A tightly focused Supreme Court hearing on Wednesday spotlighted a broader conflict simmering beneath the surface — whether states can sidestep federal Medicaid protections to restrict access to health care providers like Planned Parenthood. While abortion was not the central topic in the arguments, its shadow loomed large.
The case, brought by Planned Parenthood South Atlantic and one of its patients, challenges South Carolina’s 2018 directive cutting off Medicaid reimbursements to the health provider. The patient had sought contraception — not an abortion — yet her ability to sue under Medicaid’s protections is now what’s before the Court.
The Heart of the Fight: Individual Rights or Federal Funding Rules?
This isn’t about abortion funding. Not directly, anyway.
At the core, justices are weighing whether individuals on Medicaid can sue a state if they’re blocked from using certain providers — even for services like STI testing or birth control. It’s about the scope of Section 1983, a federal civil rights law used to enforce federally conferred rights. The twist? The Supreme Court has drawn a hard line in past rulings: just because a law gives money to states doesn’t mean it automatically gives individuals the right to sue when states don’t comply.
In this case, Medicaid requires that patients be allowed to pick any “qualified provider.” That seems straightforward. But South Carolina’s move to cut off funds — even for non-abortion services — raises the question: does this provider-choice guarantee count as a personal right?
And if it does, can courts enforce it?
South Carolina’s Move and the Legal Dominoes That Followed
Back in 2018, Governor Henry McMaster made it official: no more Medicaid dollars for Planned Parenthood.
The reasoning? He said all taxpayer funds going to the organization “result in the subsidy of abortion,” even if used for other medical care. That line sparked immediate backlash from reproductive rights groups, who noted that Medicaid funding for abortion is already tightly restricted under federal law. In South Carolina, abortion is banned after six weeks — with narrow exceptions.
So why pull funds for services like Pap smears or birth control?
That’s the question Planned Parenthood and its patient pressed in court. A federal judge sided with them, blocking McMaster’s directive. But the appeals process got complicated, dragging the case through legal technicalities.
Now, it’s landed in front of the country’s highest court — with far-reaching implications, not just for South Carolina.
What Medicaid Really Guarantees
Let’s break it down.
Medicaid is a federal-state partnership. The feds provide funding, but states must play by specific rules. One of those is the “free choice of provider” clause — basically saying Medicaid recipients can go to any provider who meets the program’s requirements.
What complicates things:
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That language isn’t explicitly written as a “right” to sue.
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Courts differ on whether it’s enforceable by patients or just a guideline for states.
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The Supreme Court has previously said that only laws that “unambiguously confer” individual rights can be enforced this way.
So is choosing your doctor a protected right? That’s what the justices are grappling with.
Reactions From the Bench: Reading Between the Robes
Justice Elena Kagan pointed out the disconnect between what the law intends and how it’s enforced. “It seems quite strange,” she said, “that a law that says Medicaid recipients are entitled to choose among qualified providers… could not be enforced by the people it’s intended to protect.”
Chief Justice John Roberts and Justice Brett Kavanaugh were more reserved, signaling concern about overextending judicial power into the state-federal funding structure.
Meanwhile, Justice Sonia Sotomayor sounded skeptical of South Carolina’s motives. “If the state wants to restrict abortion funding, it can do that,” she said. “But here, the patient wasn’t even seeking an abortion.”
It’s a tightrope walk: how to balance federal oversight, patient rights, and state discretion.
What’s Really at Stake Beyond One Lawsuit
This isn’t just about one state or one health provider.
If the court rules against Planned Parenthood’s patient, it could shut the door on similar lawsuits in other states. That would leave Medicaid users with fewer tools to fight back if their access is restricted — even for services like cancer screenings or family planning.
Why does that matter?
Because over 80 million Americans are enrolled in Medicaid, and decisions like these shape where — and how — they get care. For low-income patients, losing access to providers like Planned Parenthood could mean longer wait times, fewer clinics, and, in some areas, no nearby alternative at all.
What’s more:
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Other conservative-led states may follow South Carolina’s lead.
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Legal uncertainty could discourage providers from participating in Medicaid.
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Patients could face disruptions even when seeking care unrelated to abortion.
As the justices deliberate, the real-world ripple effect is already creeping into policy debates in other statehouses.
