By Paul Engel
September 3, 2025
- Who decides where a state can spend their funds?
- Did Congress create a “right” to use public funds at Planned Parenthood?
- Who decides which entities are qualified to participate in Medicaid?
Congress created Medicaid in 1965 to subsidize state healthcare system for people unable to afford healthcare. South Carolina has a law that prohibits public funds being used for abortion. For this reason, South Carolina disqualified Planned Parenthood from participating in the state’s Medicaid system. It should be no surprise that Planned Parenthood South Atlantic sued. The Supreme Court’s decision though, that may surprise you.
Background
Let’s start with some background on this case.
Congress created Medicaid in 1965 to subsidize state healthcare for families and individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” §1396–1.
Just where in the Constitution is Congress granted the power to “subsidize state healthcare” for any reason? It certainly isn’t the General Welfare Clause:
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States;
U.S. Constitution, Article I, Section 8, Clause 1
These subsidies are not for the general welfare of the United States, but for some of the people of the United States. Actually, since this subsidy was not given to the people, it was actually for the welfare of the several states.
Medicaid offers States “a bargain”: federal funds in exchange for compliance with congressionally imposed conditions.
So Congress offered states funding they are not authorized to spend in exchange for following their rules? Isn’t the offering of an illegal emolument as a consideration for action not the definition of a bribe?
BRIBE, crim. law. The gift or promise, which is accepted, of some advantage, as the inducement for some illegal act or omission; or of some illegal emolument, as a consideration, for preferring one person to another, in the performance of a legal act.
Bribe – The Free Legal Dictionary
So this bribe starts out with a submission to Congress’ illegal demand to regulate a state’s healthcare system.
To participate in Medicaid, States must submit a “plan for medical assistance” satisfying over 80 conditions in §1396a(a). If a State fails “to comply substantially” with any condition, the Secretary of Health and Human Services may withhold federal funding. §1396c.
State’s have a laundry list of conditions they must comply with in order to be offered the bribe from Congress. And if a state doesn’t comply to the HHS Secretary’s satisfaction, they lose their bribe.
This case involves the any-qualified-provider provision in §1396a(a)(23)(A), which requires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. The provision does not define “qualified,” leaving that to States’ traditional authority over health and safety matters.
The law states that “any individual eligible for medical assistance” can get it “from any [provider] qualified to perform the service”. However, the law does not define “qualified,” leaving it up to the states.
The question is whether individual Medicaid beneficiaries may sue state officials under 42 U. S. C. §1983 for failing to comply with the any-qualified-provider provision.
While the question before the court is can individual beneficiaries sue, there’s a lot more to this case.
South Carolina Law
We’ve looked at the background for the case, now let’s look at the relevant South Carolina law.
Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medicaid patients. It also performs abortions. Citing state law prohibiting public funds for abortion, South Carolina in July 2018 determined that Planned Parenthood could no longer participate in the State’s Medicaid program.
No one is saying the Planned Parenthood South Atlantic has to shutdown their clinics, or stop providing abortions, only that they are not eligible for the state’s Medicaid program. This is because of a state law that prohibits public funding going to abortion.
At the same time, the State took steps that, it said, would help ensure that other providers would continue offering necessary medical care and family planning services.
The state did not abandon people seeking medical care and family planning services. The state took steps to make sure they could receive care. That wasn’t good enough for Planned Parenthood or one of their patients.
Planned Parenthood and patient Julie Edwards sued, claiming the exclusion of Planned Parenthood violated the any-qualified-provider provision.
However, the state showed that Planned Parenthood was not qualified to accept public funds. They may have been qualified to provide other services, just not with public funds.
Edwards alleged she preferred Planned Parenthood for gynecological care but needed Medicaid coverage. They brought a §1983 class action “to vindicate rights secured by the federal Medicaid statutes.”
The fact that Ms. Edwards prefers Planned Parenthood doesn’t mean she has a right to getting services from them paid for by public funds. No one in the State of South Carolina is preventing her from getting services from Planned Parenthood, only that it’s not paying for their services. Her claimed “right” to Medicaid funding doesn’t include using it at unqualified establishments.
Section 1983 allows private parties to sue state actors who violate their “rights” under the federal “Constitution and laws.” But federal statutes do not automatically confer §1983-enforceable “rights.” This is especially true of spending-power statutes like Medicaid, where “the typical remedy” for violations is federal funding termination, not private suits.
Title 42 USC §1983 is the law Congress passed affirming a person’s right to sue someone for a deprivation of rights under color of law. While the court focuses on whether or not the Medicaid law established “rights” enforceable by §1983, I think there’s a more fundamental question. Does Medicaid law create a right for someone to receive medical care, at taxpayer expense, whether or not the state lists them as a qualified provider?
The district court granted summary judgment for plaintiffs and enjoined the exclusion. The Fourth Circuit affirmed. This Court then granted certiorari, vacated, and remanded in light of Health and Hospital Corporation of Marion Cty. v. Talevski, 599 U. S. 166, which addressed whether another spending-power statute created §1983-enforceable rights. On remand, the Fourth Circuit reaffirmed.
So both the district and circuit courts found for Planned Parenthood, but the Supreme Court vacated based on the case on the case Health and Hospital Corporation of Marion Cty. v. Talevski. HHC v. Talevski is a case where the court found that a Congressional act did create a §1983 enforceable right. In this case the court held:
Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under §1983.
So this court doesn’t think that the Medicaid act created a “right” enforceable by §1983.
Thomas Concurrence
Justice Thomas agreed with the court decision, but wanted to expand the scope of the case.
Individual plaintiffs may invoke Rev. Stat. §1979, 42 U. S. C. §1983, to sue state or local officials who have deprived them of “any rights, privileges, or immunities secured by the Constitution and laws.” In other words, §1983 provides a mechanism for plaintiffs to enforce constitutional or statutory provisions that confer personally held federal rights. The Court correctly holds today that §1396a(a)(23)(A) of the Medicaid Act is not such a provision. Its decision properly limits plaintiffs’ ability to bring §1983 suits premised on conditional spending legislation, and I join in full.
Justice Thomas fully agrees with the decision of the case. So why write this concurrence?
I write separately because it behooves us to reexamine more broadly this Court’s §1983 jurisprudence, which bears little resemblance to the statute as originally understood. In appropriate cases, we should reassess §1983’s bounds, including its application in the spending context and our understanding of the “rights” enforceable under §1983.
Apparently Justice Thomas wants to expand the court’s interpretation of §1983. Specifically, should §1983 be a method of redress for laws that involve spending?
Jackson Dissent
Justice Jackson wrote a dissent to the opinion, which was joined by Justices Sotomayor and Kagan.
The Civil Rights Act of 1871 was an exercise in grand ambition. It had to be. In the wake of the Civil War, the American South was consumed by a wave of terrorist violence designed to disenfranchise and intimidate the country’s newly freed citizens and their allies. The threat was existential—not just for the newly liberated, but for democracy itself—and required bold intervention. It was precisely because the goals of the 1871 Act were so ambitious that those most committed to the structures it targeted, including many in South Carolina, opposed the measure so vehemently.
The Civil Rights Act of 1871 was a grand ambition, but was only necessary because of the unwillingness of southern states to enforce the supreme law of the land. While the threat was serious, that did not authorize the federal government to also violate the Constitution which created it.
A century and a half later, the project of stymying one of the country’s great civil rights laws continues. In this latest chapter, South Carolina urges our Court to adopt a narrow and ahistorical reading of the 1871 Act’s first section, which is codified today at 42 U. S. C. §1983. That venerable provision permits any citizen to obtain redress in federal court for “the deprivation of any rights, privileges, or immunities secured by the Constitution and laws” of the United States. South Carolina asks us to hollow out that provision so that the State can evade liability for violating the rights of its Medicaid recipients to choose their own doctors. The Court abides South Carolina’s request. I would not. For that reason, I respectfully dissent.
Actually, South Carolina is not asking the court to “hollow out” the law, but abide by it. Under the Medicaid Act, states and not the federal government, determine the qualifications for participation in their publicly funded healthcare system. The people of the State of South Carolina, through their representatives, have decided that those entities that provide abortions are disqualified from receiving public funds. Neither Planned Parenthood, nor Julie Edwards, have a right to direct public healthcare dollars. Therefore, there is no deprivation of rights to litigate under §1983.
For a justice who appears so concerned about “democracy itself,” perhaps Justice Jackson should pay attention to the law rather than her political agenda. Because as a republic, the State of South Carolina has a right to direct their funds within the laws established by the people of the state and their representatives.
Conclusion
Since §1396a(a)(23)(A) of the Medicaid Act does not create a right of a provider to participate in a state’s Medicaid system, nor does it create a right for someone to use a Medicaid benefit at a provider that does not qualify, so there is no deprivation of rights, and therefore no §1983 action. Though I know this is not what those who are Planned Parenthood supporters wanted to hear, it’s the truth.
What I would like to know is how many taxpayer dollars were spent, both by the State of South Carolina in their defense of this case and by the federal government, for having to try this charade?
© 2025 Paul Engel – All Rights Reserved
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Author: Paul Engel
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