rights” granted to them by the “Constitution and laws” of the United States. However, federal statutes do not establish individually enforceable rights automatically—or even frequently. What kind of statutory language triggers §1983 liability is one of the complex questions presented by this case. The second statutory provision under the microscope in this case is the any-qualified-provider provision, §1396a(a)(23)(A) of the Medicaid Act, which appears in a long list of statutory requirements that a participating state’s Medicaid plan must meet. This provision requires a state plan to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. If a state fails to “substantially comply” with this obligation (or any other obligation in the laundry list), the Secretary of Health and Human Services is permitted to suspend Medicaid funding to the state. Respondents argued that the any-qualified-provider provision is among the rare federal statutes that create an individual right enforceable in court under §1983. Petitioners, of course, argued that it does no such thing.
During oral argument, the justices appeared sharply divided on these questions. Justices Sotomayor, Jackson, and Kagan appeared convinced that the any-qualified-provider provision does create an individually-enforceable right. Justice Thomas’ questioning focused on the exact language necessary for a statute to grant an individual an enforceable right, and Justice Kavanaugh likewise expressed a desire to adopt a bright-line test to clear up confusion in the lower courts. Justice Gorsuch—the eventual author of the majority opinion—focused in his questioning on the distinction between individual benefits in a statute and enforceable rights.
The majority opinion neatly cuts through the doctrinal thicket caused by diverging strands of Supreme Court precedent regarding when courts may read a private right of action into a statute, and particularly into legislation—like the Medicaid Act—authorized under Congress’s spending power. The Court clearly repudiated its prior precedents Wilder v. Va. Hosp. Ass’n, Wright v. City of Roanoke Redev. & Hous. Auth., and Blessing v. Freestone, which established too low a bar for finding individually enforceable rights. (The Court characterized this repudiation as “longstanding,” but the lower courts—including in this case—had continued to apply those decisions, so it seems additional clarity was called for.) It instead held that a spending-power statute confers an individually enforceable right—and not simply a mere benefit—only if it contains “clear and unambiguous” rights-creating language, as laid out in the Court’s prior cases Gonzaga Univ. v. Doe and Health & Hosp. Corp. of Marion Cnty. v. Talevski. As Talevski warns, very few statutes will meet this “stringent” and “demanding” test. This high threshold is crucial in interpreting spending-power legislation, which Supreme Court precedent establishes is akin to a contract between the federal government and the state grantees; therefore, a state grantee may be subjected to private lawsuits under §1983 as a condition of its federal funding only if it has “voluntarily and knowingly” consented to taking on this burden as part of its bargain with the federal government.
Having established the correct test, the Court then holds that the any-qualified-provider provision in the Medicaid statute does not clearly and unambiguously create an individual right. It is not sufficiently similar to the statutory provision at issue in Talevski, the key precedent in which a spending-power was held to clearly and unambiguously create an individual right. The individual plaintiff in this case, therefore, does not have a right to sue the state under §1983.
Justice Thomas, who joined the majority opinion in full, wrote a solo concurrence calling for a reexamination of the Court’s §1983 jurisprudence, which he said “bears little resemblance to the statute as originally understood.” While agreeing that the majority properly applied Supreme Court precedent to resolve this particular case, Justice Thomas zooms out to the big picture and argues (i) that spending-power legislation, being contractual and conditional in nature and therefore incapable of “securing” any rights, can never give rise to a §1983 claim and (ii) that the Court should revisit what constitutes a “right” for purposes of §1983 litigation.
In dissent, Justice Jackson, joined by Justices Kagan and Sotomayor, argued that the majority erased individual rights that Congress created. In the dissent’s view, the majority ignored the Medicaid Act’s intended purpose of ensuring healthcare autonomy and misread the text of the any-qualified-provider provision. The dissent read §1396a to confer a right because Congress would not use both “classically compulsory and explicit individual-centric terminology” that is “classically associated with establishing rights” if it intended otherwise. The majority responded by reinforcing the supremacy of the text over legislative intent and by arguing that the dissent’s approach is inconsistent with the Court’s precedent. The majority also argued that the dissent’s reading would result in the obliteration of the distinction between conferring a benefit and establishing an individual right, not just throughout the Medicaid Act but well beyond as well.
In summary, the Medina decision turns on technical legal questions about how to read a few words in the Medicaid statute, the contractual nature of spending-power legislation, and the scope of §1983 rights. It is not, on its face, about abortion rights. In fact, the word “abortion” appears just three times in the opinions issued by the Court—twice in the majority, once in the dissent— and all in recitations of the facts. But the implications of this decision for continued government funding of abortion providers are vast. The Court’s ruling that an individual Medicaid beneficiary cannot unilaterally overrule a decision made by a state’s elected leaders to prohibit funding to abortion providers clears the path for additional states to follow South Carolina’s lead and deem abortion providers unqualified to provide reimbursable Medicaid services. Given that 18 state attorneys general signed amicus briefs supporting South Carolina, further efforts to limit funding to abortion providers are likely nationwide.
The timing of the decision also highlights its importance for the ongoing public debate over government funding for abortion providers, coming as it did just a week before Congressional passage of a federal one-year defund of abortion providers as part of President Trump’s One Big Beautiful Bill. The public policy implications of this decision—much more than its helpful clarification of the legal test for when a statute creates an individually enforceable right—are likely to be its most significant legacy.
Note from the Editor: The Federalist Society takes no positions on particular legal and public policy matters. Any expressions of opinion are those of the author. We welcome responses to the views presented here. To join the debate, please email us at info@fedsoc.org.