Planned Parenthood is facing a landmark Supreme Court hearing this week that could fundamentally shift the financial future of the controversial abortion and reproductive health provider.
On April 2, the Supreme Court will hear Medina v. Planned Parenthood South Atlantic, a pivotal case that could determine whether states can prohibit all state Medicaid funds from going toward Planned Parenthood and other abortion providers — even to cover non-abortion services such as cancer screenings and contraception.
The case stems from a 2018 executive order by South Carolina Republican Gov. Henry McMaster, who directed the state health department to deem abortion providers unqualified for Medicaid reimbursements for family planning services.
“As a pro-life state, South Carolina taxpayers should not be forced to subsidize the abortion industry,” McMaster said in a recent statement supporting the case. “I am grateful for the support of members of the South Carolina delegation and the many other members of Congress who recognize the importance of this case and are standing with South Carolina as we defend our values.”
Planned Parenthood South Atlantic, which operates two clinics in South Carolina, and one of its patients sued the state, arguing that Medicaid law guarantees patients the right to choose among qualified providers for essential services.
While the case centers on a statutory question, its political ramifications are far-reaching. Planned Parenthood is the largest abortion provider in the United States and the second-largest prescriber of puberty blockers and cross-sex hormones for minors. The case has become a rallying point for anti-abortion activists and lawmakers hoping to cut off public funding for the organization once and for all.
Just one week before oral arguments, over 100 anti-abortion activists from Pennsylvania gathered in Washington, D.C., urging lawmakers to end all federal funding for Planned Parenthood. Among them was Marlene Downing, 45, a volunteer with SBA Pro-Life America, who described her own abortion experience as rooted in fear and misinformation.
“The first thing that Planned Parenthood will try to do is point you to abortion,” Downing said. “Ninety-seven percent of people that go into Planned Parenthood [leave] without their child. It’s always misleading when you’re beginning with fear.”
Planned Parenthood South Atlantic declined to comment for this story.
The nexus between Medicaid and abortion
Medicaid, the joint federal-state program that insures low-income and disabled Americans, is required by law to cover family planning services, including contraception, cervical cancer screenings, and sexually transmitted infection care. While federal law prohibits Medicaid funds from being used for abortion except in limited cases under the Hyde Amendment, the program does reimburse providers for a wide array of non-abortion services.
Planned Parenthood’s most recent annual report, covering July 2022 to June 2023, shows the organization received nearly $700 million in government reimbursements and grants, about 34% of its total revenue. A 2023 Government Accountability Office report found that Planned Parenthood affiliates received $49 million directly from the Department of Health and Human Services between 2019 and 2022. Planned Parenthood South Atlantic received $2.7 million during that time.
Opponents argue that any Medicaid funding to Planned Parenthood indirectly supports abortion because of fungibility, the idea that money for one purpose can free up funds for another.
John Bursch, a senior attorney for the conservative legal group Alliance Defending Freedom, told the Washington Examiner that the fungibility argument is essential to South Carolina’s case.
“Every dollar that Planned Parenthood doesn’t have to pay towards its overhead — rent, utilities, salaries — because it’s getting Medicaid dollars from South Carolina are dollars that they can shift for other priorities,” said Bursch, who will be arguing before the Supreme Court representing the Palmetto State.
Abortion-rights advocates have long criticized the fungibility argument, saying it is hypocritical if not evenly applied to all nonprofit organizations that provide social services.
“Fungibility is an inherent possibility when involving the private sector in any government-subsidized activity,” Joerg Dreweke, communications director at the abortion-rights Guttmacher Institute, wrote in a 2016 policy paper when the Defund Planned Parenthood movement started to regain steam.
Is there a right to sue against SC’s qualified provider criteria?
McMaster’s 2018 order declared abortion providers “unqualified” under Medicaid’s provider criteria, triggering a legal battle that reached the U.S. Court of Appeals for the 4th Circuit. A district court initially dismissed the case, but the 4th Circuit reversed, holding that patients can sue under Section 1983, a civil rights statute, to challenge states that deny them access to otherwise eligible Medicaid providers.
Julie Edwards, a South Carolina woman who relied on Planned Parenthood for birth control, brought the suit. The state argued Edwards had access to other Medicaid clinics that provided broader services and that South Carolina had the authority to steer Medicaid funds toward providers aligned with its public health values.
“What this case really boils down to is whether there is a private right to sue when someone thinks the state is violating this provision by not affording an individual the choice of their providers,” said constitutional lawyer Elizabeth Kiernan at a recent Federalist Society briefing.
South Carolina argues that the Medicaid statute, which says beneficiaries may obtain care from “any qualified provider,” does not create an enforceable individual right. The state says letting patients sue under Section 1983 would undermine states’ discretion and shift Medicaid dollars toward litigation.
Rep. Ralph Norman (R-SC) called the case “a misguided attempt to undermine” Congress’s authority over Medicaid.
“Private parties like Planned Parenthood have no right to force states to say they’re qualified Medicaid providers,” Norman said. “South Carolina has every right to determine what qualifies and disqualifies Medicaid providers in our state.”
Supporters of Planned Parenthood argue that the Medicaid law’s plain text supports patient choice and that courts have long upheld this interpretation.
Bursch says that the 4th Circuit misread the law. He pointed to the Supreme Court’s 2023 Health and Hospital Corp. v. Talevski decision, which ruled that not all federal funding statutes allow for private lawsuits unless Congress uses clear, rights-creating language.
In Talevski, the majority opinion authored by Justice Ketanji Brown Jackson permitted a lawsuit because the nursing home law at issue included a bill of rights for patients. Bursch said Medicaid’s provider-choice provision doesn’t meet that standard. “Congress didn’t say anything about rights,” Bursch said. “It simply said that a person may obtain the provider of their choice. That’s describing a benefit, not a right.”
If the high court sides with South Carolina, it could effectively block patients in all 50 states from suing over Medicaid provider choice — clearing the way for states to disqualify abortion providers without fear of federal court challenges. But the justices could also issue a narrower ruling that applies only to South Carolina’s case.
Katie Daniel, policy counsel at SBA Pro-Life America, warned that a narrow ruling could invite more litigation. “It would open the door to more of these types of lawsuits and give more power to litigious special interest groups against no-taxpayer funding state laws,” she said.
South Carolina has also argued that Planned Parenthood missed its opportunity to challenge the “unqualified provider” label through the state’s administrative process, filing one day after the deadline. That could further undercut the case’s legal standing.
How will states fill the gap if Planned Parenthood is defunded?
Laurie Sobel, a women’s health policy expert at KFF, said the focus should also be on how states plan to fill the gap in family planning services if Planned Parenthood is defunded.
“It could really impact the network for people seeking care under Medicaid,” she said, warning that providers may opt out of Medicaid altogether.
According to Planned Parenthood’s latest yearly report, the group performed 392,715 abortions in 2022, which represents just 4% of its total services. More than half of its 9.1 million services were STI testing and treatment, while about a quarter involved contraception. The organization served over 2 million patients nationwide.
Other federally qualified health centers outnumber Planned Parenthood clinics 15-to-1, according to the Congressional Research Service. But Planned Parenthood clinics still delivered over twice as many contraceptive services as those other providers.
Sobel added that even under the Hyde Amendment, Medicaid must still cover abortions in cases of rape, incest, or life endangerment — services that only a limited number of clinics can provide.
What are the implications for other states?
A ruling for South Carolina could open the floodgates for other Republican-led states to take similar action. States like Arkansas, Mississippi, and Indiana, which have previously tried to cut Planned Parenthood out of Medicaid, would likely move quickly to renew those efforts.
Texas already offers a preview. After years of litigation, Texas successfully blocked Planned Parenthood from its Medicaid program, a move upheld by the 5th Circuit. If the Supreme Court sides with South Carolina and overturns contrary rulings like the 4th Circuit’s, it would establish a uniform legal standard and limit future lawsuits challenging similar exclusions.
Since the fall of Roe v. Wade, many Republican-controlled legislatures have stepped up efforts to cut off all public support for abortion-related services. A win in Medina could accelerate that strategy, making Medicaid funding the next major battleground in the fight over abortion access.
Pro-abortion-rights states could alternatively take the ruling as the impetus to begin covering abortions through Medicaid.
Democrats in the Colorado Senate are considering a bill to allow for state Medicaid and Child Health Plan Plus funds to cover abortions starting in 2026. The measure is being considered in part because abortion is less expensive than labor and delivery costs.
A federal funding crackdown looms
In a parallel development, the Trump administration is currently reviewing active Title X family planning grants and could decide to revoke funds from health clinics, including Planned Parenthood affiliates across the country.
A White House spokesperson told the Washington Examiner last week that the move is to determine if the funds are being used against Trump’s Day One executive order scrubbing diversity, equity, and inclusion efforts from federal payrolls.
An HHS official told the Washington Examiner that the department is “concerned about the compliance of several awardees impacting $27.5 million in continuation awards.”
Combined with a possible favorable ruling in Medina for ADF, the outcome could leave Planned Parenthood scrambling to maintain services in red and purple states alike.
“I think it would be a big blow to them,” said Kelsey Pritchard, director of state public affairs for SBA Pro-Life America. “We’re talking around $500 million that could be on the line for the abortion giant.”
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Pritchard pointed to a recent New York Times investigation that exposed internal problems at Planned Parenthood, including botched procedures, unsafe clinic conditions, and staffing shortages — all while the national office continues to raise hundreds of millions in donations.
“We saw the only abortion facility in Manhattan close in the last few weeks because of problems, and part of one of the things it cited was trouble with Medicaid funding,” Pritchard said. “It’s not going to end abortion, obviously, but it’s a step in the fight, and it’s the right thing to do.”
