RECENT RULINGS

2024 Term of Court:

The Medicaid statute, 42 U.S.C. §1396 through §1396w-8 (hereafter “Medicaid”), offers federal money to states wanting to provide health care services to residents who have no other means to pay for them. To obtain the federal funds, the state must submit a health care service plan to the federal Secretary of Health and Human Services, promising to meet a large number of specific conditions Medicaid imposes on the states to obtain the federal money, see 42 U.S.C. §1396a(a). One of the conditions requires the state to allow Medicaid beneficiaries to freely choose their own, but otherwise “qualified” health care service providers to provide services.  42 U.S.C. §1396a(a)(23)(A). Medicaid requires the Secretary of Health and Human Services to approve state plans, and thereby provide the states with the promised money, that “comply substantially” with each Medicaid condition. 42 U.S.C. §1396c.  

In Medina v. Planned Parenthood, US Sup.Ct.Slip Opinion of June 26, 2025, the Court ruled that the “any-qualified-provider” condition does not allow beneficiaries, or their preferred providers, to sue state officials under the federal Civil Rights Act, 42 U.S.C. §1983, for denying beneficiaries the free choice of providers. The Court explained that the “any-qualified-provider” condition did not give Medicaid beneficiaries an unambiguous “right” to choose their own health care provider, in this case the Planned Parenthood chapter in South Carolina. The vote on the Court was 6-3, with Justices Jackson, Sotomayor, and Kagan dissenting. The dissenters argued that the Civil Rights Act itself gave the people of the United States an unambiguous right to sue state officials for most violations of federal law, including the “any-qualified-provider” condition on federal Medicaid funding.

Comment: The Civil Rights Act, as codified at 42 U.S.C. §1983, plainly authorizes private lawsuits against state officials who deprive a citizen of “any rights, privileges, or immunities secured by the Constitution and laws [of the United States].”¹ The conditions of Medicaid funding imposed on the states by 42 U.S.C. §1396a(a), including §1396a(a)(23)(A), are certainly “laws.” However, Congress retains the power to craft new laws and to invent new “rights” and “privileges” outside of the coverage of the Civil Rights Act. By assigning enforcement responsibilities for Medicaid conditions to the Secretary of Health and Human Services, and by requiring enforcement only up to the level of “substantial compliance” with the conditions, Congress most likely intended to make that limited enforcement of Medicaid “conditions” the primary remedy for alleged violations.

Dan D. Rhea

1 Explanatory bracket added.