South Carolina Can Deny Medicaid Patients Planned Parenthood Care, SCOTUS Rules

The Intercept

2 days ago

The Supreme Court moved to limit access to health care for over 1.3 million South Carolinians on Thursday by allowing the state to block Medicaid recipients from getting care at Planned Parenthood. The tight restriction on reproductive rights will likely pave the way for similar bans in other states, as ongoing attacks on abortion providers further impinge on access to maternal, gynecological, and other basic forms of health care.
In a 6-3 decision, the court determined that Planned Parenthood clinics and patients in South Carolina may not sue the state for denying Medicaid funding to the reproductive care provider. The ruling overturns repeated lower court decisions that affirmed Medicaid recipients' rights to visit a provider of their choosing that accepts the program. It comes against the backdrop of looming federal cuts to Medicaid, which would further restrict health care access for millions of low-income Americans.
In South Carolina, abortion is already subjected to a near-total ban. State law prohibits abortion after six weeks with limited exceptions — which is often before someone would be aware that they're pregnant. Republican South Carolina Gov. Henry McMaster has been direct about wanting to target Planned Parenthood because the network of clinics is known as an abortion provider.
'South Carolina has made it clear that we value the right to life,' McMaster said in a February statement. 'Therefore, taxpayers should not be forced to subsidize abortion providers who are in direct opposition to their beliefs.'
The idea that Medicaid is subsidizing abortion care in South Carolina is incredibly misleading, said Susanna Birdsong, general counsel and vice president of compliance at Planned Parenthood South Atlantic.
'Medicaid does not cover abortion except in very narrow circumstances of rape, incest in life of the pregnant person,' Birdsong said. 'That's been a federal rule since the 1970s.'
Planned Parenthood provides care for a host of other sexual and reproductive wellness concerns — meaning that low-income South Carolinians will lose access to 'health care that has nothing to do with abortion,' Birdsong said. She pointed to things like testing for sexually transmitted infections, cancer screening, and birth control.
In its ruling, the Court made clear that it was aware of the other services Planned Parenthood provides.
'Planned Parenthood South Atlantic operates two clinics in South Carolina, offering a wide range of services to Medicaid and non-Medicaid patients,' reads a summary of the decision. 'It also performs abortions.'
The Court noted that Planned Parenthood and a patient sued under the any-qualified-provider provision, which allows Medicaid patients to seek care from a provider of their choosing, but the majority determined they did not necessarily have an 'enforceable' right to do so.
Experts expect that this decision will open the floodgates for other states to pass similar bans, limiting access to the largest provider of reproductive and sexual health care in the United States for millions of lower-income Americans.
'Other states certainly have tried it before,' said Dr. Jamila Perritt, an OB-GYN and president of the nonprofit Physicians for Reproductive Health. 'Much in the same way that abortion bans really swept this country, I think we're going to see similar effects.'
The decision to limit where Medicaid patients can access care disproportionately affects women of color, said Perritt. As of 2023, the majority of people enrolled in Medicaid in South Carolina were nonwhite, and roughly 39 percent of Medicaid enrollees were Black, according to health policy research nonprofit KFF.
Even before the decision, access to health care — particularly reproductive and sexual health care — in South Carolina was a challenge for lower-income residents. Roughly 41 of the state's 46 counties are considered federally designated 'Health Professional Shortage Areas,' and Medicaid recipients are disproportionately likely to live in communities with provider shortages.
'We're talking about communities that are already marginalized from care, communities that already have disproportionately poor reproductive and sexual health outcomes,' said Perritt, who predicted the decision would have 'significant negative health consequences.'
Aside from having one of the strictest abortion bans in the country, South Carolina is one of only 10 states not to expand Medicaid coverage since the Affordable Care Act was passed in 2010. South Carolina also has the eighth-highest maternal mortality rate in the country, hovering around 47.2 pregnancy-related deaths per 100,000 live births, and some of the highest rates of sexually transmitted infections in the nation.
'It's really a state that should be investing more in its public health infrastructure and making sure that people who live in the state have access to the care that they need,' said Birdsong.
Jennifer Driver, senior director of reproductive rights for State Innovation Exchange, said, like the state's abortion ban, lower-income people in South Carolina will bear the brunt of the burden of this decision.
'It targets people who are already limited on resources to say, 'You know what? On top of that, you actually don't get to have a decision on the care that you get and the provider you get it from,' she said.
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At the same time, the Trump administration and Congress are seeking to further restrict health coverage for low-income Americans. A Congressional Budget Office report found that the House of Representatives' version of the 'Big, Beautiful, Bill' would leave 16 million Americans without health insurance and kick 7.8 million people off of Medicaid. Senate Republicans are considering their own set of Medicaid cuts, though they've been snarled by political opposition.
'This is a clear and obvious attack on people with low income, people who rely on Planned Parenthood clinics to get life-saving health services,' said Perritt. She described the decision as part of the government's broader efforts 'to eliminate access to comprehensive health care for folks, really across the country. This has to also be understood as an attack that reaches far beyond the borders of South Carolina.'