In a major decision released on June 26, 2025, the U.S. Supreme Court ruled that states can legally block Medicaid recipients from accessing care at certain providers like Planned Parenthood, even for non-abortion services such as cancer screenings, STI testing, and routine exams, if the provider also provides abortion services. South Carolina, for example, cut state funding for any medical provider that performs abortions, regardless of other services provided.
The 6 to 3 ruling came out in favor of a state’s broad authority to exclude providers from their Medicaid programs, even if those providers meet federal qualifications and offer critical care to underserved populations.
This case contended with a key question: Can Medicaid recipients use their coverage to see any qualified and willing provider? According to the Court’s majority, the answer is no, if a state decides otherwise.
This decision could carry significant implications for millions of Americans who rely on Medicaid for basic healthcare. In this post, we’ll explore what the Supreme Court’s decision means for Medicaid recipients and how elderly individuals may be affected.
What Did the Supreme Court Decide?
The Court ruled that Medicaid recipients do not have the right to sue states over provider exclusions. Writing for the majority, Justice Neil Gorsuch said that Congress did not clearly give individuals the ability to enforce the “any qualified provider” provision of the Medicaid law. The Justices have decided that the language in the statute does not “create rights,” but rather creates finance compliance. Additionally, they claim there are other avenues for patients to receive funding for providers not in their network.
Justice Ketanji Brown Jackson, in dissent, called the ruling a civil rights setback. She argued that Medicaid recipients have long relied on this provision to protect their choice of provider and that this decision allows states to sidestep their responsibilities to patients.
What this Means for Individuals on Medicaid
States may now have more power to decide which providers can participate in Medicaid, even if those providers are otherwise qualified and willing. This opens the door for states to exclude providers based on political or ideological reasons, not just medical ones.
For patients, this could mean additional restrictions on provider options and longer wait times for care. As the wait lists for Medicaid providers can already be significant, especially for long term care Medicaid beds at nursing home facilities, this ruling has the potential to exacerbate the problem of obtaining necessary care for Medicaid recipients in a timely fashion.
Medicaid recipients also lose a key protection with this ruling: they can no longer sue the state if their preferred provider is removed from the network.
Is Medicaid Being Cut?
You can read more about the funding status of Medicaid in our dedicated article here which addresses Trump and his administration’s official remarks on Medicaid budgets.
What About Medicare?
Medicare and Medicaid are distinct, but often confused programs. Everything discussed in this article refers to the Medicaid program. You can learn more about the differences between Medicaid and Medicare here.
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