Supreme Court's Medina Ruling Permits States to Refuse Funding Planned Parenthood

By Kathleen Farnan

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On June 26, the Supreme Court ruled that private beneficiaries cannot sue state officials for violating Medicaid’s “any-qualified-provider" provision under 42 U. S. C. §1983. This decision clarified that a statute must include clear and unambiguous rights-creating language in order to be privately enforceable under §1983. As a result, the Court’s decision in Medina v. Planned Parenthood opens up an avenue for other states to defund abortion providers.  

The “any-qualified-provider" provision is one of more than 80 conditions for state Medicaid plans spelled out in the Medicaid statutes.¹ In order to obtain funding for Medicaid, a state must “comply substantially” with certain conditions, one of which requires that a state must ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. In 2018, the State of South Carolina announced that it would no longer accept Planned Parenthood as a qualified medical provider of any services for purposes of the State’s Medicaid program. Planned Parenthood, along with patient Julie Edwards, sued South Carolina, claiming that the state had violated the “any-qualified-provider" provision.  

However, the fact that Congress attached the “any-qualified-provider" provision as a condition for states’ Medicaid funding does not mean that Medicaid beneficiaries automatically have a right to sue a state if that state fails to comply with the provision. The plaintiffs sought to sue the state under 42 U. S. C. §1983, a statute originally enacted under the Civil Rights Act of 1871, giving private individuals the right to sue state or local officials who have deprived them of “any rights, privileges, or immunities secured by the Constitution and laws” of the United States. However, the Court has never held that every benefit or interest created by a statute also creates a right enforceable under §1983.  

In order to decide whether Medicaid’s “any-qualified-provider" provision created an enforceable right, the Court reviewed the history of grant conditions tied to Congress’ Spending Clause legislation. The Court noted that grants from the federal government to the states enacted under the Spending Clause of the U.S. Constitution were treated as contracts between the federal government and the states. As in a contract between private entities, both the states and the federal government must be aware of what they are agreeing to in order for the agreement to be binding. In this case, the Court used a test from Gonzaga University v. Doe, which said that the statute must have an “unmistakable focus” on individuals claiming the right and must “clear[ly] and unambiguous[ly]” use “rights-creating terms.” Otherwise, a state might not realize that they had opened themselves up to private suits.  

When the Court looked at the “any-qualified-provider" provision, it found that the statute did not “clear[ly] and unambiguous[ly]” use “rights-creating terms.” Unlike previous cases where the Court determined that there was a right enforceable under §1983, the “any-qualified-provider" provision never used the term “right” or any equivalent language. Similarly, the Medicaid Act only required states to “comply substantially" with the provision, giving states some space for discretion, an allowance which would not make sense if the provision was meant to create a right. In addition, the Medicaid Act explicitly allows states to exclude medical providers who have been convicted of a felony. Clearly, then, the states have some ability to exclude unqualified providers. If the provision was meant to spell out a right, it would not have allowed the states the ability to control the scope of that right by controlling who is a qualified provider. In light of all this, the Court decided that the “any-qualified-provider" provision does not create a right privately enforceable under §1983.  

The Court’s decision in Medina respects federalism and the separation of powers by allowing the Legislative and Executive branches to enforce the terms of the grant themselves, and by leaving some discretion to the states. Along with the contract analogy, the Court had also historically used the analogy of a treaty between two nations to describe the duties laid upon the state and federal governments through spending clause legislation. In a treaty, the nations themselves are in charge of enforcing the terms of the treaty, not a third party. Similarly, unless a statute creates a right enforceable through private suits under §1983, Congress was the entity in charge of enforcing the conditions of a federal grant. In this case, the Medicaid Act stipulated that the Secretary of Health and Human Services could pull South Carolina’s grant funding if the state did not comply with the Medicaid Act’s provisions. In ruling the way they did, the Court showed proper judicial restraint and opened the door for the political branches to play their roles.  

Though this case dealt with a very technical question of statutory interpretation, the outcome was far from boring or trivial. Because the Court correctly interpreted §1983 of the 1871 Civil Rights Act, the state of South Carolina is now free to prevent tax dollars from funding abortion. States now have a roadmap for defunding Planned Parenthood and other abortion providers.

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