Medina v Planned Parenthood South Atlantic, 603 U.S.

US SCOTUS Opinion JUNE 26, 2025

In a 5–4 decision authored by Justice Alito, the Supreme Court upheld the South Carolina Department of Health and Human Services’ (SCDHHS) decision to terminate Planned Parenthood South Atlantic as a Medicaid provider. The exclusion stemmed from executive orders by Governor Henry McMaster and was implemented by the agency without a legislative enactment. The Court held that neither the Medicaid Act, nor the First or Fifth Amendments, nor the Bill of Attainder Clause prohibits a state Medicaid agency from disqualifying a provider for performing abortions, as long as the decision is based on lawful criteria and not punitive intent.

Key Holdings

• Executive Discretion Permissible: The Court confirmed that state Medicaid agencies have broad authority to determine “qualified providers”, and federal law does not create a private right enforceable under 42 U.S.C. § 1983 for patients to challenge those decisions.

• No Right Under the Medicaid Act: The Court held that the “any qualified provider” language in the Medicaid Act does not confer an enforceable individual right because it lacks the kind of “rights-creating language” required under Gonzaga Univ. v. Doe, 536 U.S. 273 (2002).

• First Amendment Not Implicated: The exclusion was based on conduct (performing abortions), not speech or viewpoint. The Court reiterated that withholding funding does not violate the First Amendment unless it penalizes protected expression.

• No Bill of Attainder: The decision was administrative, not legislative; and even if legislative, the exclusion of a provider from future funding does not constitute punishment under historical or doctrinal interpretations of the Bill of Attainder Clause.

• No Equal Protection Violation: The Court applied rational basis review and upheld the policy on the ground that states may favor childbirth over abortion in the administration of public programs.

Meaning for Alaska

This decision is foundational for states that wish to restrict public funding to abortion providers:

• Affirms Broad State Authority: States may lawfully disqualify abortion providers from Medicaid based on executive or administrative decisions, so long as they are not overtly punitive or discriminatory and follow federal participation standards.

• Limits Private Enforcement: Patients and providers cannot sue under § 1983 to enforce the “free choice of provider” provision in the Medicaid Act unless Congress speaks with clear rights-creating language, which it did not here.

• Strategic Blueprint: States looking to defund abortion providers now have a clear path: use executive directives or agency policy rather than statutes, which may attract greater constitutional scrutiny.

• Reinforces Post-Dobbs Federalism: The ruling exemplifies the Court’s continued emphasis on state autonomy in abortion-related policy, consistent with its reasoning in Dobbs v. Jackson Women’s Health Organization, 597 U.S. ___ (2022).

• Narrows Scope of Bill of Attainder Doctrine: By distinguishing between disqualification from benefits and punishment, the Court has further insulated administrative funding decisions from Attainder Clause challenges.