The Supreme Court said in its Dobbs decision that it was getting out of the business of weighing in on abortion-related policy, and yet justices will hear another case on the topic on Wednesday. Medina v. Planned Parenthood South Atlantic will address whether South Carolina can kick Planned Parenthood out of its Medicaid programs — a move that’s sure to be replicated by other Republican-controlled states itching to kneecap the nation’s largest family-planning provider. The Trump administration will appear before the Court and argue in support of the state’s policy alongside South Carolina’s legal representatives. This is the second abortion case in which the new administration has weighed in so far: Last month, the Department of Justice moved to dismiss a challenge the Biden administration had brought seeking to require that hospitals provide emergency abortion care.
So what could this mean for Planned Parenthood as well as Medicaid patients in South Carolina and beyond? Here, everything you need to know about the legal challenge.
What is this case about?
The legal fight in Medina began when Governor Henry McMaster signed an executive order in 2018 directing the state’s Department of Health and Human Services “to terminate abortion clinics as Medicaid providers.” In McMaster’s view, any Medicaid funds going to these providers — even when the money does not go toward reimbursing abortion costs — ultimately “results in the subsidy” of this care.
The move would impact more than 1 million low-income South Carolinians — or about one in five people in the state — who rely on Medicaid, including about 400,000 women between the ages of 15 and 44. So Planned Parenthood South Atlantic, the local affiliate, sued. Several lower courts sided with the organization. However, an intrastate conflict appeared when federal appeals courts sided with Arkansas and Texas, both of which also blocked Planned Parenthood from receiving Medicaid funding. This opened the door for the Supreme Court to take up the case and settle the issue.
The narrow question the justices will be considering is “whether the Medicaid Act’s any-qualified provider provision unambiguously confers a private right upon a Medicaid beneficiary to choose a specific provider.” South Carolina is arguing that Medicaid patients don’t have a right to choose their provider and can’t sue the state if they are not allowed to seek services at Planned Parenthood, according to Rachel Rebouché, a reproductive-health-law expert and the dean at Temple University’s Beasley School of Law.
“The federal Medicaid statute gives individuals the right to choose their provider so long as the providers are ‘qualified,’” she says. “The tricky part is South Carolina says that patients can’t come to court and say, ‘I have a right to choose my provider, and the state won’t let me.’ That’s the crux of the issue. If there’s no implicit right, then South Carolina says it should be able to exclude providers from Medicaid participation.”
Why is South Carolina targeting abortion providers? Isn’t there an abortion ban in the state already?
Yes. South Carolina prohibits abortion care after fetal cardiac activity is detected, usually around six weeks of pregnancy, before most people know they are pregnant. More important, the Hyde Amendment already bans federal funding for most abortions, and President Trump signed an executive order in January saying his administration will enforce the policy. Additionally, abortion care accounts for less than 5 percent of the services Planned Parenthood offers, according to the national organization’s 2023 annual report.
This is true in South Carolina, too. The affiliate has previously said it gets less than $100,000 in Medicaid reimbursements, which only goes toward services such as contraceptive care, testing and treatment for sexually transmitted infections, and cancer screenings. “Medicaid does not pay for any abortions at Planned Parenthood South Atlantic,” says Vicki Ringer, the affiliate’s director of public affairs. “The restrictions on that are very narrow.”
McMaster’s executive order and subsequent legal fight is nothing more than a political ploy, she says: “The governor of South Carolina is using his political ideology to strip low-income people in South Carolina of their health care. It is his attempt to further stigmatize abortion because he doesn’t like it but also to deny people’s rights to go to the doctor for the health care they need.”
How does this case play into the larger conservative project of “defunding” Planned Parenthood?
Republicans have been trying to “defund” Planned Parenthood for more than a decade. It’s important to be clear, however, that “defunding” in this case is not an accurate way to describe how Medicaid works. “This is not a pot of money that the government gives us. It is a reimbursement for services delivered, just like when I go to a doctor, my doctor bills my insurance company, and then the insurance company pays my doctor,” says Ringer. “This is the same thing: A Medicaid patient comes to Planned Parenthood for their annual well-woman visit, we submit that claim to Medicaid, and then we’re reimbursed.”
Conservatives argue that any amount of federal money that goes to Planned Parenthood in general supports abortion care, even if it is not directly paying for abortion services; this already disingenuous argument has even less force after Dobbs, given that so many states have banned abortion and the Planned Parenthood affiliates in those places do not offer that care. But abortion opponents know they have allies in the White House and in the Supreme Court’s conservative supermajority who may be sympathetic to their views, Ringer adds. For example, anti-abortion groups are also lobbying the Trump administration and Congress to eliminate federal funding for Planned Parenthood through the budget-reconciliation process.
Does this all have anything to do with Trump withholding Planned Parenthood’s Title X funding?
These are two separate issues. But both are part of the same effort to cripple Planned Parenthood and other reproductive-health clinics. Nine Planned Parenthood state affiliates received a notice on Monday that the White House would be freezing tens of millions of dollars that their dozens of clinics were set to receive as part of Title X family-planning grants. Just like Medicaid dollars, that money goes toward non-abortion services such as birth control, cancer screenings, and STI testing.
How would a decision in favor of South Carolina impact patients?
Ringer says South Carolina has a shortage of doctors who accept Medicaid, making Planned Parenthood South Atlantic a safety-net provider. “Without a doubt, the people who’d be hurt the most are the working poor and people who don’t get insurance benefits from their employer,” she says. “Many are women with children and people with disabilities.” She adds that not only are there health-care deserts in the state, but county health departments that offer low-cost or free services are also overwhelmed. “It takes a very long time to get an appointment with an OB/GYN there,” she says.
Still, the affiliate’s two clinics will likely remain in operation even in the face of an adverse decision. “We won’t know the full impact until we find out what the decision is,” Ringer says, “but we will keep our doors open, and we’ll find other ways to make sure that we can continue to provide that care.”
Will this case have implications beyond South Carolina?
Yes. If the Court sides with South Carolina, it could embolden other conservative states to run the same playbook, says Rebouché. That would put lots of Planned Parenthood affiliates — as well as other independent reproductive-health clinics that offer abortion care — at risk, potentially exacerbating the issue of health-care deserts. And given that Medicaid is the most commonly held insurance for Planned Parenthood patients, kicking affiliates out of states’ programs could force clinics to either turn away low-income patients or charge them out of pocket.
The case could also have repercussions for non-abortion providers who are a political target for the right, like doctors who offer gender-affirming care. “If the Supreme Court holds that there’s no right for anybody to sue if the state decides that some providers are politically favored and others are politically disfavored,” Rebouché says, “it will give a lot of power to the state to shape who’s in and who’s out of their Medicaid program.”
Will abortion-related cases keep coming before the Court?
It certainly looks like it. In addition to Medina, the Supreme Court has heard two other abortion-related cases — one about the FDA’s approval of mifepristone and another on whether hospitals can turn away patients who need emergency abortions — and it is likely that many more are coming down the pipeline. “For the anti-abortion movement, the idea is not just to end abortion in South Carolina. It’s to end it everywhere,” says Rebouché. “As it pursues that goal, it’s going to come into conflict with federal programs that support non-abortion services as well as with states that protect reproductive rights. We’re just seeing the tip of the iceberg of the conflict over abortion intensifying.”