Supreme Court Takes Case on Planned Parenthood Medicaid Coverage

The US Supreme Court on Wednesday agreed to decide if Medicaid-eligible patients can block a state program’s categorical refusal to pay health-care providers associated with Planned Parenthood.

The top court will weigh in on whether the Medicaid Act gives patients a private right of action that allows them to sue a state for violating the statute’s free-choice-of-provider section. That provision protects patients’ right to use their preferred doctors as long as they’re qualified to render the care.

This is the third time the question has come to the high court, as South Carolina officials previously asked the justices to clarify the standards for determining when private litigants can sue for alleged violations of federal statutes that don’t expressly allow them to do so.

There’s a circuit split as to whether the Medicaid Act’s free-choice-of-provider section can be interpreted as allowing private parties to sue for its violation.

The US Court of Appeals for the Fourth Circuit ruled against the state both at the preliminary injunction stage and on the merits. It’s one of five federal appeals courts, including the Sixth, Seventh, Ninth, and Tenth circuits, that have sided with the Medicaid patients.

The Fifth and Eighth circuits have said that only the federal government can take legal action to require states’ compliance.

The case arose when South Carolina officials threatened to make it virtually impossible for Medicaid patients to see providers at Planned Parenthood clinics by refusing to reimburse them for their services, even for care that wasn’t related to abortion.

The state’s health department interpreted the statement as requiring it to remove Planned Parenthood South Atlantic from its approved provider list, even though it offers a variety of nonabortion-related care services.

The petition, filed by state HHS director Robert Kerr, asked the Supreme Court to reverse the Fourth Circuit’s latest decision upholding patient Julie Edwards’ right to sue South Carolina over its threatened refusal to pay for medical treatment she receives at PPSA.

The top court sent the case back to the Fourth Circuit in June 2023 after examining the requirements for implying a private cause of action in Health & Hospital Corp. of Marion County v. Talevski.

The Talevski decision offered an “illuminating analysis,” but didn’t change the standard the top court previously applied, the Fourth Circuit said.

Alliance Defending Freedom and Jolley Law Group LLC represent Kerr. Mayer Brown LLP and Planned Parenthood Federation of America represent PPSA and Edwards.

The case is Kerr v. Planned Parenthood S. Atl., U.S., No. 23-1275, cert. granted 12/18/24.