Planned Parenthood v. Joshua Baker, 941 F.3d 687

Background

South Carolina terminated Planned Parenthood South Atlantic (PPSAT) from its Medicaid provider roster after PPSAT performed abortions outside the Medicaid program.
An individual Medicaid beneficiary who received family-planning care from PPSAT sued under 42 U.S.C. § 1983, alleging the Medicaid Act’s free-choice-of-provider clause (42 U.S.C. § 1396a(a)(23)(A)) gives recipients a private right to choose any willing, qualified provider.
The district court granted a preliminary injunction restoring PPSAT’s Medicaid enrollment, finding the plaintiff likely to succeed on the merits because the free-choice provision creates a § 1983–enforceable individual right and “qualified” means professionally competent.
South Carolina appealed, arguing (inter alia) that states may exclude providers for any lawful state interest under § 1396a(p)(1), and that the Medicaid Act’s administrative enforcement scheme and Spending Clause principles foreclose a private § 1983 remedy.
The Fourth Circuit affirmed: it held the free-choice provision unambiguously confers an individual right enforceable via § 1983; “qualified to perform” means professionally competent; and states may not exclude providers for reasons unrelated to professional competence.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Does 42 U.S.C. § 1396a(a)(23)(A) create a private right enforceable under § 1983?	The provision unambiguously confers an individual right on “any individual” eligible for Medicaid and thus is enforceable via § 1983.	The Medicaid Act is a Spending Clause scheme whose enforcement is primarily administrative; Congress did not intend private § 1983 remedies for plan requirements.	The court held the provision creates an unambiguous individual right and is enforceable under § 1983.
What is the meaning of “qualified to perform the service or services required”?	“Qualified” has its ordinary meaning: professionally fit, competent to perform the medical service required.	The State urged that “qualified” should be defined by the State’s own standards and may encompass any legitimate state interest.	The court held “qualified” means professionally competent (fitness to provide the medical service).
Can § 1396a(p)(1) be read to permit states to exclude providers for any state-law reason (e.g., to avoid association with abortion providers)?	Plaintiff: § 1396a(p)(1) permits exclusion for professional malfeasance; it does not allow exclusion for reasons unrelated to competency.	Baker: § 1396a(p)(1) gives states broad authority to disqualify providers for any state-law reason, which would supersede the free-choice requirement.	The court rejected the sweeping reading of § 1396a(p)(1); states can exclude for reasons related to professional competence/misconduct but not for unrelated policy reasons.
Was a preliminary injunction appropriate (irreparable harm, balance of equities, public interest)?	Denial of chosen qualified provider causes concrete, irreparable harm (reduced access to needed care); public interest favors preserving statutory rights.	State argued injunction would force indirect subsidization of abortion and interfere with state policy.	Court found irreparable harm, equities and public interest favor plaintiff; injunction was not an abuse of discretion.

Key Cases Cited

Schweiker v. Gray Panthers, 453 U.S. 34 (1981) (background on Medicaid beneficiaries)
Alexander v. Choate, 469 U.S. 287 (1985) (states retain discretion subject to federal baseline requirements)
J.I. Case Co. v. Borak, 377 U.S. 426 (1964) (historical approach to implying private remedies)
Cannon v. Univ. of Chicago, 441 U.S. 677 (1979) (caution against freely implying private causes of action)
Blessing v. Freestone, 520 U.S. 329 (1997) (three-factor test for § 1983–enforceable rights)
Gonzaga Univ. v. Doe, 536 U.S. 273 (2002) (statutory right must be unambiguously conferred to permit § 1983 suit)
Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498 (1990) (Medicaid provision created an enforceable right; analysis on enforceability under § 1983)
Armstrong v. Exceptional Child Ctr., 135 S. Ct. 1378 (2015) (Spending Clause/contract principles and discussion of § 1983 enforcement context)
Planned Parenthood of Ind., Inc. v. Comm’r of Ind. State Dep’t of Health, 699 F.3d 962 (7th Cir. 2012) (holding free-choice provision creates enforceable right; interprets “qualified”)
Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017) (same)
Planned Parenthood Ariz. Inc. v. Betlach, 727 F.3d 960 (9th Cir. 2013) (same)
Planned Parenthood of Kan. & Mid–Mo. v. Andersen, 882 F.3d 1205 (10th Cir. 2018) (same)
Does v. Gillespie, 867 F.3d 1034 (8th Cir. 2017) (contrary circuit decision declining to find § 1983 right)
Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1 (1981) (Spending Clause requires unambiguous conditions on states)