Latest news with #MedicaidAct
Yahoo
02-04-2025
- Health
- Yahoo
Supreme Court divided over state effort to defund Planned Parenthood
The Supreme Court appeared divided Wednesday over whether a state can block Medicaid funding for Planned Parenthood clinics, in a technical interpretation over healthcare choices that has become a larger political fight over abortion access. In nearly two hours of oral arguments, the court's conservative majority offered measured support for South Carolina's position. The specific issue is whether low-income Medicaid patients can sue in order to choose their own qualified healthcare provider. The federal-state program has shared responsibility for funding and administering it, through private healthcare providers. Federal law bans taxpayer money from going to fund almost all abortions, but Planned Parenthood also provides a range of other medical services with and without Medicaid subsidies, including gynecological care and cancer screenings. Planned Parenthood Apologizes For 'Inadvertently' Giving Sexually Explicit Coloring Book To Children Blocking the provider from Medicaid networks could effectively defund it. Given the divisive underlying issue of abortion, groups on both sides rallied outside the high court ahead of the arguments. Read On The Fox News App The state's governor in 2018 signed an executive order blocking Medicaid funding for the state's two Planned Parenthood clinics, saying it amounted to taxpayers subsidizing abortions. Courts have put that order on hold, leading to the current case. South Carolina now bans abortion around six weeks of pregnancy, or when cardiac activity is detected, with limited exceptions. The key provision in the 1965 Medicaid Act guarantees patients a "free choice of provider" that is willing and qualified. Much of the court session dealt with whether Planned Parenthood was a "qualified provider" under the Medicaid law, and whether individual patients have an unambiguous "right" to sue to see their provider of choice, under its specific language. "It seems a little bit odd to think that a problem that motivated Congress to pass this provision was that states were limiting the choices people had," said Justice Sonia Sotomayor. "It seems hard to understand that states didn't understand that they had to give individuals the right to choose a provider." Trump Admin Withholds Millions From Planned Parenthood For Civil Rights And Executive Order Violations: Report "The state has an obligation to ensure that a person... has a right to choose their doctor," added Justice Elena Kagan. "It's impossible to even say the thing without using the word 'right.'" But some conservative justices questioned how to interpret a provision that does not contain the word "right." "One can imagine a statute written as an individual benefit that's mandatory on the states but isn't right-creating" for the patient, said Justice Neil Gorsuch. "I mean, that's an imaginable scenario." Justice Samuel Alito added it was "something that's quite extraordinary" to give individuals that right to sue under the Constitution's spending clause. The votes of Chief Justice John Roberts and Justice Amy Coney Barrett could be key: They asked tough questions of both sides. Barrett offered a hypothetical of the right of a patient to go to court over their doctor accused of medical malpractice. "Does it make sense in that circumstance for Congress to want plaintiffs to be able to sue?" she asked. Planned Parenthood says its future is at stake, noting nearly $700 million – about a third of its overall nationwide revenue – originates from Medicaid reimbursements, and government grants and contracts. But the group notes just $90,000 in Medicaid funding goes to Planned Parenthood facilities every year in South Carolina, which is comparatively small to the state's total Medicaid spending. Julie Edwards, a South Carolina resident, sued along with Planned Parenthood South Atlantic, which operates two clinics in Columbia and Charleston. She has type-1 diabetes and associated medical complications and wanted to choose the Columbia clinic for its range of services, including reproductive care. A federal appeals court ruled against the state in 2024, concluding the "free choice of provider" provision "specifies an entitlement given to each Medicaid beneficiary: to choose one's preferred qualified provider without state interference." In a 2023 Supreme Court opinion involving care for nursing home residents, the justices concluded that a different law from Medicaid gives individuals the right to sue. A year earlier, the high court overturned its Roe v. Wade precedent of a nationwide right to abortion. Several states – including Texas, Missouri and Arkansas – have already done what South Carolina wants to do by cutting Medicaid funding to Planned Parenthood and more could follow if South Carolina prevails. "The people in this state do not want their tax money to go to that organization," said Republican South Carolina Gov. Henry McMaster, who attended the oral argument. "I believe the decision of this court will be that the people of South Carolina have the right to make this decision for themselves, for our state. Other states may make a different decision, but not ours. South Carolina stands for the right to life, and we'll do whatever is necessary to protect that." 'A Birth Is More Expensive Than An Abortion': Co Dems Argue Fiscal Virtues Of Liberal Healthcare Bill The Trump Justice Department is supporting the state, and abortion rights groups say the issue is about patient choice. "Our health centers serve an irreplaceable role in the state's healthcare system, providing birth control and cancer screenings to people who can't afford those services anywhere else," said Paige Johnson, interim president and CEO of Planned Parenthood South Atlantic. "Government officials should never block people from getting healthcare or be able to decide which doctor you can or cannot see." One concern raised by healthcare advocates is finding gynecological and family planning services in states with limited facilities. Low-income women often have greater difficulty traveling long distances to get such quality care, a requirement for Medicaid providers. Justice Brett Kavanaugh said he would make it his mission to bring as much clarity over when patients can go to court, which he called a 45-year "odyssey." Much of the public arguments dealt with whether a "right" to sue was a magic word to automatically decide the matter. "I'm not allergic to magic words, because magic words – if they represent the principle – will provide the clarity that will avoid the litigation that is a huge waste of resources for states, courts, providers, beneficiaries." The case is Medina (SC DOH) v. Planned Parenthood South Atlantic (23-1275). A ruling is likely by early article source: Supreme Court divided over state effort to defund Planned Parenthood
Yahoo
02-04-2025
- Health
- Yahoo
How far can red states go to oppose Planned Parenthood? Supreme Court debates Medicaid restrictions
The Supreme Court on Wednesday debated one state's effort to keep public money away from Planned Parenthood and the rights of individual patients to sue when that effort interferes with their personal medical choices. In Medina v. Planned Parenthood South Atlantic, the court is considering whether Medicaid recipients in South Carolina have a legal right to challenge a state order prohibiting Medicaid funds from going to abortion providers. Before the order went into effect, patients were covered when they went to Planned Parenthood for non-abortion services, like cancer screenings and blood pressure checks. During oral arguments on Wednesday, the court debated whether the federal Medicaid Act gives individual Medicaid recipients the right to try to force changes to a state's list of qualified providers through legal action. At least five of the nine justices seemed skeptical of South Carolina's claim that there's no individual right to bring a lawsuit under the federal law. 'Justices, including Chief Justice John G. Roberts, Jr., and Neil M. Gorsuch, pressed South Carolina's lawyer about the availability of meaningful recourse for patients other than litigation if a Medicaid recipient is denied access to their chosen medical provider,' according to The Washington Post. The Supreme Court case originated in 2018, when South Carolina Gov. Henry McMaster ordered state agencies to stop sending public funds to 'any physician or professional medical practice 'affiliated with an abortion clinic,'' according to The Washington Post. The order expanded an existing prohibition against using Medicaid funds for abortion and aimed to stop abortion providers from accessing any amount of public money. 'The payment of taxpayer funds to abortion clinics, for any purpose, results in the subsidy of abortion and the denial of the right to life,' McMaster wrote in the order. As a result of the order, Medicaid recipients are no longer covered if they use Planned Parenthood clinics for cancer screenings, birth control prescriptions and other types of non-abortion medical services. Planned Parenthood patient Julie Edwards objected to the change and, along with Planned Parenthood, sued to block it. Their lawsuit argues that South Carolina is violating the part of the federal Medicaid Act that deals with a patient's right to seek treatment from any 'qualified' provider, according to SCOTUSblog. Edwards and Planned Parenthood believe the Medicaid Act created an individual right to use the medical providers you want to use. South Carolina officials, on the other hand, say the law deals with the relationship between states and the federal government, not with the rights of individual Medicaid recipients. Edwards and Planned Parenthood won at the district and circuit court levels, where judges agreed that South Carolina's order is violating patients' rights. 'South Carolina — represented by the conservative advocacy group Alliance Defending Freedom — appealed to the Supreme Court last June, asking the justices to decide whether Edwards and Planned Parenthood have a legal right to sue to enforce the Medicaid Act. The justices agreed in December to weigh in," SCOTUSblog reported. The Planned Parenthood case is the latest in a string of abortion-related cases to reach the Supreme Court in the past three years. Since the justices returned control over abortion restrictions to states in June 2022, they've debated access to abortion pills and whether or not state-level abortion bans violate federal rules on emergency care. The court unanimously protected access to mifepristone in the first of those two cases and determined the second one was 'improvidently granted.' One of the Supreme Court briefs filed in favor of South Carolina in the Planned Parenthood case said that siding with state officials would fit the spirit of the 2022 ruling by making it clear that states can regulate abortion — and oversee abortion providers — without interference from the federal government or individual Medicaid recipients, SCOTUSblog reported.
Fox News
02-04-2025
- Health
- Fox News
Supreme Court divided over state effort to defund Planned Parenthood
The Supreme Court appeared divided Wednesday over whether a state can block Medicaid funding for Planned Parenthood clinics, in a technical interpretation over healthcare choices that has become a larger political fight over abortion access. In nearly two hours of oral arguments, the court's conservative majority offered measured support for South Carolina's position. The specific issue is whether low-income Medicaid patients can sue in order to choose their own qualified healthcare provider. The federal-state program has shared responsibility for funding and administering it, through private healthcare providers. Federal law bans taxpayer money from going to fund almost all abortions, but Planned Parenthood also provides a range of other medical services with and without Medicaid subsidies, including gynecological care and cancer screenings. Blocking the provider from Medicaid networks could effectively defund it. Given the divisive underlying issue of abortion, groups on both sides rallied outside the high court ahead of the arguments. The state's governor in 2018 signed an executive order blocking Medicaid funding for the state's two Planned Parenthood clinics, saying it amounted to taxpayers subsidizing abortions. Courts have put that order on hold, leading to the current case. South Carolina now bans abortion around six weeks of pregnancy, or when cardiac activity is detected, with limited exceptions. The key provision in the 1965 Medicaid Act guarantees patients a "free choice of provider" that is willing and qualified. Much of the court session dealt with whether Planned Parenthood was a "qualified provider" under the Medicaid law, and whether individual patients have an unambiguous "right" to sue to see their provider of choice, under its specific language. "It seems a little bit odd to think that a problem that motivated Congress to pass this provision was that states were limiting the choices people had," said Justice Sonia Sotomayor. "It seems hard to understand that states didn't understand that they had to give individuals the right to choose a provider." "The state has an obligation to ensure that a person... has a right to choose their doctor," added Justice Elena Kagan. "It's impossible to even say the thing without using the word 'right.'" But some conservative justices questioned how to interpret a provision that does not contain the word "right." "One can imagine a statute written as an individual benefit that's mandatory on the states but isn't right-creating" for the patient, said Justice Neil Gorsuch. "I mean, that's an imaginable scenario." Justice Samuel Alito added it was "something that's quite extraordinary" to give individuals that right to sue under the Constitution's spending clause. The votes of Chief Justice John Roberts and Justice Amy Coney Barrett could be key: They asked tough questions of both sides. Barrett offered a hypothetical of the right of a patient to go to court over their doctor accused of medical malpractice. "Does it make sense in that circumstance for Congress to want plaintiffs to be able to sue?" she asked. Planned Parenthood says its future is at stake, noting nearly $700 million – about a third of its overall nationwide revenue – originates from Medicaid reimbursements, and government grants and contracts. But the group notes just $90,000 in Medicaid funding goes to Planned Parenthood facilities every year in South Carolina, which is comparatively small to the state's total Medicaid spending. Julie Edwards, a South Carolina resident, sued along with Planned Parenthood South Atlantic, which operates two clinics in Columbia and Charleston. She has type-1 diabetes and associated medical complications and wanted to choose the Columbia clinic for its range of services, including reproductive care. A federal appeals court ruled against the state in 2024, concluding the "free choice of provider" provision "specifies an entitlement given to each Medicaid beneficiary: to choose one's preferred qualified provider without state interference." In a 2023 Supreme Court opinion involving care for nursing home residents, the justices concluded that a different law from Medicaid gives individuals the right to sue. A year earlier, the high court overturned its Roe v. Wade precedent of a nationwide right to abortion. Several states – including Texas, Missouri and Arkansas – have already done what South Carolina wants to do by cutting Medicaid funding to Planned Parenthood and more could follow if South Carolina prevails. "The people in this state do not want their tax money to go to that organization," said Republican South Carolina Gov. Henry McMaster, who attended the oral argument. "I believe the decision of this court will be that the people of South Carolina have the right to make this decision for themselves, for our state. Other states may make a different decision, but not ours. South Carolina stands for the right to life, and we'll do whatever is necessary to protect that." The Trump Justice Department is supporting the state, and abortion rights groups say the issue is about patient choice. "Our health centers serve an irreplaceable role in the state's healthcare system, providing birth control and cancer screenings to people who can't afford those services anywhere else," said Paige Johnson, interim president and CEO of Planned Parenthood South Atlantic. "Government officials should never block people from getting healthcare or be able to decide which doctor you can or cannot see." One concern raised by healthcare advocates is finding gynecological and family planning services in states with limited facilities. Low-income women often have greater difficulty traveling long distances to get such quality care, a requirement for Medicaid providers. Justice Brett Kavanaugh said he would make it his mission to bring as much clarity over when patients can go to court, which he called a 45-year "odyssey." Much of the public arguments dealt with whether a "right" to sue was a magic word to automatically decide the matter. "I'm not allergic to magic words, because magic words – if they represent the principle – will provide the clarity that will avoid the litigation that is a huge waste of resources for states, courts, providers, beneficiaries." The case is Medina (SC DOH) v. Planned Parenthood South Atlantic (23-1275). A ruling is likely by early summer.
Yahoo
02-04-2025
- Health
- Yahoo
How 2 words could decide whether SC can remove Planned Parenthood from list of Medicaid providers
Supporters and opponents of Planned Parenthood hold signs outside a U.S. Supreme Court hearing Wednesday, April 2, 2025, on a case that will decide whether South Carolina can remove Planned Parenthood from Medicaid rolls as a provider for non-abortion health care services. (Photo by Sofia Resnick/States Newsroom) Whether South Carolina Medicaid patients can go to the doctor of their choice could hinge on two words in federal law, attorneys argued to the U.S. Supreme Court on Wednesday. A section of the federal Medicaid Act says patients 'may obtain' care from any provider who is willing and qualified. It will be up to the nation's highest court to decide what that means. Attorneys for South Carolina and the U.S. government contend that allows states to choose which providers can be reimbursed for Medicaid-covered health care services. An attorney for Planned Parenthood argued those words give patients the right to see the provider of their choice. The case stems from a 2018 executive order in which Gov. Henry McMaster directed the state's Medicaid agency to remove abortion clinics from the list of providers that patients can choose to visit for non-abortion health care services. Under federal law, Medicaid can't pay for abortions. But Planned Parenthood also offers 'family planning' services Medicaid does cover, such as breast and cervical cancer screenings, birth control, and testing and treatment for sexually transmitted infections. Because the Medicaid Act doesn't explicitly use the word 'right,' or similar words, such as 'privilege,' 'entitlement' or 'immunity,' the state isn't legally obligated to allow patients to see whatever health care provider they want, argued John Bursch, an attorney representing the state, and Kyle Hawkins, an attorney for the Office of the Solicitor General. 'We're looking for unmistakable rights-creating language,' said Hawkins, who presented the federal government's arguments in support of the state. Justices Sonia Sotomayor and Kentaji Brown Jackson seemed to differ. Requiring certain phrasing would be like telling Congress there are 'magic words' that can make the court interpret the law a certain way, said the justices who are generally considered liberal. Justice Elana Kagan was more direct in her questioning. The law's phrasing seems to clearly convey that a patient has the right to choose their provider, she said. 'It's impossible to even say the thing without using the word 'right,'' Kagan said. The use of the word 'may' is not related to a person's choice in what provider they visit but rather whether they choose to seek out health care at all, Kagan said. 'The 'may' is just, 'You may see a doctor,'' Kagan said. 'We're not forcing people to see doctors.' If the court interpreted the law as allowing states to deny Medicaid reimbursements to any doctor or practice state politicians deem unqualified, that could lead to any number of arbitrary decisions about who to include or exclude from the provider list, she said. Some states might decide to approve only the providers that perform abortions, offer contraception or do gender transition treatment, while other states might decide the opposite, she said. 'Every state could split up the world by providers like that, right?' Kagan said. Allowing states to do that, she added, would give patients 'no ability to come back and say, 'That's wrong, I'm entitled to see my provider of choice, regardless of what they think about contraception or abortion or gender transition treatment.'' Congress passed that part of the Medicaid Act because some states were trying to 'steer their Medicaid beneficiaries to certain providers and away from others,' Jackson said. That suggests Congress intended people to be able to choose which providers they want to see, said Nicole Saharsky, attorney for Planned Parenthood South Atlantic. 'There aren't that many things that are more important than being able to choose your doctor, the person that you see when you're at your most vulnerable, facing some of the most significant challenges to your life and your health,' Saharsky said. 'Congress said a long time ago, 'This is something we want to protect.'' In response, Bursch argued that interpreting the wording as giving patients the right to choose their provider could open up a flood of lawsuits from people whose preferred doctors aren't on the list. SC's Planned Parenthood Medicaid funding case before the Supreme Court 7 years after McMaster's order The law already creates an appeals process for patients who feel their care isn't sufficient, Bursch said. Providers can also appeal to the courts if they feel they were unfairly excluded, he said. He likened the process to private insurance, in which an insurance company will only cover care provided by doctors considered part of its network. 'The beneficiary doesn't have the right to whip out a magic wand and then just hit on the head the doctor that they want, and then they must be qualified under Medicaid,' Bursch said. But that process doesn't allow a person to appeal until they've seen the provider, meaning that person couldn't challenge the decision to remove a health care provider from the list entirely, said Justice Amy Coney Barrett. 'That's the beneficiary taking the risk, going to the provider she wants to see and then potentially having to pay out of pocket,' Barrett said. Activists on both sides gathered outside the U.S. Supreme Court during the hearing, with competing bright pink signs that read 'defund' or 'fund' Planned Parenthood. But representatives for Planned Parenthood said justices' ruling is not about the organization's ability to operate, but whether patients will lose access to health care. 'If we lose, it won't shut us down,' said Molly Rivera, communications director for Planned Parenthood South Atlantic. 'The real impact is going to be on the patients. It's going to be on people who rely on Medicaid and Title X for preventative health care.' Other activists who traveled to the nation's capital showed their support with homemade signs. They included Alex Brunken; her husband, John McNeil; and their son, Glen, who came from Slippery Rock, Pennsylvania, to support Planned Parenthood. 'Poor people should also get to choose who their providers are, not just wealthy people,' said Brunken, who described her work as being in 'reproductive health care,' adding she wanted her son to see the work she and her co-workers do. This week, the Trump administration also temporarily froze nearly $30 million in Title X family-planning grants to Planned Parenthood affiliates, which the Guttmacher Institute estimates could impact more than 1 million people seeking contraception, testing for sexually transmitted infections or other reproductive health services. The Alliance Defending Freedom, which is representing South Carolina officials in the lawsuit, argues that any money going to Planned Parenthood ultimately goes toward funding abortion. 'We know that money is fungible, so any dollar that's going to an abortion facility like Planned Parenthood — even earmarked for other services — is going to enable more dollars that they have to then go towards things like their abortion activism or performing more abortions,' said Gabriella McIntyre, legal counsel at Alliance Defending Freedom. 'States need to be free to fund real, comprehensive, high-quality health care in their states and exclude organizations like Planned Parenthood' from their limited funding, she said. McIntyre said South Carolina has 'nearly 200 high quality, comprehensive healthcare facilities that are publicly funded' where Medicaid patients could go instead of Planned Parenthood for family planning services. Rivera and other reproductive rights advocates in the state have argued there is a dearth of reproductive health providers who accept Medicaid and who are accepting new patients. Rivera said Planned Parenthood, which is a nonprofit, actually loses money as a Medicaid provider because the government's reimbursement rates are lower than the cost of the approved services they provide, such as cervical cancer screenings and birth control. That's why many for-profit health providers do not accept or limit the amount of Medicaid patients they see, which Planned Parenthood does not, she said. She said she worries residents of South Carolina, where most abortions are currently banned after six weeks' gestation, might have to start traveling out of state — not just for abortions, but for birth control and Pap smears. 'Both of our health centers, Columbia and Charleston, are also part of Title X, so we see people for Title X and Medicaid, and if you can't do either because of the government, I don't know where people are going to go,' Rivera said. 'Especially with cancer screenings, early detection saves lives. So, if you have to travel across state lines for your Pap smear, are you going to be able to do that? People will just forgo care.' While reproductive rights advocates outside the court rallied in favor of patients' rights, U.S. Rep. Ralph Norman of South Carolina's Fifth District argued states should have the right to determine their Medicaid providers. He called it a case about choice as laid out in the 10th amendment of the U.S. Constitution as giving powers to the states. It's about the state's choice 'to determine where limited resources go, the choice of South Carolinians to align our Medicaid policies with our values, and the choice of our nation to uphold the principles of federalism that our founders so wisely enshrined,' Norman, a Rock Hill Republican who might run for governor, said while addressing national anti-abortion leaders. 'I urge the court behind us to affirm our right to make these decisions free from outside interference, and I will continue to fight just alongside each one of you until this right is protected.'
Yahoo
02-04-2025
- Health
- Yahoo
What's at stake in the Supreme Court case Medina v. Planned Parenthood South Atlantic?
(Photo by Jane Norman/States Newsroom) By KFF Health News/Laurie Sobel, Usha Ranji, and Alina Salganicoff On April 2nd, the Supreme Court of the United States will hear oral arguments in Medina v. Planned Parenthood South Atlantic. The case addresses whether Medicaid beneficiaries can seek relief in federal court to enforce Medicaid's 'free-choice of provider provision,' which allows Medicaid beneficiaries to seek care from any provider that is qualified and willing to participate in the program. While the case focuses on this specific question, it has its origins in broader efforts by anti-abortion policymakers to exclude Planned Parenthood clinics from the Medicaid program and, ultimately, eliminate all federal payments to Planned Parenthood centers. In this brief, we describe the case, the Medicaid policies underlying it, and potential implications for Medicaid beneficiaries' access to reproductive health services. The Supreme Court's review of this case is limited to one question: Can a Medicaid beneficiary bring a civil action to enforce the Medicaid Act's free choice of provider? This question is similar to one that the Court decided in 2023 (Health and Hospital Corp of Marion County v. Talevski ) when it ruled (7-2) that patients do have a private right of action to enforce certain conditions that federal Medicaid law imposes on states and health care providers. However, the current case involves a different provision of federal law relating to free choice of provider under the Medicaid Act. Planned Parenthood and the individual beneficiary who has brought this case take the position that Medicaid beneficiaries meet the requirements to sue in order to enforce the free choice of provider provision. The Trump administrationhas weighed in on the side of South Carolina, contending that Medicaid beneficiaries should not be permitted to bring an action to enforce this provision. In 2018, South Carolina's Governor McMaster (R) issued an executive order prohibiting any clinic that provides abortion care from participating in the state's Medicaid program. The order states that the state funds used to reimburse providers could be used to indirectly subsidize abortion care even though Medicaid only pays for non-abortion family planning services. The executive order had a direct impact on the Planned Parenthood clinics that offer abortion services in the state (South Carolina limits abortion to up to six weeks of pregnancy) but also offer enrollees other Medicaid-covered services including contraceptive care and STI screening and treatment. The state has historically reimbursed these providers for the non-abortion medical care they provide to Medicaid enrollees just like it pays for all other medical care. The federal Hyde Amendment bans the use of federal funds (including Medicaid) from being used to pay for abortions unless the pregnancy is a result of rape or incest or endangers the life of the pregnant person. States operate Medicaid programs under federal guidance, and one of the federal provisions of the Medicaid law is known as free choice of provider. This provision states that 'A State plan for medical assistance must… provide that any individual eligible for medical assistance… may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required… who undertakes to provide him such services.' Additionally, because many states require Medicaid beneficiaries to enroll in managed care, limiting their care to a defined network of providers, federal law states that beneficiaries may seek care from any Medicaid provider for family planning services specifically, even those outside the plan network. The larger context for this case involves how a state determines who is a qualified provider, even though the Supreme Court is more narrowly focusing on private right of action. The statute does not define the word 'qualified,' but longstanding federal regulations, recognize states' authority to 'set reasonable standards relating to the qualifications of providers.' The final lines of the regulation say that States need not provide payments to providers with certain felony convictions. The regulations and a separate provision contemplate that '[i]n addition to any other authority, a State may exclude' any provider from Medicaid for certain reasons 'for which the Secretary could exclude' the provider from participating in Medicare. In 2016, in a 'Dear Medicaid Director letter' issued during the Obama administration, CMS wrote that states have the authority to set standards that providers must meet, but to disqualify a willing provider, the state must have a legitimate reason such as concerns about the fitness of the provider to meet the standards or evidence of fraud. It went on to say that states cannot target a specific provider and 'The failure of a state to apply otherwise reasonable standards in an evenhanded manner may suggest such targeting.' CMS went on to say that 'states may not deny qualification to family planning providers…solely because they separately provide…abortion or another service that the state does not approve of.' This letter was rescinded by the Trump administration in 2018. Whether it be through the Courts or through administrative actions, this issue will likely continue to be debated and legally challenged for the foreseeable future. The Supreme Court, however, is only considering whether Medicaid beneficiaries have the right to bring a case to enforce their right to choose their provider. The Court is not considering whether South Carolina acted properly when it excluded Planned Parenthood from its Medicaid program, deeming them 'unqualified' because they provide abortion services as well as other reproductive health care services. If the Supreme Court finds that Medicaid beneficiaries have the right to bring an action to enforce their right to choose any provider, the case will then go back down to the district court to determine whether South Carolina acted within its authority to exclude Planned Parenthood as a nonqualified provider. If the Supreme Court rules that Medicaid beneficiaries do not have a private right of action, then Planned Parenthood itself could appeal South Carolina's decision that found them to be an unqualified provider. A civil rights statute, Section 1983, has long provided a mechanism for individuals to enforce the rights provided to them under federal programs, including Medicaid. There is a long history of litigation related to private enforcement of the Medicaid Act. While courts have affirmed the authority for individuals to use Section 1983 to protect Medicaid rights, the Supreme Court has issued decisions that have narrowed this authority. Currently there is a three-pronged test (pursuant to the cases Blessing v Freestone (1997), Gonzaga University v. Doe (2002), and Health & Hosp. Corp of Marion County v. Talevski(2023)) based on legal precedent that courts use to evaluate whether a federal law establishes an enforceable right: whether the plaintiff is an intended beneficiary of the statute; whether the plaintiff's asserted interests are specific enough to be enforced; and whether the statute imposes a binding obligation on the State. In Talevski, the most recent Supreme Court case to consider this right, the high court reaffirmed the holdings in Gonzaga that a statutory provision is enforceable under Section 1983 when the provision is 'phrased in terms of the persons benefits' and contains 'right-creating individual centric language with an unmistakable focus on the benefited class.' Federal circuit courts have generally upheld private enforcement of rights for Medicaid enrollees. Before the Supreme Court Talevski ruling in 2023, there was a split among circuit court rulings. In 2019 there were four circuit court opinions that all ruled in favor of beneficiaries' right to enforce Medicaid provisions. However, in 2020, three of four circuit court decisions did not rule in favor of Medicaid enrollees, including one decision from the 5th Circuit Court of Appeals which ruled in favor of Texas' decision to exclude Planned Parenthood. Until the Medina case, the Supreme Court had previously refused to review multiple cases in which Planned Parenthood patients were found to have an enforceable right. An earlier version of the Medina case, Planned Parenthood South Atlantic v. Baker, went up to the Supreme Court but was denied review. This is the first time the current configuration of the Supreme Court will hear a case involving Planned Parenthood. While this case is narrowly focused on whether Medicaid beneficiaries have the right to sue to enforce their right to choose any willing, qualified provider, the Supreme Court's decision will have implications for the many states wishing to exclude providers, such as Planned Parenthood, based on abortion politics and not based on clinical qualifications to provide medical services. If Medicaid beneficiaries cannot bring an action to enforce the free choice of provider provision, then states will have greater latitude to exclude providers, such as Planned Parenthood, based on political objections. This case has the potential to curtail low-income individuals' access to preventive reproductive health care in South Carolina and potentially in many states in the nation. The Medicaid program covers one in five reproductive age women and is the largest source of coverage for women with low incomes, covering over four in ten (Figure 1). All state Medicaid programs must cover family planning services, which includes contraceptive care plus a range of related services such as physical exams, cancer screenings, pregnancy testing and counseling, and screenings for other conditions. Medicaid is an essential source of financing for safety-net clinics and is widely considered to be the largest single public payer of family planning services. KFF research has found that specialty reproductive health care clinics such as Planned Parenthood centers offer a broader range of services to their patients compared to non-specialized clinics. Other states are likely to follow suit if the Court rules in South Carolina's favor. In fact, several other states, such as Texas, Arkansas, Indiana, and Missouri have tried to keep Planned Parenthood clinics out of their Medicaid networks, and while some of these efforts were blocked by CMS and courts because they violate the free choice of provider requirements, there have been exceptions. Federal courts upheld Arkansas and Texas decisions excluding Planned Parenthood from their Medicaid programs. South Carolina filed a waiver application to CMS during the first Trump Administration to exclude Planned Parenthood clinics from their Medicaid program, and Tennessee also has a similar waiver pending. No action has been taken to date on these waivers. Blocking Planned Parenthood from receiving Medicaid reimbursements or other public funds has been shown to reduce low-income women's access to contraceptives. In 2013, Texas replaced its Medicaid family planning program with a 100% state funded program that excluded Planned Parenthood as a participating provider. Following the policy change, there was a sizable drop in Medicaid claims for long-acting contraceptives such as IUDs or implants, and injectable contraceptives and an increase in Medicaid-funded births. The federal Solicitor General was granted approval to participate in oral arguments and has taken the position of South Carolina in this case. The Supreme Court will hear oral arguments on April 2nd and is expected to issue a ruling by the end of the term in June 2025. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
