Supreme Court Empowers States to Defund Planned Parenthood

How the Supreme Court's Medicaid Ruling Redefined the Right to Sue—and May Reshape Access to Reproductive Care

On June 26, 2025, the U.S. Supreme Court issued a 6–3 decision in Medina v. Planned Parenthood South Atlantic, a case that did not directly address whether states could ban abortion or defund reproductive health providers—but may now allow them to do both by different means.

The Court ruled that individual Medicaid beneficiaries do not have the legal right to sue a state for violating the “free choice of provider” clause of federal Medicaid law. This effectively ends a long-standing route for challenging state policies that exclude certain clinics—such as Planned Parenthood—from Medicaid programs. The ruling gives South Carolina, and potentially other states, the authority to exclude providers based on their association with abortion, even if the services funded by Medicaid (such as STI testing or birth control) have nothing to do with abortion.

🔎 What the Case Was About

The conflict originated in 2018 when South Carolina Governor Henry McMaster signed an executive order barring any clinic that performs abortions from receiving Medicaid reimbursements. The directive targeted Planned Parenthood South Atlantic, which operates two clinics in the state and provides a wide range of services beyond abortion, including cancer screenings and contraceptive care.

McMaster’s rationale was ideological: even if Medicaid funds were not directly used for abortions, he claimed that any payment to an abortion provider amounted to a taxpayer subsidy of abortion.

The order was challenged in court by Planned Parenthood South Atlantic and a Medicaid patient, Julie Edwards, who argued that the exclusion violated Medicaid’s “free choice of provider” clause. That provision gives patients the right to receive care from any provider qualified and willing to participate in Medicaid.

Lower courts repeatedly sided with Planned Parenthood, and McMaster’s order was blocked. However, the Supreme Court reframed the issue—not as a question of whether the exclusion violated federal law, but whether patients had the right to sue at all.

In the majority opinion authored by Justice Neil Gorsuch, the Court concluded that the free choice provision did not create an enforceable right under 42 U.S.C. § 1983. Without a clear Congressional mandate authorizing private lawsuits, the Court declined to recognize one.

📚 Dissent and Legal Impact

Justices Sotomayor, Kagan, and Jackson dissented. Justice Sotomayor warned that the ruling “strips Medicaid beneficiaries of recourse when a state denies them access to qualified providers for ideological reasons.” She argued that this change in legal doctrine could allow states to exclude not just abortion providers but any controversial provider group.

This concern is echoed by legal scholars. Nicole Huberfeld, a professor of health law at Boston University, explained to The Guardian that the decision effectively removes one of the few checks on state-level Medicaid discrimination.

“If patients can’t sue,” Huberfeld said, “it’s far harder to stop states from discriminating against controversial care.”
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⚖️ Legal Mechanism, Political Strategy

The legal arguments made by South Carolina were supported by the conservative legal advocacy group Alliance Defending Freedom (ADF), a longstanding opponent of abortion access. ADF’s attorney, John Bursch, argued that the “free choice of provider” clause was a guideline, not a guarantee, and lacked “rights-creating language.”

The ruling has significant implications for how federal entitlements can be enforced. Legal analysts refer to this as a “rights-without-remedies” framework: Medicaid still offers choice on paper, but patients now lack the power to enforce that promise in court.

🗺️ The National Context

Planned Parenthood serves over 2.4 million patients annually, and nearly half rely on Medicaid. Most of these services involve general reproductive health—not abortion. But by severing the reimbursement channel, states can push such clinics out of the public health infrastructure.

Other red states—including Tennessee, Texas, and Arkansas—are now likely to follow South Carolina’s lead. By targeting the provider relationship rather than banning services outright, these states may bypass both legal challenges and political backlash.

🧭 What Comes Next

The ruling does not ban Planned Parenthood. It does not end Medicaid. But it alters the terrain on which both operate.

It shifts enforcement power away from individuals and toward state executives and health agencies. For low-income patients in politically polarized states, the implications are real: they may soon find fewer providers available to accept their Medicaid plan—not because those providers are unqualified, but because they are politically inconvenient.

And unlike in the past, they may now have no legal standing to challenge that exclusion.