Washington — The Supreme Court is set to hear arguments on Wednesday regarding a prolonged legal battle concerning South Carolina’s efforts to exclude Planned Parenthood from its Medicaid program.
This case comes before the court as the landscape for abortion services has dramatically changed following the overturning of Roe v. Wade in 2022. Currently, a dozen states have implemented near-total bans on abortion, and an additional four states, including South Carolina, prohibit the procedure after six weeks of pregnancy.
Although Planned Parenthood offers abortion services outside of Medicaid, in accordance with state laws, anti-abortion advocates and lawmakers at both the state and federal levels have continually sought to block public health funding to the organization. Its facilities also provide services such as contraception, pregnancy testing, gender-affirming care, and screenings for cancers and chronic conditions like diabetes and high blood pressure.
The core issue in this case is technical: whether Medicaid beneficiaries have the right to sue to enforce a provision of the Medicaid Act that permits them to choose their qualified healthcare provider. If South Carolina triumphs in this case, it could set a precedent for other states to defund Planned Parenthood in their Medicaid programs.
The legal dispute regarding Planned Parenthood’s funding in South Carolina originated in July 2018, when Governor Henry McMaster issued an executive order directing the state’s health department to categorize abortion providers as unqualified for providing family-planning services under Medicaid, leading to the termination of their provider agreements.
While federal law prohibits Medicaid from covering abortions except in cases of rape, incest, or when a mother’s life is at risk, the state contended that because funds are interchangeable, providing Medicaid dollars to abortion providers allows those funds to free up other money for the procedure.
The South Carolina Department of Health and Human Services informed Planned Parenthood South Atlantic, which has clinics in Charleston and Columbia, that its provider agreements would be terminated on the grounds of unqualification to serve Medicaid recipients.
Planned Parenthood South Atlantic offers a range of services, including prenatal and postpartum care, cancer screenings, physical examinations, and health assessments. However, the state argues that there are over 140 alternative federally qualified health clinics and pregnancy centers in South Carolina that accept Medicaid and can provide services to low-income patients.
According to the Kaiser Family Foundation, nearly 20% of South Carolina residents rely on Medicaid for insurance, and 25% reside in medically underserved areas.
Following Planned Parenthood’s disqualification from South Carolina’s Medicaid program, Julie Edwards, a patient who had received services from the organization, partnered with Planned Parenthood to file a lawsuit against the state’s termination decision.
In her lawsuit, Edwards contended that the state’s cancellation of Planned Parenthood South Atlantic’s agreement infringed upon her right to choose her healthcare provider under the Medicaid Act and requested that a federal district court permit her and other patients to continue receiving care from Planned Parenthood.
The district court ruled in favor of Edwards, determining that Medicaid patients can sue to access healthcare services from their chosen qualified and willing provider. The court also stated that South Carolina likely violated this right, known as the any-qualified provider requirement, by improperly terminating Planned Parenthood’s involvement in the Medicaid program.
A federal appeals court repeatedly affirmed Edwards’ right to sue and blocked South Carolina from excluding Planned Parenthood from its Medicaid program. In December, the Supreme Court accepted South Carolina’s appeal for consideration.
Proponents of South Carolina’s action argue that states are in a better position to decide how to allocate federal Medicaid funds, asserting that this leads to more effective care for low-income patients and their families.
“There are approximately 200 publicly funded healthcare clinics in South Carolina offering a comprehensive range of high-quality health services, including family planning,” remarked John Bursch, a lawyer with Alliance Defending Freedom, a conservative legal organization representing South Carolina in the Supreme Court.
He added, “South Carolina has the right to determine that there are better alternatives available, and that’s precisely what it has done.”
Several states have taken measures to prevent Planned Parenthood from accessing 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—have ruled that Medicaid patients do not possess the right to sue regarding a state’s decision to exclude Planned Parenthood from their Medicaid programs.
Conversely, multiple other appeals courts have obstructed state attempts to sever the organization from Medicaid funding. If the Supreme Court rules in favor of South Carolina, it would open the door for additional states to eliminate Planned Parenthood from their Medicaid programs.
“The rationale behind this is quite straightforward,” Bursch stated. “Many Americans oppose their tax dollars supporting the abortion industry, especially when those funds could be better allocated to legitimate healthcare.”
However, Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a pro-abortion rights research organization, emphasized that the issue at stake is the entitlement of Medicaid beneficiaries to receive necessary healthcare from trusted providers.
“Should the case yield a loss, not only would Medicaid patients in South Carolina be unable to access Planned Parenthood, but its effects could reverberate nationally, especially in states looking to limit Medicaid recipients from obtaining care. This fundamentally undermines their ability to access essential reproductive health services provided by Planned Parenthood,” she asserted.
Friedrich-Karnik also indicated that a ruling in favor of South Carolina would empower the Trump administration to encourage states to remove Planned Parenthood from their Medicaid plans.
“This strengthens the federal government’s and state governments’ resolve to impose access restrictions,” she noted.
The Trump administration is supporting South Carolina in this case and cautioned that a decision affirming the lower courts could lead to an influx of litigation as beneficiaries seek to enforce other Medicaid law provisions and related statutes.
Additionally, Project 2025, a policy guide led by the conservative Heritage Foundation, advocates for the Department of Health and Human Services to restrict Planned Parenthood’s Medicaid funding by reiterating that states can revoke the organization’s public funding from state plans.
A Supreme Court decision is anticipated by the end of June.
