The US Supreme Court’s recent ruling that Medicaid beneficiaries have no right to sue state programs for refusing to pay for services offered by abortion providers may have unintended downstream effects, attorneys said.
There’s now nothing to stop a state from contracting or refusing to contract with certain providers based on an ideological or moral agenda, said Sara Rosenbaum, a Medicaid scholar and former health law and policy professor at George Washington University’s School of Public Health.
States essentially can cut off poor people’s access to providers regardless of the type of care they offer: “abortion today, gender-affirming care tomorrow,” she said.
And it gives blue states the opportunity to deny reimbursements to providers they don’t like as well, Rosenbaum said.
“Left-leaning states are already routinely excluding pro-life pregnancy centers from their Medicaid programs—and finding many other ways to persecute these life-saving centers as well, including demanding their donor lists, accusing them of false advertising, and refusing to meaningfully investigate when the clinics are attacked and vandalized,” said John Bursch, senior counsel at the conservative Christian law firm Alliance Defending Freedom.
“Medicaid reimbursement is the least of their worries,” he said.
Access Denied
Medicaid is a cooperative program between all 50 states and the federal government that’s funded with money from both entities. States must file their plans with the federal government for its approval.
The 6-3 decision is in most ways a technical ruling—the court said beneficiaries can’t sue under a federal civil rights law to enforce a Medicaid Act provision that says states must permit patients to use their preferred providers.
Only the US Department of Health and Human Services can require states to comply with the free-choice-of-provider provision, the majority said.
The ruling means states “can direct Medicaid funding—funds intended to help low-income individuals obtain necessary medical assistance—to comprehensive health care rather than entities that exist primarily to perform abortions,” ADF said in a statement.
Other groups, like CatholicVote, called the decision “a significant victory for the pro-life movement.”
But at the same time, it effectively blocks people from accessing medical care from certain providers unless they can afford to pay for it out of pocket, said Katie Keith, director of the Center for Health Policy & the Law at Georgetown Law’s O’Neill Institute.
Keith said she “wouldn’t be surprised” if state Medicaid programs begin denying funds to providers based solely on the type of care they offer. States “will try to push the envelope,” and the issue will be back at the Supreme Court, she said.
The decision doesn’t change the Medicaid Act or any of its requirements, Keith noted. But it could undermine access to required benefits like hospital care and x-ray services from providers the states may defund for other reasons, she said.
It’s hard to think of an example of a provider that offers only a single medical service, Keith said. South Carolina—the state at the center of the Supreme Court case—targeted a provider, not individual services, she said.
Rosenbaum noted that even in the case before top court, Planned Parenthood sought Medicaid reimbursement for medical services unrelated to abortion.
By law, federal money can’t be used to pay for abortions except in instances of rape or incest or when necessary to save the pregnant person’s life, but 20 states pay for all or medically necessary abortions, according to a KFF November 2024 report.
Ideological Decisions
The ruling allows states to arbitrarily accept or reject providers’ Medicaid applications based on ideological matters completely unrelated to their qualifications to offer the particular medical services—the only measure provided by the Medicaid statute, Rosenbaum said.
Family planning providers are a likely target, as are HIV/AIDS and addiction services providers, she said.
But it goes both ways—a left-leaning state could refuse to reimburse providers that offer natural family planning or abstinence-only services, she said.
The “jarring” decision allows state Medicaid officials to pick and choose between diagnoses they like and don’t like, Rosenbaum said.
The Catholic Medical Association, and the Christian Medical & Dental Associations didn’t respond to requests for comment on this point.
Qualified Providers
The Medicaid Act requires providers to be qualified to perform the services they offer. The Supreme Court decision hasn’t changed that mandate, and states are still free to reject applicants they deem unqualified, Keith said.
Texas Medicaid, for example, deemed Planned Parenthood “unqualified” several years ago based on videos purporting to show affiliates selling fetal tissue. The videos have been debunked, but a lengthy lawsuit followed the action, she said.
Suhasini Ravi, a senior associate also at the O’Neill Institute, added that providers can appeal Medicaid denials through administrative channels and in state courts.
Or, according to Rosenbaum, they could petition the HHS secretary to enforce the free-choice provision in particular cases. But that’s a “weak” remedy because HHS “hasn’t ever” done it, she cautioned.
HHS has always viewed the law that gives citizens the right to sue the government for civil rights violations, 42 U.S.C. § 1983, as a coequal remedy to federal enforcement, she said.
Planned Parenthood has received funding from Bloomberg Philanthropies, the charitable organization founded by Michael Bloomberg. Bloomberg Law is operated by entities controlled by Michael Bloomberg.
The case is Medina v. Planned Parenthood S. Atl., U.S., No. 25-1275, 6/26/25.
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