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In a major decision with broad implications for reproductive health access, the U.S. Supreme Court ruled 6-3 on Thursday that states may block Planned Parenthood from receiving Medicaid funds for non-abortion services like contraception and cancer screenings. The ruling eliminates one of Planned Parenthood’s primary defenses: lawsuits brought by patients seeking to preserve access to care.
The court’s conservative majority, led by Justice Neil Gorsuch, determined that Medicaid law does not give patients the right to sue states over provider choice, even though the law nominally allows Medicaid recipients to select their own qualified provider.
“Deciding whether to permit private enforcement poses delicate policy questions involving competing costs and benefits — decisions for elected representatives, not judges,” Gorsuch wrote in the majority opinion.
The ruling stems from a South Carolina case, where Gov. Henry McMaster’s administration had moved to block Medicaid funding to Planned Parenthood in 2018. The order was challenged by Julie Edwards, a diabetic patient who said her health made birth control essential, and that she wanted to continue seeing Planned Parenthood for those services.
Although lower courts sided with Edwards, the Supreme Court reversed that trajectory, leaving patients with only administrative options for challenging Medicaid coverage decisions — not court action.
Impact on Patients and Clinics
Critics say the ruling could severely limit health care access, especially for low-income, rural, and marginalized populations who rely on Planned Parenthood as a provider for routine and preventive care. The Guttmacher Institute, which supports abortion rights, called it a “systematic decimation of reproductive health care.”
“It will strip South Carolinians — and countless other Medicaid recipients — of a deeply personal freedom,” Justice Ketanji Brown Jackson wrote in a strong dissent, joined by Justices Sotomayor and Kagan.
“The ability to decide who treats us at our most vulnerable,” she added, “has now been handed to bureaucrats.”
Public health advocates, including the American Cancer Society, warned that eliminating lawsuits as an enforcement mechanism would make it harder for Medicaid patients to ensure access to their provider of choice, potentially delaying life-saving care.
A Broader Conservative Strategy
Though the case was not directly about abortion, it arrives amid a larger Republican-led effort to defund Planned Parenthood, one of the most visible providers of reproductive health services in the U.S. Federal law already prohibits using Medicaid funds for abortions, except in limited cases. However, Planned Parenthood also provides a wide range of non-abortion care, including STI testing, contraception, and cancer screenings.
In South Carolina, Planned Parenthood receives about $90,000 annually in Medicaid reimbursements — a tiny fraction of the state’s budget, but one the administration has aggressively sought to eliminate. After the Supreme Court overturned Roe v. Wade in 2022, South Carolina banned abortion at roughly six weeks gestation.
McMaster, celebrating the Supreme Court’s decision, said:
“Seven years ago, we took a stand to protect the sanctity of life and defend South Carolina’s authority and values — and today, we are finally victorious.”
What’s Next?
The ruling opens the door for other Republican-led states to cut off Medicaid contracts with Planned Parenthood, potentially shuttering over 200 health centers across the country, many in areas where access to reproductive care is already limited.
It also marks a significant shift in how Medicaid law can be enforced, with individual patients no longer able to sue to assert their rights under the program. Advocates say this sets a dangerous precedent and further erodes accountability in the nation’s largest public health program, which covers one in four Americans.
“This ruling doesn’t just impact Planned Parenthood,” said Destiny Lopez of the Guttmacher Institute. “It weakens the legal standing of every Medicaid patient in the country.”
As legal experts, public health advocates, and political leaders begin to process the ruling’s implications, one thing is clear: the battle over reproductive health care in America is far from over.
