The Supreme Court ruled 6-3 on Thursday morning that federal law does not prevent South Carolina from barring abortion providers from its Medicaid program, reversing a lower court decision that had kept Planned Parenthood's funding intact for years.

The decision in Medina v. Planned Parenthood is a landmark victory for state sovereignty and a decisive blow to the legal theory that Medicaid recipients have a privately enforceable right to choose any qualified provider, including abortion providers, under federal law.

Justice Neil Gorsuch authored the majority opinion, joined by Chief Justice John Roberts and Justices Clarence Thomas, Samuel Alito, Brett Kavanaugh, and Amy Coney Barrett. The core of the ruling is straightforward: the Medicaid statute's "free choice of provider" language does not create an individual right that patients can enforce in court.

The Legal Question That Finally Got Answered

According to the Christian Post, this case has wound through the courts since 2018, when South Carolina Gov. Henry McMaster ordered the state's Department of Health and Human Services to terminate Medicaid agreements with any abortion providers. Planned Parenthood, which operated two facilities in the state, filed a lawsuit along with a patient. A federal district court blocked the state from enforcing McMaster's order, and in March 2024, a three-judge panel of the 4th U.S. Circuit Court of Appeals unanimously upheld that decision.

The Supreme Court granted certiorari in a miscellaneous order last December, taking up the case then known as Kerr v. Planned Parenthood South Atlantic. Arguments were to focus on the threshold legal question: Does the Medicaid Act's provider-choice provision create an enforceable right under 42 United States Code §1983?

Gorsuch's answer was no. And the reasoning left little room for ambiguity.

"To prove that a statute secures an enforceable right, privilege, or immunity, and does not just provide a benefit or protect an interest, a plaintiff must show that the law in question 'clear[ly] and unambiguous[ly]' uses 'rights-creating terms.'"

Gorsuch drew a line that courts have often blurred: the difference between a benefit Congress chose to provide and an individual right Congress intended to be enforceable by private lawsuit. He wrote that there is a "longstanding line between mere benefits and enforceable rights" and that Congress bears the burden of providing states with "clear and unambiguous notice of an individually enforceable right."

The Medicaid statute, Gorsuch explained, does not meet that standard:

"After announcing that state Medicaid plans must allow individuals to obtain care from any qualified provider, the provision proceeds to carve out various exceptions to that rule. … Neither paragraph uses clear and unambiguous rights-creating language, so neither supports a private suit under [42 United States Code §1983]."

In other words, the statute sets expectations for how state Medicaid programs should operate. It does not hand individual recipients a private cause of action to sue when a state decides which providers qualify.

The Dissent's Familiar Playbook

Justice Ketanji Brown Jackson authored the dissent, joined by Justices Sonia Sotomayor and Elena Kagan. Jackson argued that the free-choice-of-provider provision "readily creates an enforceable right" and accused the majority of misapplying the Court's own precedent.

"Congress made a deliberate choice to protect Medicaid recipients' ability to choose their own providers by employing statutory language that it knew, based on its Medicare experience, would achieve that end. Congress's intent could not have been clearer."

Jackson's argument rested on congressional intent, tracing the Medicaid language back to a similar provision in the Medicare Act. She contended that Congress adopted "nearly identical language" from Medicare precisely because it had already functioned as a guarantee of provider choice in that program.

It's a tidy argument. It also asks the Court to do something Gorsuch's majority explicitly refused to do: infer rights from legislative history rather than requiring them to be stated plainly in the text. If Congress wanted to create a privately enforceable right, Congress had the tools to say so. It didn't.

What This Actually Means for States

The practical implications are significant. For years, Planned Parenthood and its allies used the "free choice of provider" clause as a legal shield, arguing in court after court that states could not exclude abortion providers from Medicaid, no matter what state lawmakers or governors decided. That shield is gone.

States that want to direct Medicaid dollars away from abortion providers can now do so without facing the specific legal challenge that kept South Carolina tied up in litigation for the better part of a decade. The ruling does not mandate that states defund anyone. It restores the authority that was always supposed to belong to state governments administering their own Medicaid programs.

This is the federalism principle working as designed. States set priorities. States decide which providers meet their qualifications. The federal government sets broad parameters, but it does not conscript states into funding organizations that violate state policy on abortion.

The 4th Circuit's Overreach

Worth noting is how the lower courts handled this case. The 4th Circuit panel that unanimously upheld the district court's injunction was led by Circuit Judge Harvie Wilkinson, a Reagan appointee, who framed the issue in strikingly sympathetic terms for Planned Parenthood: "Preserving access to Planned Parenthood and other providers means preserving an affordable choice and quality care for an untold number of mothers and infants in South Carolina."

That is not legal reasoning. That is a policy preference dressed in judicial robes. Whether Planned Parenthood provides quality care is a question for state health officials and legislators, not for federal judges deciding a statutory interpretation case. The Supreme Court's reversal was a correction not just of a legal conclusion but of a lower court that confused its role with that of a legislature.

The Bigger Picture

For the broader pro-life movement, this ruling matters beyond the immediate question of Medicaid funding. It closes a litigation pathway that Planned Parenthood had relied on across multiple states and multiple circuits. The organization's legal strategy depended on courts reading enforceable individual rights into statutory language that, as Gorsuch demonstrated, simply doesn't contain them.

The left will frame this as an assault on healthcare access. Expect the usual rhetoric about vulnerable women losing services. But the framing collapses under scrutiny. Medicaid recipients in South Carolina are not losing healthcare. They are losing the ability to receive Medicaid-funded services from abortion providers specifically. Other qualified providers remain available. The state is not eliminating care. It is exercising its legitimate authority over which entities participate in its programs.

Something is clarifying about the 6-3 split. The three dissenters read congressional intent where the text was silent. The six justices in the majority read the text as written. That divide is not new, but it is worth marking every time it surfaces. Textualism won. And in this case, textualism aligned with the principle that states, not federal courts, should govern the structure of their own healthcare programs.

South Carolina fought this battle for nearly eight years. On Thursday morning, the highest court in the land told the state what its governor knew in 2018: the decision was always yours to make.