On Wednesday morning, the Supreme Court will hear arguments in Medina v. Planned Parenthood South Atlantic, a case about South Carolina’s attempt to exclude a Planned Parenthood affiliate from the state Medicaid program. If the court sides with South Carolina, it could lead to more states following suit and limiting people’s access to healthcare.
As an approved Medicaid provider, Planned Parenthood offers care including birth control, STI testing and treatment, and cancer screenings like Pap smears and breast exams to patients with that form of insurance. (The state already bans Medicaid from covering abortions in most circumstances, which is a bad policy, but providers follow the law—along with a state ban on abortion after six weeks of pregnancy.) But in 2018, South Carolina Gov. Henry McMaster (R) signed an executive order directing the state health department to declare abortion providers unqualified to participate in Medicaid because, he said, that “results in the subsidy of abortion.” PPSAT and a Medicaid patient named Julie Edwards sued the health department for violating her right to see any qualified provider.
The court agreed to hear the case in December, a few weeks after Donald Trump won the election, and a final ruling isn’t expected until late June, which is when the court releases its biggest decisions.
“The people in this state do not want their tax money to go to that organization,” McMaster said of Planned Parenthood. Sen. Lindsey Graham (R-S.C.) said in February, “Most Americans oppose their hard-earned tax dollars being used to subsidize abortion.”
Here’s what you need to know about the case and how Trump could turn a bad ruling national, with some help from Project 2025.
What exactly is the issue before the court?
The legal question in the case isn’t whether states can kick Planned Parenthood out of Medicaid, but rather if patients can sue states that do so in order to keep seeing the health care provider they trust. Edwards and PPSAT argue they can sue state officials in federal court under Section 1983 of a civil rights law that dates back to 1871.
The Medicaid Act has what’s known as a “free choice of provider” provision, which says that patients should be able to see any qualified Medicaid provider they want. Five circuit courts of appeals have said that private plaintiffs, including individuals and healthcare providers, can sue states to enforce that part of the Medicaid Act, while two other appeals courts have ruled that only the federal government can take Medicaid enforcement action against states. (This is known as a “circuit split,” and the Supreme Court typically weighs in to resolve the differing interpretations.)
Importantly, South Carolina didn’t disqualify Planned Parenthood because of concerns over professional competency, but rather because it offers abortion. The state wrote in a February brief: “PPSAT can restore Medicaid funding if it stops performing abortions—but it has chosen not to do so.”
Sure, but what’s the case really about?
It’s a longtime conservative goal to block any federal money from going to abortion providers, including Planned Parenthood. Activists refer to this effort as “defunding,” which is a misnomer. When people with Medicaid insurance choose to get care at Planned Parenthood, the program reimburses the organization for services provided. Contrary to the implication of the word “defund,” there’s no line item in the budget for Planned Parenthood. But anti-abortion advocates view targeting this funding source, and thereby depriving clinics of non-abortion patients, as a way to bankrupt and shutter clinics.
How big of a deal would a ruling against Planned Parenthood be?
Conservatives argue that low-income women with Medicaid can simply get their birth control and other health services at other clinics. (About 20% of South Carolina women of reproductive age, or one in five, are enrolled in Medicaid.) But as PPSAT chief medical officer Dr. Katherine Farris explained in a Friday press call, that’s way easier said than done.
First, not a lot of health care providers accept Medicaid because reimbursement rates are so low, Farris said. “Medicaid, as a general rule, reimburses far less than other insurance providers, which means that often the money we get back for the service we have provided doesn’t even cover that service,” she said. Then, if there is a Medicaid provider nearby, they might have a long wait list. “I regularly hear from patients that they want to get an IUD and if they call the health department, the next IUD appointment is three months from now, and if they want to come into my clinic, they can get that IUD placed the same day,” Farris said. “That is a massive difference.”
Nationwide data from the Guttmacher Institute shows that, compared to health departments or federally qualified health centers, Planned Parenthood clinics have more kinds of contraception, offer a 12-month supply of birth control pills, and are more likely to have same-day insertions of IUDs and implants.
If South Carolina wins, it would give Republican-led states the green light to block Medicaid patients from accessing care at abortion providers, including Planned Parenthood and independent clinics. The Trump Department of Health and Human Services could even officially encourage states to exclude abortion providers from Medicaid.
And since the case is broadly about whether people can enforce their right to choose a Medicaid provider, a ruling for South Carolina could impact people’s ability to access other forms of care beyond reproductive health, including gender-affirming care.
Um, could Trump make this go national?
Yes. The Project 2025 playbook, written for a second Trump administration, said that not only should HHS issue guidance that states can exclude abortion providers from Medicaid, but that it should also propose formal rules that would disqualify abortion providers nationwide from the program. (This portion of Project 2025 calls out Planned Parenthood by name.) Yes, including in “blue” states like New York and California. If this happens, it would be a big deal as roughly two-thirds (64%) of women with Medicaid coverage are of reproductive age (19 to 49), according to KFF, formerly known as the Kaiser Family Foundation.
Plus, the Trump administration is attacking access to birth control in other ways, including by freezing grants from the Title X family planning programs over ridiculous concerns about DEI.
Abortion clinics are already facing massive financial pressure after the fall of Roe v. Wade, and a reduction in funds from Medicaid, Title X, or both, could lead to even more clinics shuttering—which, again, is the goal of many Republicans. Since Dobbs, 76 independent clinics have closed, though some new clinics have opened. It’s still a net loss.
Who’s involved in the case?
South Carolina is being represented in the case by lawyers Alliance Defending Freedom, the right-wing Christian law firm that’s behind multiple anti-abortion cases. ADF represented Mississippi in the Dobbs case that overturned Roe, plus the anti-abortion doctors who sued the FDA to try to remove the abortion drug mifepristone from the market, and is defending Idaho’s abortion ban in a lawsuit the Trump administration dropped last month. (In the abortion pill case, the Supreme Court said these doctors couldn’t sue the FDA, but now three states are trying to keep the litigation going.)
Lawyers for the Trump administration will argue alongside South Carolina, so yeah, they fully support this policy move.
The Supreme Court just granted this petition. The Department of Justice will officially argue on April 2 that states can kick abortion providers like Planned Parenthood out of the Medicaid program where they provide birth control, cancer screenings, STI testing, and more. An attempt to "defund" PP
— Susan Rinkunas (@susanrinkunas.com) 2025-03-21T18:21:22.197Z
Nearly 100 Republican members of Congress filed an amicus brief in support of South Carolina, while 238 Democrats filed a brief in support of PPSAT.
So what’s going to happen?
With this court? No idea, sorry. In a normal world, the case would be an easy win for Planned Parenthood, but we left that world a long time ago. Sure, it’s technically possible that the Supreme Court took this case to resolve the aforementioned “circuit split” and reaffirm its 2023 ruling about Medicaid patients’ right to file lawsuits, known as Health and Hospital Corporation v. Talevski. But that case didn’t involve abortion, and this 6-3 conservative supermajority hates abortion rights.
Even if the justices do sound skeptical of South Carolina’s arguments, that doesn’t mean the threat to reproductive healthcare is gone. As we explained above, Trump could do a lot of harm himself.
We’ll be back with more after the hearing on Wednesday.
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