The future of Medicaid beneficiaries’ right to choose their own providers—and Planned Parenthood’s eligibility in Medicaid—is unclear following today’s oral arguments before the Supreme Court in Medina v. Planned Parenthood South Atlantic.

At its core, the case is about the South Carolina Department of Health and Human Services’ (HHS) attempt to exclude Planned Parenthood clinics from the state’s Medicaid program, which serves low-income patients. In 2018, South Carolina Gov. Henry McMaster directed the state HHS to exclude abortion clinics from Medicaid coverage, SCOTUSBlog reported.

As the regional publication Post and Courier reported, about 70 percent of South Carolina’s Medicaid funding comes from federal funds, while the other 30 percent is state-funded. The Hyde Amendment, passed in 1977, already prevents federal funds from paying for abortion care, except in cases of rape, incest, or if the life of the pregnant person is at risk.

After Planned Parenthood, which says it serves hundreds of Medicaid patients at its two South Carolina clinics, took the case to federal court, it made its way to the Fourth Circuit Court of Appeals. In 2024, the Fourth Circuit rejected South Carolina’s bid to kick Planned Parenthood off Medicaid and reaffirmed Medicaid beneficiaries’ “individual right” to freely choose their own providers, and to enforce that right through litigation. South Carolina, represented by the conservative law firm Alliance Defending Freedom (ADF), then appealed the case to the Supreme Court.

During oral arguments, ADF attorney John Bursch seemed hung up on the idea that federal law does not expressly guarantee Medicaid patients the “right” to choose their own providers. The liberal trio of justices—Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson—pressed Bursch on his apparent use of a “magic words” test, as he insisted federal statutes instead assured choice of provider as a “benefit.” Nicole Saharsky, who represented Planned Parenthood South Atlantic before the Court, argued that Congress had already addressed the issue in creating the free-choice-of-provider provision in the Medicaid Act after states “arbitrarily” excluded certain health-care providers from Medicaid.

“There aren’t that many things that are more important than being able to choose your doctor—the person that you see when you’re at your most vulnerable, facing some of the most significant challenges to your life and your health,” Saharsky said. “And Congress said a long time ago, this is something we want to protect. We want people on Medicaid, who are insured through Medicaid, to have the same right that people who have private insurance enjoy because it’s so foundational to individual dignity and individual autonomy.”

The three liberal justices appeared skeptical of South Carolina’s arguments, but the remaining six had less of a consensus. Justice Amy Coney Barrett, in particular, didn’t seem to fully buy South Carolina’s case for booting Planned Parenthood from Medicaid. The conservative majority largely seemed more willing to rehash its decision in the frequently-cited 2023 case Health and Hospital Corporation of Marion County, Ind. v. Talevski case, in which the conservative justices joined the liberal minority to rule that the Federal Nursing Home Reform Act created an individual right to action in regards to nursing home standards of care. It also reaffirmed a test that required an unambiguous conferring of individually enforceable rights. (Justices Samuel Alito and Clarence Thomas dissented.)

A decision in the case is expected later this term. Reproductive rights advocates and health-care providers, including from Planned Parenthood, warned against potentially devastating consequences for low-income patients if the Supreme Court rules in South Carolina’s favor.

“Medicaid recipients in South Carolina, if the state were to prevail in this case, would basically lose their access to the provider of their choice—Planned Parenthood,” said Catherine Peyton Humphreville, a senior staff attorney at Planned Parenthood Federation of America. Humphreville added that Planned Parenthood clinicians are the only health-care providers many of those patients see, meaning people could lose access to birth control, annual exams, cancer screenings, STI screening and treatment, and other preventive services offered at their clinics.

Depending on how the Supreme Court ultimately rules, the decision could come with far-reaching implications for Medicaid patients nationwide.

“While [Medina v. Planned Parenthood South Atlantic] presents a technical question about whether the Medicaid law confers a right on Medicaid participants to see the provider of their choice, the actual, underlying question is whether the government may prevent citizens from receiving medically appropriate care from their doctor of choice because the government doesn’t approve of the provider,” Molly Meegan, chief legal officer and general counsel of the American College of Obstetricians and Gynecologists (ACOG), said in a statement.

If the justices rule that the Medicaid Act does not allow for an individual to sue to preserve access to providers of their choosing, enforcement of the free-choice-of-provider provision would largely fall to the federal government, which Planned Parenthood argued would render the provision toothless. It could also embolden other states to exclude entire swaths of providers based on politics and the kinds of care they provide, rather than whether providers are qualified to provide that health care.

And with a presidential administration hostile to reproductive health care, it’s unlikely that federal authorities would step in to ensure patient access to providers blocked by anti-choice states—especially since it sent Kyle Hawkins, counselor to the U.S. Solicitor General, to argue for South Carolina on the administration’s behalf.

Earlier this week, Donald Trump’s administration announced it was freezing tens of millions of dollars in Title X funding to nine Planned Parenthood affiliates, POLITICO first reported. Planned Parenthood did not immediately respond to Rewire News Group’s questions about how the Court’s ruling, coupled with the Trump administration’s cuts to the organization’s Title X funding, will impact its bottom line.

It’s not the first step the administration has taken to undermine reproductive health-care access. Since the start of Trump’s second term, the president and members of his administration have re-instituted the global gag rule on abortion, called the safety of the abortion drug mifepristone—which is safer than Tylenol—into question, and banned the federal funding of gender-affirming care for individuals under 19. And Trump’s Department of Justice could enforce the Comstock Act to restrict medication abortion access nationwide.

With Trump in the White House and a Republican majority in both chambers of Congress, a Supreme Court ruling in favor of South Carolina could leave millions of Medicaid patients with fewer options and less autonomy over their care.

“Legislative interference in access to medical care is dangerous,” added Meegan, who penned ACOG’s amicus brief in Medina. “Limiting access to disfavored providers is just another form of controlling access to care—and, in turn, controlling people’s health and lives.”