Supreme Court Rules Medicaid Enrollees Cannot Sue States to Enforce Right to Free Choice of Provider

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The Supreme Court on June 26 in Medina v. Planned Parenthood that Medicaid enrollees cannot bring private lawsuits against states to enforce their right to choose among willing and qualified providers—the so-called “free choice of provider” provision. This decision may pave the way for states to limit participation by providers for reasons unrelated to quality of care or program integrity.

This case concerns a longstanding Civil Rights Act provision, known as “section 1983,” which creates a legal mechanism for individuals to sue states based on violations of their rights under the U.S. Constitution or federal laws. The Supreme Court’s 2023 decision in Health & Hospital Corporation of Marion County v. Talevski that patients can bring such lawsuits to enforce certain federal Medicaid rights. In Medina, the Court’s 6–3 decision chips away at the prior standard reaffirmed in Talevski. The Court said that federally funded programs like Medicaid are less likely to create enforceable rights than other types of statutes. The decision also underscored the need for express “rights-creating” language, directing courts to parse Congress’s phrasing choices in defining legal requirements.

The immediate impact of this decision is that, in the multiple states that have banned abortion providers from their Medicaid programs, Medicaid enrollees can no longer file legal challenges to overturn those policies—notwithstanding a history of largely successful litigation on this point. The Centers for Medicare & Medicaid Services (CMS) retains the ability to enforce federal Medicaid requirements but has been historically reluctant to initiate compliance actions. Moreover, the Trump Administration has made clear that it supports state efforts to exclude abortion providers from Medicaid.

Medina has impacts beyond the abortion context, however. Without the threat of enrollee lawsuits to enforce the free choice requirement, states may feel more emboldened to use Medicaid program participation as a tool for implementing state policy priorities unrelated to the Medicaid program. Medina could also lay the groundwork for federal courts to determine that other rights under the Medicaid program are not enforceable by private lawsuit, potentially including requirements that were viewed as enforceable under the pre-Medina standard.

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