Washington — The Supreme Court is hearing arguments Wednesday in a yearslong court fight over South Carolina’s attempt to boot Planned Parenthood from its Medicaid program.
The case arrives at the high court as the landscape for abortion care has shifted drastically following the reversal of Roe v. Wade in 2022. A dozen states have near-total bans on abortion, while another four states, including South Carolina, outlaw the procedure after six weeks gestation.
While Planned Parenthood provides abortion services outside of Medicaid as allowed under state laws, anti-abortion rights groups and lawmakers at the state and federal levels have long been working to keep public health dollars away from the group. Its clinics also offer contraception, pregnancy testing, gender-affirming care and screenings for cancer and conditions like diabetes and high blood pressure.
The question in the case is a technical one: whether Medicaid beneficiaries can sue to enforce a provision of the Medicaid Act that allows them to seek care from the qualified provider of their choosing. But if South Carolina prevails in the dispute, it could pave the way for more states to defund Planned Parenthood through their state Medicaid plans.
The legal battle over Planned Parenthood’s funding in South Carolina began in July 2018, when Gov. Henry McMaster issued an executive order directing the state’s health department to deem abortion providers unqualified to provide family-planning services under Medicaid and terminate enrollment agreements.
Federal law prohibits Medicaid from paying for abortions except in cases of rape or incest, or to save the life of the mother. But the state argued that because money is fungible, giving Medicaid dollars to abortion providers frees up other money to provide the procedure.
The South Carolina Department of Health and Human Services notified Planned Parenthood South Atlantic, which has clinics in Charleston and Columbia, that its provider agreements were being cancelled because it was no longer qualified to provide services to Medicaid recipients.
Planned Parenthood South Atlantic offers prenatal and postpartum services, as well as cancer screenings, physical exams and screenings for health conditions and cancer. But the state says that there are more than 140 other federally qualified health clinics and pregnancy centers across South Carolina who accept Medicaid and can provide services to low-income patients.
Nearly 20% of South Carolina residents are insured through Medicaid, according to the Kaiser Family Foundation, and 25% of its residents live in medically underserved areas.
After Planned Parenthood was disqualified from participating in South Carolina’s Medicaid program, Julie Edwards, a patient who received health services from the Planned Parenthood affiliate, and the organization filed a lawsuit challenging the state’s termination decision.
Edwards alleged in her lawsuit that the state’s cancellation of Planned Parenthood South Atlantic’s agreement violated her right to choose her provider under the Medicaid Act and asked a federal district court to issue an order allowing her and other patients to continue receiving care from Planned Parenthood.
The district court sided with Edwards, finding that Medicaid patients can sue to obtain health care services from their preferred qualified and willing provider. The court also held that South Carolina likely violated that right, called the any-qualified provider requirement, by terminating Planned Parenthood’s participation in the state Medicaid program without cause.
A federal appeals court on numerous different occasions concluded that Edwards’ had a right to sue and blocked South Carolina from excluding Planned Parenthood from its Medicaid program. The Supreme Court agreed in December to take up South Carolina’s appeal.
Defenders of South Carolina’s move have argued that states are better suited to decide where to spend the Medicaid dollars they receive from the federal government, which they said leads to better treatment for low-income patients and their families.
“You’ve got roughly 200 publicly funded health care clinics in South Carolina that provide a broad range of high-quality health care services, including family-planning services,” said John Bursch, a lawyer with the Alliance Defending Freedom, a conservative legal group. Bursch is arguing on behalf of South Carolina at the Supreme Court.
He continued, “South Carolina is entitled to decide that there are better options, and that’s exactly what it’s done.”
Several states have taken steps to block Planned Parenthood from receiving Medicaid funding, including Texas, Mississippi, Missouri and Arkansas. Two federal appeals courts, the U.S. Court of Appeals for the 5th Circuit and the U.S. Court of Appeals for the 8th Circuit, ruled that Medicaid patients do not have a right to sue over the state’s decision to exclude Planned Parenthood from states’ Medicaid programs.
But several other appeals courts have blocked state efforts to cut off the organization from Medicaid dollars. If the Supreme Court rules for South Carolina, it would clear the way for more states to exclude Planned Parenthood from their Medicaid programs.
“The reason why they would do that is pretty simple,” Bursch said. “Many Americans don’t want their tax dollars propping up the abortion industry, especially when those dollars can be better spent on real health care.”
But Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a pro-abortion rights research organization, said at stake in the case is the ability of Medicaid beneficiaries to get the health care they need from the provider they know and trust.
“A loss in this case not only means that Medicaid patients in South Carolina would be unable to access Planned Parenthood, the ripple effect of that could mean that Medicaid patients across the country and particularly in states that might be inclined to want to restrict Medicaid recipients’ ability to get care, it could affect all of those folks, and it fundamentally affects their ability to access really needed reproductive health care services that Planned Parenthood provides,” she said.
Friedrich-Karnik also said that a win for South Carolina would encourage the Trump administration to urge states to kick Planned Parenthood off state Medicaid plans.
“It emboldens the federal government, and it emboldens state governments who would like to restrict people’s access in this way to do so,” she said.
The Trump administration is backing South Carolina in the case and warned that a decision affirming the lower courts would invite a flood of litigation as beneficiaries seek to enforce other provisions of the Medicaid law and other statutes.
Separately, Project 2025, the policy blueprint overseen by the conservative Heritage Foundation, calls on the Department of Health and Human Services to limit Planned Parenthood’s funding through Medicaid in part by issuing guidance reemphasizing that states can strip the group of its public dollars in state plans.
A decision from the Supreme Court is expected by the end of June.
