On April 7, 2025, the U.S. Supreme Court began hearing arguments in a landmark case that could significantly reshape the balance of power between states and the federal government regarding Medicaid funding, specifically in cases involving Planned Parenthood and other providers of reproductive health services.
At the heart of the case is a decision by South Carolina to remove Planned Parenthood as a Medicaid provider, citing its connection to abortion services, even though federal Medicaid funds are prohibited from being used for abortions under the Hyde Amendment. South Carolina argues that it should have the authority to determine which healthcare providers qualify for participation in its Medicaid program. Opponents argue that such exclusion violates federal law and limits patients’ right to choose their healthcare providers.
The case, titled Edwards v. McMaster, stems from a 2018 executive order by South Carolina Governor Henry McMaster, which effectively disqualified Planned Parenthood from participating in Medicaid, even for services unrelated to abortion, such as cancer screenings, contraception, and STD testing. Lower federal courts blocked the order, leading to a series of appeals that eventually brought the issue before the Supreme Court.
During the oral arguments, conservative justices appeared sympathetic to the state’s position. Justice Samuel Alito noted that “federalism requires deference to states in managing their own healthcare programs.” Justice Clarence Thomas echoed that sentiment, warning against what he called “federal micromanagement of state-administered services.”
In contrast, liberal justices questioned whether patients’ rights were being violated. Justice Sonia Sotomayor asked whether “ideological disagreement with a provider’s lawful practices can justify restricting access to care for thousands of low-income women.” Justice Elena Kagan emphasized that Medicaid is a federal-state partnership and that federal rules include a requirement for “freedom of choice” for patients in selecting qualified providers.
Outside the Supreme Court building, hundreds of activists gathered in peaceful protest. Supporters of Planned Parenthood held signs reading “Care, Not Politics” and “My Body, My Medicaid.” Counter-protesters, many representing religious and pro-life organizations, expressed their support for South Carolina’s actions and called for the complete defunding of organizations that perform abortions.
Health policy experts warn that a ruling in favor of South Carolina could set a precedent, allowing other states to follow suit. At least eight states have introduced similar legislation or executive actions that mirror South Carolina’s approach. If the Court upholds the state’s authority, analysts predict a wave of provider exclusions nationwide, potentially disrupting care for millions of Medicaid recipients, particularly in rural and underserved communities.
Legal scholars also note that this case could have broader implications beyond reproductive health, impacting how states define “qualified providers” across various areas of care, from mental health services to HIV prevention programs.
The Department of Health and Human Services has filed an amicus brief in support of the plaintiffs, arguing that allowing states to unilaterally exclude providers for ideological reasons contradicts federal Medicaid law and undermines the program’s mission to provide comprehensive, accessible healthcare.
A decision is expected by June 2025, and with the Court’s current 6-3 conservative majority, legal analysts say the ruling could tilt in favor of state authority. However, some speculate that Chief Justice John Roberts may seek a narrower ruling to avoid fueling further polarization in an already politically sensitive area.
Until then, healthcare providers, advocacy groups, and millions of Medicaid recipients are watching closely—aware that the Court’s ruling could redefine the future of reproductive health access in America.