This case arose in 2018 after a South Carolina executive order terminated Planned Parenthood’s Medicaid enrollment.

On December 18, 2024, the Supreme Court of the United States granted certiorari to decide whether “the Medicaid Act’s any-qualified-provider provision unambiguously confers a private right upon a Medicaid beneficiary to choose a specific provider.” The case in question concerns the right of the South Carolina Department of Health and Human Services to terminate the Medicaid enrollment of Planned Parenthood South Atlantic and the right of Planned Parenthood and its patients to challenge that termination in court. Planned Parenthood argues that the any-qualified-provider provision is enforceable by a lawsuit brought under 42 U.S.C. § 1983, which grants parties a private right of action to sue over rights violations, provided that the rights violated are, among other things, “unambiguously conferred.” In answering whether rights provided under the any-qualified-provider provision are “unambiguously conferred,” this case has potential not only to determine the scope of Medicaid patients’ right to choose their provider but also to establish new precedent for what rights are eligible for Section 1983 enforcement.

This case arose in 2018 after a South Carolina executive order terminated Planned Parenthood’s Medicaid enrollment. Planned Parenthood sued on behalf of its Medicaid patients to argue that the termination violated those patients’ rights to select a provider under Section 1396a(a)(23)(A) of the Medicaid Act. This provision, often called the any-qualified-provider provision or the free-choice-of-provider provision, allows Medicaid patients to obtain treatment from any provider “qualified to perform the service or services required.” Although the legality of the termination may turn on the scope of this provision and the ability of states to determine what constitutes a “qualified” provider, the Supreme Court’s writ of certiorari says that the Court will answer only one question for this case: whether this provision creates a right that Medicaid patients can enforce with a Section 1983 suit.

Section 1983 provides that if any actor uses a state law to deprive a United States person “of any rights, privileges, or immunities secured by the Constitution and laws,” that person may sue the actor in response. However, not all benefits granted by state laws constitute “rights, privileges, or immunities” enforceable by Section 1983. Therefore, the Supreme Court has created a framework for determining which rights are enforceable by Section 1983 and which are not. While the details of that framework are a key question in this case, one bright-line rule established by the Court is that a right must be “unambiguously conferred” to be enforceable by Section 1983.

In this case, Planned Parenthood argues that the right under the Medicaid Act to obtain medical assistance from any “qualified” provider constitutes a “right[], privilege[], or immunit[y] secured by the Constitution and laws.” It, on behalf of its Medicaid patients, therefore sued South Carolina under Section 1983 to enjoin its Medicaid termination. South Carolina, however, argues that this right under the Medicaid Act does not constitute a “right[], privilege[], or immunit[y] secured by the Constitution and laws” for Section 1983 purposes, so Planned Parenthood’s case must be dismissed. The case has been through a series of judgments and appeals from different courts, and all of them have sided with Planned Parenthood.

The Supreme Court’s decision may affect both the right of Medicaid patients to select providers in particular as well as the ability of private parties to challenge provisions in the Medicaid Act (and other statutes) in general. A key part of South Carolina’s argument in favor of certiorari is that the Supreme Court’s precedent for determining whether a right is enforceable under Section 1983 has become ambiguous at best and inconsistent at worst, so lower courts need new guidance from the Supreme Court on where to draw that distinction. Now that the Court has granted certiorari, South Carolina will presumably ask the Court to draw that distinction in a way that does not permit Medicaid patients to challenge a state’s determination as to which providers are “qualified.” If it does, that will limit patients’ ability to challenge state decisions over Medicaid enrollment and increase states’ freedom in making such decisions.

But regardless of where the Court draws the distinction, the Court’s opinion has potential to impact the outcomes of future Section 1983 suits, particularly in the Medicaid context. The question of whether one provision in the Medicaid Act has Section 1983 enforceability may affect the same question for other provisions in the Medicaid Act. And in answering that question, the Court may articulate an overarching bright-line rule for all Section 1983 suits, as South Carolina requested in its petition. Thus, although the Court has only granted certiorari, this case has much potential to affect both providers and patients, particularly in the Medicaid context. We will continue to monitor the situation as it progresses.

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If you have any questions about this Alert, please contact Jonathan L. Swichar, Bradley A. Wasser, Taylor Hertzler, any of the attorneys in our Healthcare Industry Litigation Group, any of the attorneys in our Health Law Practice Group or the attorney in the firm with whom you are regularly in contact.

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