MEDINA, DIRECTOR, SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES v. PLANNED PARENTHOOD SOUTH ATLANTIC et al.
No. 23–1275
Supreme Court of the United States
Argued April 2, 2025—Decided June 26, 2025
606 U.S. 357
OCTOBER TERM, 2024
Syllabus
MEDINA, DIRECTOR, SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES v. PLANNED PARENTHOOD SOUTH ATLANTIC et al.
certiorari to the united states court of appeals for the fourth circuit
Congress created Medicaid in 1965 to subsidize state healthcare for families and individuals “whose income and resources are insufficient to meet the costs of necessary medical services.”
Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medicaid patients. It also performs abortions. Citing state law prohibiting public funds for abortion, South Carolina in July 2018 determined that Planned Parenthood could no longer participate in the State‘s Medicaid program. At the same time, the State took steps that, it said, would help ensure that other providers would continue offering necessary medical care and family planning services. Planned Parenthood and patient Julie Edwards sued, claiming the exclusion of Planned Parenthood violated the any-qualified-provider provision. Edwards alleged she preferred Planned Parenthood for gynecological care but needed Medicaid coverage. They brought a
Section 1983 allows private parties to sue state actors who violate their “rights” under the federal “Constitution and laws.” But federal statutes do not automatically confer
The district court granted summary judgment for plaintiffs and enjoined the exclusion. The Fourth Circuit affirmed. This Court then granted certiorari, vacated, and remanded in light of Health and Hospital Corporation of Marion Cty. v. Talevski, 599 U. S. 166, which addressed whether another spending-power statute created
Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under
(a) Congress sometimes allows private enforcement through
To prove an enforceable right, plaintiffs must show the statute “clear[ly] and unambiguous[ly]” uses “rights-creating terms” with “an unmistakable focus” on individuals. Id., at 284, 290. This is a “stringent” and “demanding” test. Talevski, 599 U. S., at 180, 186. Even qualifying statutes may be unenforceable if Congress provided alternative remedies.
These rules vindicate separation of powers. Courts once assumed authority to provide whatever remedies seemed necessary
(b) Spending-power statutes are especially unlikely to confer enforceable rights. Unlike Commerce Clause or other regulatory powers, Congress‘s spending authority rests on the “Taxing Clause” (
Early courts described federal grants as contracts, not commands. Federal-state agreements resemble treaties between “two sovereignties.” Neil, Moore & Co. v. Ohio, 3 How. 720, 742. Treaties may benefit citizens but generally do not confer individually enforceable rights against sovereigns, instead depending on the contracting governments for enforcement. Thus, “Congress alone has the power to enforce” grant conditions. Emigrant Co. v. County of Adams, 100 U. S. 61, 69. Pp. 369–372.
(c) In Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, the Court established that spending-power legislation is “much in the nature of a contract.” Id., at 17. The “typical remedy for state noncompliance” is federal funding termination. Id., at 28. Private enforcement requires showing States “voluntarily and knowingly” consented to private suits, meaning Congress must “clear[ly]” and “unambiguously” alert States that private enforcement was a funding condition. Id., at 17.
Gonzaga held that spending-power legislation cannot support
Talevski reaffirmed that Gonzaga “sets forth [the] established method.” 599 U. S., at 183. Statutory provisions must “unambiguously confer individual federal rights“—a “demanding bar” cleared only in “atypical” cases. Id., at 180, 183–184. The statutes there qualified because they “expressly” used clear “rights-creating language.” Id., at 184, 186 (internal quotation marks omitted).
Earlier cases like Wilder v. Virginia Hospital Assn., 496 U. S. 498, Wright v. Roanoke Redevelopment and Housing Authority, 479 U. S. 418, and Blessing v. Freestone, 520 U. S. 329, suggested less demanding standards, but Gonzaga “reject[ed]” any approach permitting “anything short of an unambiguously conferred right.” 536 U. S., at 283. Lower courts should not rely on these repudiated precedents. Pp. 372–376.
(d) Section 1396a(a)(23)(A) lacks the required clear rights-creating language. Since Pennhurst, only three sets of spending-power statutes have been found to confer
Talevski addressed Federal Nursing Home Reform Act provisions requiring facilities
The any-qualified-provider provision looks nothing like these. Section 1396a(a)(23)(A) states that Medicaid plans must “provide that . . . any individual eligible for medical assistance . . . may obtain such assistance from any . . . qualified” provider. This language addresses state duties and may benefit providers and patients, but lacks FNHRA‘s clear “rights-creating language,” Talevski, 599 U. S., at 186 (internal quotation marks omitted).
Congress knows how to create clear rights, as FNHRA shows by giving nursing-home residents “the right to choose a personal attending physician.”
The provision‘s exceptions confirm this reading. States may exclude providers “convicted of a felony” and “determin[e]” which convictions qualify.
The statutory context supports this conclusion. The Medicaid Act requires only “substantia[l]” compliance,
(e) Four counterarguments are offered. First, the claim that Congress modeled
95 F. 4th 152, reversed and remanded.
Gorsuch, J., delivered the opinion of the Court, in which Roberts, C. J., and Thomas, Alito, Kavanaugh, and Barrett, JJ., joined. Thomas, J., filed a concurring opinion, post, p. 386. Jackson, J., filed a dissenting opinion, in which Sotomayor and Kagan, JJ., joined, post, p. 397.
John J. Bursch argued the cause for petitioner. With him on the briefs were James A. Campbell, Erin M. Hawley, Christopher P. Schandevel, Caroline C. Lindsay, Kelly M. Jolley, and Ariail B. Kirk.
Kyle D. Hawkins argued the cause for the United States as amicus curiae urging reversal. On the brief were Acting Solicitor General Harris, Acting Assistant Attorney General Shumate, Deputy Solicitor General Kneedler, Zoe A. Jacoby, Joshua M. Salzman, and Laura E. Myron.
Nicole A. Saharsky argued the cause for respondents. With her on the brief were Miriam R. Nemetz, Minh Nguyen-Dang, Carmen Longoria-Green, Jennifer Sandman, and Hannah Swanson.*
Briefs of amici curiae urging affirmance were filed for the Commonwealth of Massachusetts et al. by Andrea Joy Campbell, Attorney General of Massachusetts, and Gerard J. Cedrone, Deputy State Solicitor, and by the Attorneys General for their respective jurisdictions as follows: Rob Bonta of California, Philip J. Weiser of Colorado, Kathleen Jennings of Delaware, Brian L. Schwalb of the District of Columbia, Anne E. Lopez of Hawaii, Anthony G. Brown of Maryland, Dana Nessel of Michigan, Keith Ellison of Minnesota, Aaron D. Ford of Nevada, Matthew J. Platkin of New Jersey, Raúl Torrez of New Mexico, Letitia James of New York, Jeff Jackson of North Carolina, Dan Rayfield of Oregon, Peter F. Neronha of Rhode Island, and Nicholas W. Brown of Washington; for the American Cancer Society Cancer Action Network et al. by Thomas W. Curvin, John H. Fleming, and Mary Rouvelas; for the American College of Obstetricians and Gynecologists et al. by Janice Mac Avoy and Francisco Negrón, Jr.; for Former Senior Officials of the Dept. of Health and Human Services by Skye L. Perryman and Stephen I. Vladeck; for Health Policy Scholars by Carolyn F. Corwin; for the Information Society Project at Yale Law School by Priscilla J. Smith; for Local Governments et al. by Jonathan B. Miller, Cheran Ivery, Christian D. Menefee, David J. Hackett, John P. Markovs, Lyndsey M. Olson, David Chiu, Meredith A. Johnson, and Rachel A. Neil; for Medicaid Beneficiaries C. M. et al. by Ian Heath Gershengorn; for the National Health Law Program et al. by Donald B. Verrilli, Jr., and Jane Perkins; for Organizations Advancing Reproductive Rights, Health, and Justice by Autumn Katz and Amy Myrick; for Religious Organizations et al. by Jaime A. Santos and Amelia Brown; for the Women‘s Bar Association of the District of Columbia et al. by Heather Richardson; for 7 South Carolina Healthcare Policy Experts et al. by Jessica L. Ellsworth; and for 238 Members of Congress by Christopher E. Babbitt.
Briefs of amici curiae were filed for the American Public Health Association et al. by Thomas Barker; for the Life Legal Defense Foundation by Catherine Short and Sheila A. Green; and for 138 Women Hurt by Planned Parenthood Abortions et al. by Allan E. Parker, Jr., Mary Browning, and R. Clayton Trotter.
Justice Gorsuch delivered the opinion of the Court.
Medicaid offers States “a bargain.” Armstrong v. Exceptional Child Center, Inc., 575 U. S. 320, 323 (2015). In return for federal funds, States agree “to spend them in accordance with congressionally imposed conditions.” Ibid. Should a State fail to comply substantially with those conditions, the Secretary of Health and Human Services can withhold some or all of its federal Medicaid funding. This case poses the question whether, in addition to that remedy, individual Medicaid beneficiaries may sue state officials for failing to comply with one funding condition spelled out in
I
Congress created Medicaid in 1965 to subsidize state efforts to provide healthcare to families and individuals “‘whose income and resources are insufficient to meet the costs of necessary medical services.‘” Armstrong, 575 U. S., at 323 (quoting
This case concerns one of the conditions state plans must meet. Located in
The parties’ dispute concerns whether, in addition to that remedy, the law recognizes another. The dispute arose this way. Planned Parenthood South Atlantic operates two clinics in South Carolina, one in each of the State‘s two most populous cities. Planned Parenthood South Atlantic v. Kerr, 95 F. 4th 152, 156–157 (CA4 2024). At both locations, the group offers “a wide range” of services to Medicaid and non-Medicaid patients. Ibid. It also performs abortions. Ibid. Citing a state law prohibiting the use of its own public funds for abortion, South Carolina announced in July 2018 that Planned Parenthood could no longer participate in the State‘s Medicaid program. App. to Pet. for Cert. 157a–162a. At the same time, the State took steps that, it said, would help ensure that a “variety of other nongovernmental entities and governmental agencies” would continue to provide “access to necessary medical care and important women‘s health and family planning services.” Id., at 158a. According to the State, it has “140 [other] federally qualified health clinics and pregnancy centers, not counting the numerous private health providers who accept Medicaid.” Brief for Petitioner 9.
In response to the State‘s announcement, Planned Parenthood and one of its patients, Julie Edwards, sued the director of the State‘s Department of Health and Human Services. They argued that South Carolina‘s exclusion of Planned Parenthood from its Medicaid program violated the any-qualified-provider provision. Specifically, Ms. Edwards alleged that, while she regularly visits other medical care providers, she has had especially positive experiences with Planned Parenthood and would like “to shift all [her] gynecological and reproductive health care there.” App. 32, 33. But none of that will be possible, she continued, unless Medicaid covers those services. Ibid. Based on these allegations, Ms. Edwards and Planned Parenthood brought a putative class action “pursuant to
First enacted as part of the Civil Rights Act of 1871,
Appreciating all this, the plaintiffs argued that their case implicated an exception to the usual rule. The any-qualified-provider provision, they said, is among those rare federal spending-power statutes that confer individual rights enforceable under
On appeal, the Fourth Circuit affirmed the district court‘s decision. Planned Parenthood South Atlantic v. Kerr, 27 F. 4th 945 (2022). Writing separately, Judge Richardson expressed “confusion and uncertainty” about this Court‘s directions addressing when spending-power legislation creates enforceable rights under
Seeking review of the Fourth Circuit‘s decision, the State filed a petition for certiorari in this Court. In light of our intervening decision in Talevski, 599 U. S. 166, in which we addressed whether another spending-power statute created
On remand, the court of appeals reaffirmed its earlier decision. 95 F. 4th, at 153. And, once more, Judge Richardson wrote separately. Even after Talevski, he said, lower courts “continue[d] to lack the guidance” they need from this Court to determine when a federal spending-power statute creates a right that private parties can enforce under
In response to the Fourth Circuit‘s latest decision, the State filed another petition for certiorari. In it, South Carolina noted that other lower courts have disagreed with the Fourth Circuit regarding whether
II
To resolve the circuits’ disagreement and address our lower court colleagues’
A
The Constitution charges the Executive Branch with enforcing federal law.
Historically, individuals brought
To prove that a statute secures an enforceable right, privilege, or immunity, and does not just provide a benefit or protect an interest, a plaintiff must show that the law in question “clear[ly] and unambiguous[ly]” uses “rights-creating terms.” Id., at 284, 290. In addition, the statute must display “‘an unmistakable focus‘” on individuals like the plaintiff. Id., at 284 (emphasis deleted); accord, Talevski, 599 U. S., at 183. We have described this as a “stringent” and “demanding” test. Id., at 180, 186; accord, post, at 405 (Jackson, J., dissenting) (describing Gonzaga as setting forth “a restrictive test“). And even for the rare statute that satisfies it, this Court has said, a
These rules seek to “vindicat[e] the separation of powers.” Talevski, 599 U. S., at 183. To be sure, there was a time in the mid-20th century when “the Court assumed it to be a proper judicial function to provide” whatever “remedies” it deemed “necessary to make effective a statute‘s purpose.” Ziglar v. Abbasi, 582 U. S. 120, 131–132 (2017) (internal quotation marks omitted). But, as this Court has since come to appreciate, no statute pursues any single “purpos[e] at all costs.” American Express Co. v. Italian Colors Restaurant, 570 U. S. 228, 234 (2013) (internal quotation marks omitted). And, often enough, Congress may “not wish to pursue [a] provision‘s purpose to the extent of authorizing private suits.” Hernández v. Mesa, 589 U. S. 93, 100 (2020). After all, the decision whether to let private plaintiffs enforce a new statutory right poses delicate questions of public policy. New rights for some mean new duties for others. And private enforcement actions, meritorious or not, can force governments to direct money away from public services and spend it instead on litigation. See ibid. The job of resolving how best to weigh those competing costs and benefits belongs to the people‘s elected representatives, not unelected judges charged with applying the law as they find
B
Though it is rare enough for any statute to confer an enforceable right, spending-power statutes like Medicaid are especially unlikely to do so. The reasons why take a little unpacking.
When Congress passes a law, say, regulating commerce between the States or outlawing piracy, it can point for authority to the Commerce Clause,
The Constitution has no “Spending Clause,” strictly speaking. Instead, we usually trace Congress‘s spending power to Article I, section eight, clause one, which gives Congress the “Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.” Unlike other enumerated powers, this provision does not expressly endow Congress with the power to regulate conduct. Nor does it include “the power to issue direct orders to the governments of the States.” Murphy v. National Collegiate Athletic Assn., 584 U. S. 453, 471 (2018).
As the Court observed in United States v. Butler, 297 U. S. 1, 65–67 (1936), the meaning of Article I‘s “general welfare” language provoked fierce debate right from the start. At one extreme, Gouverneur Morris thought it authorized Congress to tax, spend, and regulate broadly in pursuit of the “general Welfare.” D. Schwartz, Mr. Madison‘s War on the General Welfare Clause, 56 U. C. D. L. Rev. 887, 915 (2022). Alexander Hamilton took a more modest view. He thought the language gave Congress the power to raise and “appropriate money” for “objects” of “General” (as opposed to “local“) importance. Report on the Subject of Manufactures (Dec. 5, 1791), in 10 Papers of Alexander Hamilton 230, 303–304 (H. Syrett ed. 1966) (emphasis deleted). But he denied that those powers included as well “a power to do what ever else should appear to Congress conducive to the General Welfare.” Ibid. James Madison advanced a narrower position still. As he saw it, the language authorized Congress to spend money only in support of its other enumerated powers. A. LaCroix, The Interbellum Constitution: Federalism in the Long Founding Moment, 67 Stan. L. Rev. 397, 407 (2015) (LaCroix).
Over time, Hamilton‘s view gained ground. So, for example, as Justice Story
Consistent with this understanding, early courts described federal grants not as commands but as contracts. Consider, for example, how this Court approached a dispute concerning the first major federal highway. The Cumberland Road once supplied a vital link between the East Coast and the old Northwest. LaCroix 420. Starting in the 1830s, the federal government gradually transferred control of the road to several States. J. Young, A Political and Constitutional Study of the Cumberland Road 78–98 (1902). One transfer to Ohio came with a condition: The State could not charge tolls on wagons carrying federal property. Id., at 96–98. When a disagreement arose about the scope of that toll exemption, this Court looked to “the expectations of the parties,” a familiar feature of contract law, to resolve it. Neil, Moore & Co. v. Ohio, 3 How. 720, 741 (1845). In doing so, the Court emphasized that it was enforcing requirements “well known” to the parties when the “compact was made.” Ibid.; see also McGee v. Mathis, 4 Wall. 143, 155 (1866) (“It is not doubted that the grant by the United States to the State upon conditions, and the acceptance of the grant by the State, constituted a contract“).
At the same time, the Court recognized that agreements between state and federal governments are not exactly the same as contracts “between individuals.” Searight v. Stokes, 3 How. 151, 167 (1845). In many respects, the Court suggested, federal-state agreements are really more like treaties between “two sovereignties.” See Neil, Moore & Co., 3 How., at 742. And, while treaties may seek to benefit the citizens of the compacting nations, they generally do not confer individually enforceable rights against a sovereign, but “depen[d] for the enforcement of [their] provisions on . . . the governments which are parties to” them. Head Money Cases, 112 U. S. 580, 598 (1884).2 Adapting this logic to the context of federal grants, the Court concluded that, as a rule, “Congress alone has the power to enforce” the conditions it attaches to its grants. Emigrant Co. v. County of Adams, 100 U. S. 61, 69 (1879); see also Mills County v. Railroad Cos., 107 U. S. 557, 566 (1883).
C
For much of the Nation‘s history, the Court had little occasion to employ these ideas. Congress rarely granted money to States and, when it did, those grants rarely
Take Pennhurst. There, private plaintiffs sought to sue the Commonwealth of Pennsylvania for failing to fulfill the terms of a federal healthcare grant. 451 U. S., at 6. In assessing whether the suit could proceed, the Court began by observing that “legislation enacted pursuant to the spending power is much in the nature of a contract: in return for federal funds, the States agree to comply with federally imposed conditions.” Id., at 17. And the “typical remedy for state noncompliance” with a federal grant‘s conditions is an “action by the Federal Government to terminate funds to the State.” Id., at 28. Given these principles, the Court reasoned, whether a private party may sue to enforce the terms of a federal grant depends on “whether the State voluntarily and knowingly” consented to answer private claims as part of its bargain with the federal government. Id., at 17. And to satisfy this standard, the Court held, a plaintiff must show, at a minimum, that Congress alerted the State in advance, “clear[ly]” and “unambiguously,” that responding to private enforcement suits was a condition of its offer. Ibid.4
In Gonzaga, the Court restated these principles and explored how they interact with
Just two Terms ago, we reaffirmed these points. In Talevski, the Court faced another private
Admittedly, this Court briefly experimented with a different approach, and that fact has given rise to some confusion in the lower courts. For a time, as we have seen, the Court sometimes took an expansive view of its power to imply private causes of action to enforce federal laws. See Part II–A, supra. Moved by the same spirit, the Court sometimes took a broad view of its authority to confer new rights under spending-power statutes that did not expressly provide them. In Wilder v. Virginia Hospital Association, for example, the Court suggested that spending-power legislation can give rise to an enforceable right under
340–341 (1997). Some lower court judges, including in this case, still consult Wilder, Wright, and Blessing when asking whether a spending-power statute creates an enforceable individual right. See, e. g., 95 F. 4th, at 163–165; id., at 170 (Richardson, J., concurring in judgment).
They should not. Gonzaga “reject[ed]” any reading of our prior cases that would “permit anything short of an unambiguously conferred right to support a cause of action brought under
All of these warnings came for now-familiar reasons. Because spending-power legislation is “in the nature of a contract,” a grantee must “voluntarily and knowingly” consent to answer private
III
With these principles in hand, we turn to the question whether the plaintiffs before us may maintain a
Since Pennhurst, this Court has identified only three sets of spending-power statutes that confer enforceable rights under
Talevski addressed two provisions of the Federal Nursing Home Reform Act (FNHRA). See 599 U. S., at 181–182. The first obliged nursing-home facilities to “protect and promote” residents’ “right to be free from” unnecessary “physical or chemical restraints.”
The any-qualified-provider provision before us looks nothing like those FNHRA provisions. Section
To be sure, Congress could have taken a different approach when drafting
“(c) Requirements relating to residents’ rights
“(1) General rights
“(A) Specified rights
“A nursing facility must protect and promote the rights of each resident, including each of the following rights:
“(i) Free choice
“The right to choose a personal attending physician . . . .”
§ 1396r(c) (emphasis added).
As this language shows, Congress knows how to give a grantee clear and unambiguous notice that, if it accepts federal funds, it may face private suits asserting an individual right to choose a medical provider. Tellingly, too, Congress adopted this FNHRA provision in legislation that also amended
The remainder of
Expanding our view beyond
Notable, too, is where Congress placed the any-qualified-provider provision. It appears in a subsection titled “Contents.”
Observe, as well, what it would mean if
Take one example. See Brief for United States as Amicus Curiae 27–29 (offering others). Section
IV
Seeking to persuade us otherwise, the plaintiffs and dissent offer four principal counterarguments.
First, the plaintiffs and dissent appeal to legislative history. The hearings and committee reports leading to
Second, the plaintiffs and dissent contend, Congress modeled
This argument stumbles out of the gate. Its premise—that
Third, instead of grappling meaningfully with the test our precedents provide, the dissent proposes to rewrite it. In the dissent‘s view, a statute confers a privately enforceable right whenever it uses “compulsory” and “individual-centric terminology,” as long as it also evokes “language classically associated with establishing rights.” Post, at 408 (opinion of Jackson, J.). When it comes to that last requirement, the dissent reasons this way: Congress enacted
Our precedents do not authorize anything like the dissent‘s approach—and for good reasons. To start, while a title may underscore that the statutory text creates a right, “[i]t has long been established that the title of an Act cannot enlarge or confer powers” by itself. Pennhurst, 451 U. S., at 19, n. 14 (internal quotation marks omitted); see A. Scalia & B. Garner, Reading Law: The
Even beyond that, the dissent‘s test would risk obliterating the longstanding line between mere benefits and enforceable rights. See supra, at 368, 375, 376. If, as the dissent says,
Fourth and finally, the plaintiffs and dissent advance a policy argument. Only
For another, funding cutoffs may not be the only way to enforce
For another thing still, if existing remedies prove insufficient, Congress can create new ones. So, for example, it might do as it did in FNHRA and revise
*
Section 1983 permits private plaintiffs to sue for violations of federal spending-power statutes only in “atypical” situations, Talevski, 599 U. S., at 183, where the provision in question “clear[ly]” and “unambiguous[ly]” confers an individual “right,” Gonzaga, 536 U. S., at 290. Section 1396a(a)(23)(A) is not such a statute. Because the Fourth Circuit concluded otherwise, its judgment is reversed and the case is remanded for further proceedings consistent with this opinion.
It is so ordered.
Justice Thomas, concurring.
Individual plaintiffs may invoke
I
The history of
A
Congress enacted
”Be it enacted . . . That any person who, under color of any law, statute, ordinance, regulation, custom, or usage of any State, shall subject, or cause to be subjected, any person within the jurisdiction of the United States to the deprivation of any rights, privileges, or immunities secured by the Constitution of the United States, shall . . . be liable to the party injured in any action at law, suit in equity, or other proper proceeding for redress . . . .” 17 Stat. 13.
In 1874, Congress extended
Section 1983 has remained virtually unchanged, with only relatively minor revisions. The current provision allows injured parties to sue state and local officials for “the deprivation of any rights, privileges, or immunities secured by the Constitution and laws” that they cause “under color of” state law.
B
Although the text of
When courts did face
This Court‘s
The Court continued to broaden
This jurisprudential shift has transformed
II
The “scant resemblance” between
As I explained at length in Talevski, this Court has erred in extending
This conclusion flows from a proper understanding of spending legislation. An exercise of Congress‘s power to spend “is no more than a disposition of funds.” Id., at 196. That description holds even when Congress imposes conditions on the receipt of federal funds: Conditional spending legislation amounts to a “contractual offer,” whose conditions “have no effect . . . unless and until they are freely accepted by the” recipient. Id., at 196, 201. It thus is ” ‘only the agreement—and not the statute—[that] makes the terms obligatory on the funds recipient.’ ” Id., at 204.
In other words, conditional spending legislation does not itself “secure any rights.” Id., at 201. It cannot “make certain” or “guarantee” the obligations imposed by the spending conditions. J. Worcester, A Dictionary of the English Language 1299 (1860); accord, Webster‘s New International Dictionary 1911 (1909). Accordingly, any third parties who benefit from those obligations cannot derive an enforceable federal right from the legislation: “[S]uch third-party rights . . . are ‘secured’ (if at all) . . . only by the contract between the recipient and the United States.” Talevski, 599 U. S., at 205 (Thomas, J., dissenting) (some internal quotation marks omitted).
Were it otherwise, conditional spending legislation would be unconstitutional. When the would-be recipient of federal funds is a State, treating spending conditions as imposing mandatory obligations “would contradict the bedrock constitutional prohibition against federal commandeering of the States.” Id., at 196. That prohibition protects state sovereignty by barring Congress from “conscript[ing] state governments as its agents” or “requir[ing] the States to govern according to [its] instructions.” New York v. United States, 505 U. S. 144, 162, 178 (1992). Moreover, the historical record makes clear that Congress‘s “spending power is the power to spend only” and does not “carry with it any independent regulatory authority.” Talevski, 599 U. S., at 206, 224 (Thomas, J., dissenting).
I therefore continue to think that the Talevski majority erred “[i]n holding that spending conditions . . . can directly impose obligations on the States with the force of federal law.” Id., at 229; see id., at 177–180 (majority opinion). When “fairly possible,” we ordinarily read statutes “to avoid . . . the conclusion that [they are] unconstitutional.” United States v. Jin Fuey Moy, 241 U. S. 394, 401 (1916). Yet, Talevski chose an implausible reading of
This case does not present an occasion to remedy our error because the petitioner did not ask us to revisit our precedents. But, in a case where the issue is properly presented, I would make clear that spending conditions—which are by definition conditional—cannot “secure” rights.
B
Separately, I question whether our current understanding of
Our cases have glossed over the threshold question of what constitutes a “right” under
Applying these inquiries, the Court has recognized a wide variety of constitutional and statutory “rights” enforceable under
We should revisit the threshold question of what constitutes a “right” under
Even assuming that courts should give the term “rights” in
that is, he has no right to public employment. McAuliffe v. Mayor and Bd. of Aldermen of New Bedford, 155 Mass. 216, 220, 29 N. E. 517 (1892). That view remained “unchallenged dogma” for “most of th[e 20th] century.” Connick v. Myers, 461 U. S. 138, 143 (1983).
Only in the 1960s and 1970s did the Court replace its traditional distinction between rights and benefits with a dramatically expanded conception of “rights.” Most notably, in Goldberg v. Kelly, 397 U. S. 254 (1970), the Court held that welfare benefits, previously thought of as gratuities, are in fact property for purposes of the
The modern
* * *
The Court properly applies our precedents to resolve the question presented. As it makes clear, even under current doctrine, courts should not too readily recognize a statutory right as enforceable under
Justice Jackson, with whom Justice Sotomayor and Justice Kagan join, dissenting.
The Civil Rights Act of 1871 was an exercise in grand ambition. It had to be. In the wake of the Civil War, the American South was consumed by a wave of terrorist violence designed to disenfranchise and intimidate the country‘s newly freed citizens and their allies. The threat was existential—not just for the newly liberated, but for democracy itself—and required bold intervention. It was precisely because the goals of the 1871 Act were so ambitious that those most committed to the structures it targeted, including many in South Carolina, opposed the measure so vehemently.
A century and a half later, the project of stymying one of the country‘s great civil rights laws continues. In this latestchapter, South Carolina urges our Court to adopt a narrow and ahistorical reading of the 1871 Act‘s first section, which is codified today at
I
This case concerns South Carolina‘s obligations under the Medicaid Act. Signed
Any State that wishes to receive federal funds under the program must submit a proposed Medicaid plan to the Department of Health and Human Services (HHS).
Still, the Medicaid Act imposes certain plan requirements on States as a condition of receiving federal funding. If a State “fail[s] to comply substantially” with those conditions,HHS may withhold further funding from that State.
One of the conditions that the Medicaid Act imposes on participating States is the requirement that Medicaid recipients be able to choose their own healthcare providers without government interference. The statute explicitly requires that every State‘s Medicaid plan must “provide that . . . any individual eligible for medical assistance (including drugs) may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”
The dispute in this case arises from South Carolina‘s failure to comply with that provision. In 2018, the State‘s Governor issued an executive order deeming all “abortion clinics” unqualified to provide healthcare services and directing the State‘s Department of Health and Human Services to terminate them from the State‘s Medicaid program. App. to Pet. for Cert. 157a–160a. That executive order would have forced two clinics operated by Planned Parenthood South Atlantic (PPSAT)—one in Charleston and one in Columbia—to stop serving any patients who rely on Medicaid.
One of those patients is respondent Julie Edwards. Before she became a PPSAT patient, Edwards had struggled to find a healthcare provider capable of meeting her needs as adiabetic whose condition heightened the risks associated with pregnancy. At PPSAT, she found doctors who were able to provide her with the services she needed, as well as a respectful and judgment-free environment to receive care.
Edwards filed this lawsuit against state health officials under
The District Court entered summary judgment in Edwards‘s favor and enjoined the State from terminating PPSAT from its Medicaid program. Planned Parenthood South Atlantic v. Baker, 487 F. Supp. 3d 443, 448 (SC 2020). The Fourth Circuit affirmed. Planned Parenthood South Atlantic v. Kerr, 27 F. 4th 945, 959 (2022). In a careful opinion authored by Judge Wilkinson, the panel held that the free-choice-of-provider provision conferred an individual right on Medicaid recipients to select their own healthcare providers and that, as such, that right was enforceable under
South Carolina petitioned for certiorari. While its petition was pending, this Court decided Health and Hospital Corporation of Marion County v. Talevski, 599 U. S. 166 (2023), which considered whether a different provision of the Medicaid Act conferred rights enforceable under
On remand, the Fourth Circuit once again determined that the free-choice-of-provider provision establishes an individual right that can be enforced under
II
Two years ago, in Health and Hospital Corporation of Marion County v. Talevski, 599 U. S. 166, this Court outlined the test for determining whether a federal statute is privately enforceable under
A
The Civil Rights Act of 1871 was designed to bolster the protections of the Civil War Amendments and earlier Reconstruction statutes, which had failed to “preven[t] postbellum state actors from continuing to deprive American citizens of federally protected rights.” Talevski, 599 U. S., at 176. White supremacist violence was spreading across the South, aided at times by state and local officials, and the mayhemposed a fundamental threat to both public safety and the rule of law. E. Foner, Reconstruction: America‘s Unfinished Revolution 1863–1877, pp. 442–444 (1988).
The 1871 Act aimed to combat that threat in various ways. One of them, embedded in the Act‘s very first section, was to “ope[n] the federal courts to private citizens, offering a uniquely federal remedy against incursions under the claimed authority of state law upon rights secured by the Constitution and laws of the Nation.” Mitchum v. Foster, 407 U. S. 225, 239 (1972).
The text of that provision, now codified at
Thus, in Maine v. Thiboutot, 448 U. S. 1, 4 (1980), we expressly rejected a State‘s contention that the phrase “and laws” refers only to civil rights laws enacted under Congress‘s
At the same time, our cases also recognize that
The test we apply for determining whether a statute creates such “rights, privileges, or immunities” has gradually grown more restrictive over the years. During the 1980s and 1990s, the Court adhered to Thiboutot‘s plain-language approach to
In Wilder v. Virginia Hospital Assn., 496 U. S. 498, 509–510 (1990), for instance, we held that healthcare providers could use
A few years after Wilder, Congress endorsed our holistic approach to evaluating whether statutes create rights that are enforceable under
The Court decided Blessing v. Freestone, 520 U. S. 329 (1997), three years after Congress adopted the Suter fix. With no mention of
Although the Blessing factors aimed merely to synthesize our past decisions, they also struck a balance between
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In Gonzaga University v. Doe, 536 U. S. 273 (2002), the Court adopted a restrictive test for determining whether a federal statute creates rights enforceable under
To justify that stricter standard, the Court relied heavily on the fact that Congress had enacted FERPA under its spending powers. We noted that, in ” `legislation enacted pursuant to the spending power, the typical remedy for state noncompliance with federally imposed conditions is . . . action by the Federal Government to terminate funds.’ ” Id., at 280 (quoting Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, 28 (1981)). For that reason, we explained, recipients of federal funds must have clear notice that their failure to comply with a particular funding condition might “subjec[t] them to private suits for money damages” under
But while Gonzaga made the test for evaluating the enforceability of statutory rights under
Talevski‘s analysis began by restating “the Gonzaga test.” Id., at 183 (citing Gonzaga, 536 U. S., at 284, 287). As we recounted, that test asks whether “the provision in question is ` “phrased in terms of the persons benefited” ’ and contains `rights-creating,’ individual-centric language with an ` “unmistakable focus on the benefited class.” ’ ” 599 U. S., at 183 (quoting Gonzaga, 536 U. S., at 284, 287). Although we recognized that this test was “stringent,” we held that the two FNHRA provisions at issue satisfied it. 599 U. S., at 186. We cited the fact that both provisions appeared in a list of ” `[r]equirements relating to residents’ rights.’ ” Id., at 184. And we outlined how the text of each provision “unambiguously confer[red] rights upon the residents of nursing-home facilities“: The unnecessary-restraint provision required nursing homes to ” `protect and promote . . . [t]he right to be free from . . . any physical or chemical restraints’ ” not needed for treatment, while the predischarge-notice provision referred to ” `transfer and discharge rights’ ” and stated thatnursing homes ” `must not transfer or discharge [a] resident’ ” without notice. Id., at 184–185.
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Medicaid‘s free-choice-of-provider provision easily satisfies the unambiguous-conferral test. To start, the text of the provision is plainly ” ` “phrased in terms of the persons benefited” ’ “—namely, Medicaid recipients. Id., at 183. The provision states that every Medicaid plan “must . . . provide that . . . any individual eligible for medical assistance (including drugs) may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”
Congress also used rights-creating language in the heading of the provision when it enacted the original session law. The provision was entitled: “FREE CHOICE BY INDIVIDUALS ELIGIBLE FOR MEDICAL ASSISTANCE,” 81 Stat. 903 (emphasis added).4 This phrasing indisputably invokes language classically associated with establishing rights. E. g.,
The provision‘s history confirms what the text makes evident: that Congress intended the provision to be binding. Congress enacted the free-choice-of-provider provision in1967—just two years after the original Medicaid Act—in direct response to efforts by some jurisdictions to steer Medicaid beneficiaries to specific providers. See H. R. Rep. No. 544, at 122. To prevent States from interfering with Medicaid recipients’ freedom to choose their own providers, Congress adopted nearly identical language from a provision of the Medicare Act that—in both purpose and effect—had guaranteed that right to Medicare beneficiaries.
That clarity is perhaps why, in the only other case where we have had occasion to construe the free-choice-of-provider provision, we repeatedly used the word “right” to describe the protection it confers. In O‘Bannon v. Town Court Nursing Center, 447 U. S. 773 (1980), a group of elderly Medicaid recipients sought to leverage the provision to assert “a constitutional right to a hearing” before Medicaid officials could strip their nursing home of funding. Id., at 775. In rejecting the recipients’ understanding of the provision, we explained what the provision does protect. As we put it, “§ 1396a(a)(23) gives recipients the right to choose among a range of qualified providers, without government interference.” Id., at 785 (first emphasis added; citation omitted). We used the word “right” again in the next sentence to elaborate on that description: “By implication,” we said, the provision “also confers an absolute right to be free from government interference with the choice to remain in a home that continues to be qualified.” Ibid. (emphasis added).5
Although O‘Bannon was not a case about
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The majority‘s effort to resist the natural and obvious rights-creating reading of the Medicaid Act‘s free-choice-of-provider provision is, ultimately, unpersuasive. The Court holds that the provision does not confer any individual rights on Medicaid recipients, but reaches that conclusion by applying a version of the unambiguous-conferral test that we did not endorse in Talevski or Gonzaga. In doing so, the Court adopts an approach to
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The approach that the Court follows today differs conspicuously from the approach we developed in Gonzaga and reaffirmed in Talevski. To see how, start by observing that the majority chooses not to frame its analysis around the question that guided our thinking in those cases: namely, whether “the provision in question is ` “phrased in terms of the persons benefited” ’ and contains `rights-creating,’ individual-centric language with an ` “unmistakable focus on the benefited class.” ’ ” Talevski, 599 U. S., at 183 (quoting Gonzaga, 536 U. S., at 284, 287). Instead, the Court builds its analysis around the simplistic premise that Medicaid‘s free-choice-of-provider provision “looks nothing like th[e] FNHRA provisions” we upheld in Talevski. Ante, at 377.
That approach warps our reasoning in Talevski. Nowhere in our opinion did we single out FNHRA as the sole or definitive model for conferring individual rights. To the contrary, the reason we went out of our way to reaffirm “the Gonzaga test” was to remove any doubts about “our established method for ascertaining unambiguous conferral.” 599 U. S., at 183. Talevski was merely an application of that methodology to the statutory provision at issue in that case.
Yet, now, the majority disregards the established method and, in its place, looks to FNHRA itself as “the only reliable yardstick against which to measure whether spending-power legislation confers a privately enforceable right.” Ante, at 377. In short, the majority construes our requirement that Congress “manifes[t] an `unambiguous’ intent to confer individual rights,” Gonzaga, 536 U. S., at 280, as a requirement that Congress manifest an unambiguous intent to imitate FNHRA.
The majority‘s hyperfocus on FNHRA also widens the gap between our Gonzaga test and the text of
The majority‘s FNHRA-or-bust approach makes even less sense when
Indeed, if actual notice were the touchstone, this would be an easy case: By the time South Carolina chose to terminate PPSAT as a Medicaid provider in 2018, the State had ample reason to know that it could be sued under
ing recipients the right to choose” their providers “without government interference.” 447 U. S., at 785 (emphasis added). And Congress itself had reaffirmed, via the Suter fix, that the Medicaid Act‘s “State plan requirements” could create enforceable rights.
In any event, the majority‘s FNHRA-centric approach to fair notice fails on its own terms. The free-choice-of-provider provision mirrors the FNHRA provisions from Talevski in all respects that matter: both employ individual-centric language that focuses on the relevant beneficiaries and combine it with mandatory language directed at the relevant grant recipients. The provision also employs rights-creating language: As explained above, Congress explicitly used the words “free choice” in the provision‘s original head-ing—words that plainly reflect rights-creating intent. See Part II–C, supra. The fact that the provision does not specifically use the
Congress ultimately has wide discretion to use whatever language it wishes to create individual rights. We require only that it do so unambiguously. As the court below aptly put it, it is not our role “to limit Congress to a thin thesaurus of our own design.” 95 F. 4th, at 166.
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In typical parade-of-horribles-like fashion, the majority also expresses the concern that, if the Court were to hold that the free-choice-of-provider provision confers an individual right, it would mean that “[m]any other Medicaid plan requirements would likely do the same.” Ante, at 380. But case law from the lower courts demonstrates that this fear is unfounded. Those courts have recognized only a tinyhandful of the nearly 90 provisions contained in the Medicaid Act‘s list of state-plan requirements as actually conferring individual rights. See Brief for National Health Law Program et al. as Amici Curiae 18–24 (highlighting the small number of provisions in
Meanwhile, the vast majority of the provisions on the Medicaid Act‘s list of state-plan requirements have never generated any
Nor were the floodgates opened by this Court‘s decisions in Wilder, Blessing, or any other cases that predate the restrictive test for
reinforces that the free-choice-of-provider provision is, in fact, the “atypical” spending statute that creates individual rights, Talevski, 599 U. S., at 183—contrary to the majority‘s assertions otherwise. Ante, at 380, 383.
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Finally, JUSTICE THOMAS‘s concurrence calls for a “fundamental reexamination of our
Take his observation that courts decided relatively few cases under
JUSTICE THOMAS also suggests that the word “rights,” as used in
All of which is to say: more caution (and more research) may be warranted before
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Congress enacted the
The Court‘s decision today is not the first to so weaken the landmark civil rights protections that Congress enacted during the Reconstruction Era. See, e. g., Civil Rights Cases, 109 U. S. 3 (1883); United States v. Cruikshank, 92 U. S. 542 (1876); Blyew v. United States, 13 Wall. 581 (1872). That means we do have a sense of what comes next: as with those past rulings, today‘s decision is likely to result in tangible harm to real people. At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians—and countless other Medicaid recipients around the country—of a deeply personal freedom: the “ability to decide who treats us at our most vulnerable.” Kerr, 95 F. 4th, at 169. The Court today disregards Congress‘s express desire to prevent that very outcome.
REPORTER‘S NOTE
The attached opinion has been revised to reflect the usual publication and citation style of the United States Reports. The revised pagination makes available the official United States Reports citation in advance of publication. The syllabus has been prepared by the Reporter of Decisions for the convenience of the reader and constitutes no part of the opinion of the Court. A list of counsel who argued or filed briefs in this case, and who were members of the bar of this Court at the time this case was argued, has been inserted following the syllabus. Other revisions may include adjustments to formatting, captions, citation form, and any errant punctuation. The following additional edits were made:
p. 374, line 14: “brought” is inserted before “under”
p. 404, line 6 from bottom: “or” is changed to “and”