SUPREME COURT OF THE UNITED STATES
_________________
No. 23–1275
_________________
EUNICE MEDINA, DIRECTOR, SOUTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, PETITIONER v. PLANNED
PARENTHOOD SOUTH ATLANTIC,
ET AL.
ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF
APPEALS FOR THE FOURTH CIRCUIT
[June 26, 2025]
JUSTICE GORSUCH delivered the opinion of the Court.
Medicaid offers States “a bargain.” Armstrong v. Excep
tional Child Center, Inc., 575 U. S. 320, 323 (2015). In re
turn for federal funds, States agree “to spend them in ac
cordance with congressionally imposed conditions.” Ibid.
Should a State fail to comply substantially with those con
ditions, the Secretary of Health and Human Services can
withhold some or all of its federal Medicaid funding. This
case poses the question whether, in addition to that remedy,
individual Medicaid beneficiaries may sue state officials for
failing to comply with one funding condition spelled out in
42 U. S. C. §1396a(a)(23)(A).
I
Congress created Medicaid in 1965 to subsidize state ef
forts to provide healthcare to families and individuals
“‘whose income and resources are insufficient to meet the
costs of necessary medical services.’” Armstrong, 575 U. S.,
at 323 (quoting §1396–1). Today, all 50 States participate
2
MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
in Medicaid. Congressional Research Service, Medicaid: An
Overview 1 (2025) (CRS). In order to do so, a State must
submit to the Secretary a “plan for medical assistance.”
§1396a(a); see also §1396–1. To win the Secretary’s ap
proval, that plan must satisfy more than 80 separate condi
tions Congress has set out in §1396a(a). Once the Secretary
approves a plan, federal funds begin flowing to help the
State execute it. Of course, States must contribute their
own money, too. See §1396d(b). Historically, the federal
government has provided on average about 57% of the
funds required to implement Medicaid, and States have
supplied the balance. CRS 21.
This case concerns one of the conditions state plans
must meet. Located in §1396a(a)(23)(A), Medicaid’s any-
qualified-provider provision, as it is sometimes called, re
quires States to ensure that “any individual eligible for
medical assistance . . . may obtain” it “from any [provider]
qualified to perform the service . . . who undertakes to pro
vide” it. The provision does not define the term “qualified,”
perhaps because States have traditionally exercised pri
mary responsibility over “matters of health and safety,” in
cluding the regulation of the practice of medicine. De Buono
v. NYSA–ILA Medical and Clinical Services Fund, 520
U. S. 806, 814 (1997); see also Linder v. United States, 268
U. S. 5, 18 (1925); 42 CFR §431.51(c)(2) (2024). But every
one acknowledges that, if a State fails “to comply substan
tially” with this (or any) congressionally specified condition,
the Secretary may withhold some or all of the State’s fed
eral funding until he is “satisfied that there will no longer
be any such failure to comply.” §1396c.
The parties’ dispute concerns whether, in addition to that
remedy, the law recognizes another. The dispute arose this
way. Planned Parenthood South Atlantic operates two clin
ics in South Carolina, one in each of the State’s two most
populous cities. Planned Parenthood South Atlantic v.
Kerr, 95 F. 4th 152, 156–157 (CA4 2024). At both locations,
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Opinion of the Court
3
the group offers “a wide range” of services to Medicaid and
non-Medicaid patients. Ibid. It also performs abortions.
Ibid. Citing a state law prohibiting the use of its own public
funds for abortion, South Carolina announced in July 2018
that Planned Parenthood could no longer participate in the
State’s Medicaid program. App. to Pet. for Cert. 157a–162a.
At the same time, the State took steps that, it said, would
help ensure that a “variety of other nongovernmental enti
ties and governmental agencies” would continue to provide
“access to necessary medical care and important women’s
health and family planning services.” Id., at 158a. Accord
ing to the State, it has “140 [other] federally qualified
health clinics and pregnancy centers, not counting the nu
merous private health providers who accept Medicaid.”
Brief for Petitioner 9.
In response to the State’s announcement, Planned
Parenthood and one of its patients, Julie Edwards, sued the
director of the State’s Department of Health and Human
Services. They argued that South Carolina’s exclusion of
Planned Parenthood from its Medicaid program violated
the any-qualified-provider provision. Specifically, Ms. Ed
wards alleged that, while she regularly visits other medical
care providers, she has had especially positive experiences
with Planned Parenthood and would like “to shift all [her]
gynecological and reproductive health care there.’’ App. 32,
33. But none of that will be possible, she continued, unless
Medicaid covers those services. Ibid. Based on these alle
gations, Ms. Edwards and Planned Parenthood brought a
putative class action “pursuant to 42 U. S. C. §1983 to vin
dicate rights secured by the federal Medicaid statutes.” Id.,
at 1.
First enacted as part of the Civil Rights Act of 1871,
§1983 allows private parties to sue state actors who violate
their “rights” under “the Constitution and laws” of the
United States. But federal statutes do not confer “rights”
enforceable under §1983 “as a matter of course.” Health
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MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
and Hospital Corporation of Marion Cty. v. Talevski, 599
U. S. 166, 183 (2023). That is particularly true of statutes,
like Medicaid, enacted pursuant to Congress’s spending
power. The spending power allows Congress to offer funds
to States that agree to certain conditions. See, e.g., South
Dakota v. Dole, 483 U. S. 203, 207–208 (1987). But when a
State violates those conditions, “‘the typical remedy’” is not
a private enforcement suit “‘but rather action by the Fed
eral Government to terminate funds to the State.’” Gon
zaga Univ. v. Doe, 536 U. S. 273, 280 (2002) (quoting
Pennhurst State School and Hospital v. Halderman, 451
U. S. 1, 28 (1981)).
Appreciating all this, the plaintiffs argued that their
case implicated an exception to the usual rule. The any
qualified-provider provision, they said, is among those rare
federal spending-power statutes that confer individual
rights enforceable under §1983. And, they submitted,
South Carolina violated Ms. Edwards’s rights under that
provision when it denied her the opportunity to select
Planned Parenthood as her healthcare provider. Agreeing
with the plaintiffs’ assessment, the district court granted
summary judgment to them and entered a permanent in
junction preventing the State from excluding Planned
Parenthood from its Medicaid program.
Planned
Parenthood South Atlantic v. Baker, 487 F. Supp. 3d 443,
448 (SC 2020).
On appeal, the Fourth Circuit affirmed the district court’s
decision. Planned Parenthood South Atlantic v. Kerr, 27
F. 4th 945 (2022). Writing separately, Judge Richardson
expressed “confusion and uncertainty” about this Court’s
directions addressing when spending-power legislation cre
ates enforceable rights under §1983. Id., at 959 (opinion
concurring in judgment). And he voiced “hop[e]” that we
might provide “clarity . . . soon.” Ibid.
Seeking review of the Fourth Circuit’s decision, the State
filed a petition for certiorari in this Court. In light of our
Cite as: 606 U. S. ____ (2025)
Opinion of the Court
5
intervening decision in Talevski, 599 U. S. 166, in which we
addressed whether another spending-power statute created
§1983-enforceable rights, we granted the State’s petition,
vacated the decision of the court of appeals, and remanded
the case for further proceedings.
Kerr v. Planned
Parenthood South Atlantic, 599 U. S. ___ (2023).
On remand, the court of appeals reaffirmed its earlier de
cision. 95 F. 4th, at 153. And, once more, Judge Richardson
wrote separately. Even after Talevski, he said, lower courts
“continue[d] to lack the guidance” they need from this Court
to determine when a federal spending-power statute cre
ates a right that private parties can enforce under §1983.
95 F. 4th, at 170 (opinion concurring in judgment). Other
circuit judges have expressed similar concerns. See, e.g.,
Saint Anthony Hospital v. Whitehorn, 132 F. 4th 962, 971
(CA7 2025) (en banc); id., at 982 (Hamilton, J., dissenting);
New York State Citizens’ Coalition for Children v. Poole,
935 F. 3d 56, 60 (CA2 2019) (Livingston, J., dissenting from
denial of rehearing en banc).
In response to the Fourth Circuit’s latest decision, the
State filed another petition for certiorari. In it, South Car
olina noted that other lower courts have disagreed with the
Fourth Circuit regarding whether §1396a(a)(23)(A) confers
an individually enforceable right. Cf. Planned Parenthood
of Greater Tex. Family Planning & Preventative Health
Servs., Inc. v. Kauffman, 981 F. 3d 347, 350 (CA5 2020) (en
banc); Does v. Gillespie, 867 F. 3d 1034, 1037 (CA8 2017).
We agreed to hear the case. 604 U. S. ___ (2024).
II
To resolve the circuits’ disagreement and address our
lower court colleagues’ calls for clarification, we begin by
outlining how to determine whether a statute confers an in
dividually enforceable right under §1983.
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MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
A
The Constitution charges the Executive Branch with en
forcing federal law. Art. II, §3. But sometimes Congress
also allows private parties to enforce the law through civil
litigation. In §1983, Congress did just that, authorizing in
dividuals to sue anyone who, under color of state law, de
prives them of “rights, privileges, or immunities secured by
the Constitution and laws” of the United States.
Historically, individuals brought §1983 suits to vindicate
rights protected by the Constitution. But, in 1980, this
Court recognized that §1983 also authorizes private parties
to pursue violations of their federal statutory rights. Maine
v. Thiboutot, 448 U. S. 1. Still, this Court has emphasized,
statutes create individual rights only in “atypical case[s].”
Talevski, 599 U. S., at 183. Routinely, of course, federal leg
islation seeks to benefit one group or another. (Why pass
legislation otherwise?) But §1983 provides a cause of action
“only for the deprivation of ‘rights, privileges, or immuni
ties,’” not “‘benefits’ or ‘interests.’” Gonzaga, 536 U. S., at
283.
To prove that a statute secures an enforceable right, priv
ilege, or immunity, and does not just provide a benefit or
protect an interest, a plaintiff must show that the law in
question “clear[ly] and unambiguous[ly]” uses “rights-
creating terms.” Id., at 284, 290. In addition, the statute
must display “‘an unmistakable focus’” on individuals like
the plaintiff. Id., at 284 (emphasis deleted); accord, Talev
ski, 599 U. S., at 183. We have described this as a “strin
gent” and “demanding” test. Id., at 180, 186; accord, post,
at 9 (JACKSON, J., dissenting) (describing Gonzaga as set
ting forth “a restrictive test”). And even for the rare statute
that satisfies it, this Court has said, a §1983 action still may
not be available if Congress has displaced §1983’s general
cause of action with a more specific remedy. Rancho Palos
Verdes v. Abrams, 544 U. S. 113, 120 (2005).
These rules seek to “vindicat[e] the separation of powers.”
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Opinion of the Court
7
Talevski, 599 U. S., at 183. To be sure, there was a time in
the mid-20th century when “the Court assumed it to be a
proper judicial function to provide” whatever “remedies” it
deemed “necessary to make effective a statute’s purpose.”
Ziglar v. Abbasi, 582 U. S. 120, 131–132 (2017) (internal
quotation marks omitted). But, as this Court has since
come to appreciate, no statute pursues any single “pur
pos[e] at all costs.” American Express Co. v. Italian Colors
Restaurant, 570 U. S. 228, 234 (2013) (internal quotation
marks omitted). And, often enough, Congress may “not
wish to pursue [a] provision’s purpose to the extent of au
thorizing private suits.” Hernández v. Mesa, 589 U. S. 93,
100 (2020). After all, the decision whether to let private
plaintiffs enforce a new statutory right poses delicate ques
tions of public policy. New rights for some mean new duties
for others. And private enforcement actions, meritorious or
not, can force governments to direct money away from pub
lic services and spend it instead on litigation. See ibid. The
job of resolving how best to weigh those competing costs and
benefits belongs to the people’s elected representatives, not
unelected judges charged with applying the law as they find
it.
See Alexander v. Sandoval, 532 U. S. 275, 286 (2001);
Gonzaga, 536 U. S., at 285.1
——————
1 Cannon v. University of Chicago, 441 U. S. 677, 691 (1979), and its
aftermath illustrate the shift in this Court’s approach. In Cannon, the
Court inferred new private causes of action from the terms of Title VI of
the Civil Rights Act of 1964 and Title IX of the Education Amendments
of 1972. Though Congress later “ratified Cannon’s holding,” Sandoval,
532 U. S., at 280, the Court has retreated from Cannon’s reasoning,
which “exemplified” an “expansive rights-creating approach” that later
decisions “abandoned,” Franklin v. Gwinnett County Public Schools, 503
U. S. 60, 77 (1992) (Scalia, J., concurring in judgment); see also Ston
eridge Investment Partners, LLC v. Scientific-Atlanta, Inc., 552 U. S. 148,
164–165 (2008) (quoting Justice Powell’s Cannon dissent). So while this
Court has said it remains bound by Cannon’s “holdin[g],” it has empha
sized that the decision’s “language” no longer controls. Sandoval, 532
U. S., at 282.
8
MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
B
Though it is rare enough for any statute to confer an en
forceable right, spending-power statutes like Medicaid are
especially unlikely to do so. The reasons why take a little
unpacking.
When Congress passes a law, say, regulating commerce
between the States or outlawing piracy, it can point for au
thority to the Commerce Clause, U. S. Const., Art. I, §8,
cl. 3, or the Piracies Clause, cl. 10. In enumerated areas
like those, the Constitution vests Congress with the power
to regulate conduct. But when Congress distributes money,
its authority rests on a different footing.
The Constitution has no “Spending Clause,” strictly
speaking. Instead, we usually trace Congress’s spending
power to Article I, section eight, clause one, which gives
Congress the “Power To lay and collect Taxes, Duties, Im
posts and Excises, to pay the Debts and provide for the com
mon Defence and general Welfare of the United States.”
Unlike other enumerated powers, this provision does not
expressly endow Congress with the power to regulate con
duct. Nor does it include “the power to issue direct orders
to the governments of the States.” Murphy v. National Col
legiate Athletic Assn., 584 U. S. 453, 471 (2018).
As the Court observed in United States v. Butler, the
meaning of Article I’s “general welfare” language provoked
fierce debate right from the start. 297 U. S. 1, 65–67 (1936).
At one extreme, Gouverneur Morris thought it authorized
Congress to tax, spend, and regulate broadly in pursuit of
the “general Welfare.” D. Schwartz, Mr. Madison’s War on
the General Welfare Clause, 56 U. C. D. L. Rev. 887, 915
(2022). Alexander Hamilton took a more modest view. He
thought the language gave Congress the power to raise and
“appropriate money” for “objects” of “General” (as opposed
to “local”) importance. Report on the Subject of Manufac
tures (Dec. 5, 1791), in 10 Papers of Alexander Hamilton
230, 303–304 (H. Syrett ed. 1966) (emphasis deleted). But
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Opinion of the Court
9
he denied that those powers included as well “a power to do
whatever else should appear to Congress conducive to the
General Welfare.” Ibid. James Madison advanced a nar
rower position still. As he saw it, the language authorized
Congress to spend money only in support of its other enu
merated powers. A. LaCroix, The Interbellum Constitu
tion: Federalism in the Long Founding Moment, 67 Stan.
L. Rev. 397, 407 (2015) (LaCroix).
Over time, Hamilton’s view gained ground. So, for exam
ple, as Justice Story saw it, Congress may raise and “appro
priat[e] . . . money” to advance the “general welfare.” 3 J.
Story, Commentaries on the Constitution of the United
States §1269, p. 150 (1833). But nothing in Article I, section
eight, clause one endows Congress with a power to regulate,
for if it did, the “enumeration of specific powers” elsewhere
in Article I would be rendered largely pointless, and the Na
tion would trade a limited federal government for “an un
limited” one. 2 id., §§904, 906, pp. 367, 369; see also Butler,
297 U. S., at 66 (Justice Story’s “reading . . . is the correct
one”); J. Monroe, Message From the President of the United
States 32–33 (1822); E. Corwin, The Spending Power of
Congress—Apropos the Maternity Act, 36 Harv. L. Rev.
548, 564–566 (1923).
Consistent with this understanding, early courts de
scribed federal grants not as commands but as contracts.
Consider, for example, how this Court approached a dispute
concerning the first major federal highway. The Cumber
land Road once supplied a vital link between the East Coast
and the old Northwest. LaCroix 420. Starting in the 1830s,
the federal government gradually transferred control of the
road to several States. J. Young, A Political and Constitu
tional Study of the Cumberland Road 78–98 (1902). One
transfer to Ohio came with a condition: The State could not
charge tolls on wagons carrying federal property. Id., at
96–98. When a disagreement arose about the scope of that
toll exemption, this Court looked to “the expectations of the
10 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
parties,” a familiar feature of contract law, to resolve it.
Neil, Moore & Co. v. Ohio, 3 How. 720, 741 (1845). In doing
so, the Court emphasized that it was enforcing require
ments “well known” to the parties when the “compact was
made.” Ibid.; see also McGee v. Mathis, 4 Wall. 143, 155
(1866) (“It is not doubted that the grant by the United
States to the State upon conditions, and the acceptance of
the grant by the State, constituted a contract”).
At the same time, the Court recognized that agreements
between state and federal governments are not exactly the
same as contracts “between individuals.” Searight v.
Stokes, 3 How. 151, 167 (1845). In many respects, the Court
suggested, federal-state agreements are really more like
treaties “between two sovereignties.” See Neil, Moore &
Co., 3 How., at 742. And, while treaties may seek to benefit
the citizens of the compacting nations, they generally do not
confer individually enforceable rights against a sovereign,
but “depen[d] for the enforcement of [their] provisions on
. . . the governments which are parties to” them. Head
Money Cases, 112 U. S. 580, 598 (1884).2 Adapting this
logic to the context of federal grants, the Court concluded
that, as a rule, “Congress alone has the power to enforce”
the conditions it attaches to its grants. Emigrant Co. v.
County of Adams, 100 U. S. 61, 69 (1879); see also Mills
County v. Railroad Cos., 107 U. S. 557, 566 (1883).
C
For much of the Nation’s history, the Court had little oc
casion to employ these ideas. Congress rarely granted
money to States and, when it did, those grants rarely came
——————
2Much the same holds true today. While treaties may benefit individ
uals or groups, this Court has said, “the background presumption” is that
treaties “ ‘do not create private rights or provide for a private cause of
action.’ ” Medellín v. Texas, 552 U. S. 491, 506, n. 3 (2008) (quoting 2
Restatement (Third) of Foreign Relations Law of the United States §907,
Comment a, p. 395 (1986); emphasis added).
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Opinion of the Court
11
with many conditions. See D. Currie, The Constitution in
Congress: Democrats and Whigs, 1829–1861, pp. 42–45
(2005). But that began to change during the New Deal.
And when disputes about those grant conditions arose, this
Court returned to the old contract and treaty analogies to
ensure that spending-power legislation did not pass the
“point at which pressure turns into compulsion.” Steward
Machine Co. v. Davis, 301 U. S. 548, 590 (1937); see also
Massachusetts v. Mellon, 262 U. S. 447, 480 (1923); Butler,
297 U. S., at 73–75; Oklahoma v. Civil Serv. Comm’n, 330
U. S. 127, 143–144 (1947). The same analogies guided the
Court, too, after federal grants exploded in the 1960s, gen
erating “an unprecedented” wave of litigation in which pri
vate parties sought to challenge state compliance with fed
eral grant conditions. E. Tomlinson & J. Mashaw, The
Enforcement of Federal Standards in Grant-In-Aid Pro
grams: Suggestions for Beneficiary Involvement, 58 Va.
L. Rev. 600, 630 (1972).3
Take Pennhurst. There, private plaintiffs sought to sue
the Commonwealth of Pennsylvania for failing to fulfill the
terms of a federal healthcare grant. 451 U. S., at 6. In as
sessing whether the suit could proceed, the Court began by
observing that “legislation enacted pursuant to the spend
ing power is much in the nature of a contract: in return for
federal funds, the States agree to comply with federally im
posed conditions.” Id., at 17. And the “typical remedy for
state noncompliance” with a federal grant’s conditions is an
“action by the Federal Government to terminate funds to
the State.” Id., at 28. Given these principles, the Court
reasoned, whether a private party may sue to enforce the
——————
3Between 1940 and 2023, federal outlays to state and local govern
ments increased by more than 50 times in constant dollars. Office of
Management and Budget, Historical Tables, Budget of the United States
Government, Summary Comparison of Total Outlays for Grants to State
and Local Governments: 1940–2029 (2024) (Table 12.1), https://www.
govinfo.gov/app/details/BUDGET-2025-TAB/BUDGET-2025-TAB-13-1.
12 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
terms of a federal grant depends on “whether the State vol
untarily and knowingly” consented to answer private
claims as part of its bargain with the federal government.
Id., at 17. And to satisfy this standard, the Court held, a
plaintiff must show, at a minimum, that Congress alerted
the State in advance, “clear[ly]” and “unambiguously,” that
responding to private enforcement suits was a condition of
its offer. Ibid.4
In Gonzaga, the Court restated these principles and ex
plored how they interact with §1983. Spending-power leg
islation, the Court explained, cannot provide the basis for a
§1983 enforcement suit unless Congress “speaks with a
clear voice, and manifests an unambiguous intent to confer
individual rights.” 536 U. S., at 280 (alteration and inter
nal quotation marks omitted). Only that kind of “unmis
takable” notice, the Court said, suffices to alert grantees
that they might be subject “to private suits . . . whenever
they fail to comply with a federal funding condition.” Id.,
at 286–287, and n. 5 (internal quotation marks omitted).
And, the Court concluded, because the statute at issue be
fore it did not clearly and unambiguously confer a “right to
support a cause of action under §1983,” the plaintiff ’s suit
——————
4Beyond the rule that Congress must clearly and unambiguously alert
States to conditions associated with federal funding, our cases have ar
ticulated other limits on spending-power legislation. First, as previously
observed, “the exercise of the spending power must be in pursuit of ‘the
general welfare,’ ” rather than private or merely local interests. South
Dakota v. Dole, 483 U. S. 203, 207 (1987); see supra, at 8–9. Second,
grant conditions must relate “to the federal interest in particular na
tional projects or programs.” Dole, 483 U. S., at 207 (internal quotation
marks omitted). Third, “other constitutional provisions may provide an
independent bar to the conditional grant of federal funds.” Id., at 208.
Finally, spending-power conditions are legitimate only if the State’s ac
ceptance of them is in fact voluntary. National Federation of Independ
ent Business v. Sebelius, 567 U. S. 519, 581–582 (2012) (opinion of
ROBERTS, C. J.); see also id., at 676 (Scalia, Kennedy, THOMAS, and ALITO,
JJ., dissenting).
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could not proceed. Id., at 283, 290.5
13
Just two Terms ago, we reaffirmed these points. In
Talevski, the Court faced another private §1983 suit alleg
ing that recipients of federal funding had violated grant
conditions. To decide whether the plaintiffs could proceed,
we turned to Gonzaga, recognizing that it “sets forth our
established method” for analyzing suits like that. Talevski,
599 U. S., at 183. In doing so, we reiterated that the rele
vant “[s]tatutory provisions must unambiguously confer in
dividual federal rights” before a §1983 claim might proceed.
Id., at 180. That standard, we emphasized, is a “demanding
bar” and a “significant hurdle” that will be cleared only in
the “atypical case.” Id., at 180, 183–184. And, applying
that test, we found the statutes in question satisfied it pre
cisely because they “expressly” employed the sort of clear
and unambiguous “rights-creating language” Gonzaga de
mands. 599 U. S., at 184, 186 (internal quotation marks
omitted).
Admittedly, this Court briefly experimented with a dif
ferent approach, and that fact has given rise to some confu
sion in the lower courts. For a time, as we have seen, the
Court sometimes took an expansive view of its power to im
ply private causes of action to enforce federal laws. See
Part II–A, supra. Moved by the same spirit, the Court
——————
5 Gonzaga involved federal funds granted to a private university, not a
State. But our spending-power cases have applied similar principles to
state and private recipients of federal aid. See, e.g., Cummings v. Prem
ier Rehab Keller, 596 U. S. 212, 219–220 (2022). Whether a State or pri
vate recipient is involved, after all, §1983 actions to enforce federal stat
utes present a question sounding in the separation of powers, given that
it is for Congress, not the courts, to confer “rights upon a class of benefi
ciaries” sufficient to support a cause of action. See Gonzaga, 536 U. S.,
at 285; Part II–A, supra. And grants to private parties can risk altering
the Constitution’s balance of federal-state authority, too, by expanding
federal regulation beyond Congress’s enumerated powers and into areas
traditionally reserved for the States. See Gonzaga, 536 U. S., at 286, and
n. 5; cf. Gregory v. Ashcroft, 501 U. S. 452, 460–461 (1991).
14 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
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sometimes took a broad view of its authority to confer new
rights under spending-power statutes that did not ex
pressly provide them. In Wilder v. Virginia Hospital Asso
ciation, for example, the Court suggested that spending
power legislation can give rise to an enforceable right under
§1983 so long as the legislation is “intended to benefit the
putative plaintiff ” and the plaintiff ’s interest in the statute
is not “too vague and amorphous.” 496 U. S. 498, 509 (1990)
(alteration and internal quotation marks omitted); see
Wright v. Roanoke Redevelopment and Housing Authority,
479 U. S. 418, 423–424, 431–432 (1987). Building on those
same ideas in Blessing v. Freestone, the Court outlined a
three-factor test for recognizing new privately enforceable
rights. 520 U. S. 329, 340–341 (1997). Some lower court
judges, including in this case, still consult Wilder, Wright,
and Blessing when asking whether a spending-power stat
ute creates an enforceable individual right. See, e.g., 95
F. 4th, at 163–165; id., at 170 (Richardson, J., concurring in
judgment).
They should not. Gonzaga “reject[ed]” any reading of our
prior cases that would “permit anything short of an unam
biguously conferred right to support a cause of action
brought under §1983.” 536 U. S., at 283. Armstrong “repu
diate[d]” any other approach. 575 U. S., at 330, n. And
Talevski reaffirmed that “Gonzaga sets forth our estab
lished method” for determining whether a spending-power
statute confers individual rights. 599 U. S., at 183.
All of these warnings came for now-familiar reasons. Be
cause spending-power legislation is “in the nature of a con
tract,” a grantee must “voluntarily and knowingly” consent
to answer private §1983 enforcement suits before they
may proceed. Pennhurst, 451 U. S., at 17; see id., at 28.
And that consent cannot be fairly inferred if the federal
spending-power statute fails to provide “clear and unambig
uous” notice that it creates a personally enforceable right.
Gonzaga, 536 U. S., at 290. To the extent lower courts feel
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Opinion of the Court
15
obliged, or permitted, to consider the contrary reasoning of
Wilder, Wright, or Blessing, they should resist the impulse.
III
With these principles in hand, we turn to the question
whether the plaintiffs before us may maintain a §1983 suit
to enforce Medicaid’s any-qualified-provider provision. To
succeed, they must show, at a minimum, that
§1396a(a)(23)(A) does not just seek to benefit them or serve
their interests but “clear[ly] and unambiguous[ly]” gives
them individual federal rights. Gonzaga, 536 U. S., at 290.6
Since Pennhurst, this Court has identified only three sets
of spending-power statutes that confer enforceable rights
under §1983—those at issue in Wright, Wilder, and Talev
ski.
But given this Court’s longstanding repudiation of
Wright and Wilder’s reasoning, the statutes at issue in
Talevski supply the only reliable yardstick against which to
measure whether spending-power legislation confers a pri
vately enforceable right.
Talevski addressed two provisions of the Federal Nursing
Home Reform Act (FNHRA). See 599 U. S., at 181–182.
The first obliged nursing-home facilities to “protect and pro
mote” residents’ “right to be free from” unnecessary “physi
cal or chemical restraints.” 42 U. S. C. §1396r(c)(1)(A)(ii)
(emphasis added). The second appeared in a subparagraph
titled “[t]ransfer and discharge rights.” §1396r(c)(2)(A)
(emphasis added). And both provisions sat in a subsection
called “[r]equirements relating to residents’ rights.”
§1396r(c) (emphasis added).
The any-qualified-provider provision before us looks
——————
6As we have seen, the plaintiffs must also show that the provision in
question displays “an unmistakable focus” on individuals like them.
Gonzaga, 536 U. S., at 284 (emphasis deleted; internal quotation marks
omitted). And even then, a §1983 action may not be available if Congress
has displaced that general cause of action with a more specific remedy.
See supra, at 6. To resolve this case, however, we need not reach those
questions.
16 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
nothing like those FNHRA provisions.
Section
1396a(a)(23)(A) indicates that state Medicaid plans must
“provide that . . . any individual eligible for medical assis
tance (including drugs) may obtain such assistance from
any institution, agency, community pharmacy, or person,
qualified to perform the service or services required . . . who
undertakes to provide him such services.” Doubtless, this
language speaks to what a State must do to participate in
Medicaid, and a State that fails to fulfill its duty might lose
federal funding. Doubtless, too, this provision seeks to ben
efit both providers and patients.
But missing from
§1396a(a)(23)(A) is anything like FNHRA’s clear and unam
biguous “rights-creating language.” Talevski, 599 U. S., at
186 (internal quotation marks omitted).
To be sure, Congress could have taken a different ap
proach when drafting §1396a(a)(23)(A). In fact, FNHRA of
fers an example almost perfectly on point. One of its provi
sions gives nursing-home residents the right to choose their
own attending physicians. Here is the provision in context:
“(c) Requirements relating to residents’ rights
“(1) General rights
“(A) Specified rights
“A nursing facility must protect and promote the
rights of each resident, including each of the follow
ing rights:
“(i) Free choice
“The right to choose a personal attending physi
cian . . . .” §1396r(c) (emphasis added).
As this language shows, Congress knows how to give a
grantee clear and unambiguous notice that, if it accepts fed
eral funds, it may face private suits asserting an individual
right to choose a medical provider. Tellingly, too, Congress
adopted this FNHRA provision in legislation that also
amended §1396a(a)(23). Yet Congress’s work in the two
Cite as: 606 U. S. ____ (2025)
Opinion of the Court
17
provisions could not have been more different. See 101
Stat. 1330–152; Talevski, 599 U. S., at 181, n. 10. Someday,
Congress might choose to revise §1396a(a)(23) to resemble
FNHRA. But that is not the law we have. Cf. Feliciano v.
Department of Transportation, 605 U. S. ___, ___ (2025)
(slip op., at 6).
The remainder of §1396a(a)(23) only serves to confirm
our conclusion. After announcing that state Medicaid plans
must allow individuals to obtain care from any qualified
provider, the provision proceeds to carve out various excep
tions to that rule. So, for example, the statute allows States
to exclude from their Medicaid programs certain providers
“convicted of a felony”—and, what is more, to “determin[e]”
which felony convictions qualify for that exclusion.
§1396a(a)(23)(B). All that makes perfect sense if
§1396a(a)(23)(A) speaks only to a State’s duties to the fed
eral government. But it is an arrangement a good deal
harder to understand if §1396a(a)(23)(A) also confers an in
dividually enforceable right, for that would mean Congress
sought to convey a right against the States in one breath
but let States control its scope in the next.
Expanding our view beyond §1396a(a)(23) to the sur
rounding statutory context yields similar clues. To con
tinue receiving federal funding, the Medicaid Act says, a
State need only “comply substantially” with the any
qualified-provider mandate. §1396c. And, as this Court
recognized in Gonzaga, that focus on “‘aggregate’” compli
ance suggests that a statute addresses a State’s obligations
to the federal government, not the rights “‘of any particular
person.’” 536 U. S., at 288. Sometimes, we appreciate, a
provision may overcome this weighty statutory evidence. In
Talevski, after all, the Court found two FNHRA provisions
to confer individual rights even though that statute also
speaks of “substantial compliance.” See Brief for Respond
ents 35–36. But, at risk of repetition, the provisions at is
sue there employed explicit and unmistakable “‘rights
18 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
creating language,’” 599 U. S., at 186, and §1396a(a)(23)(A)
does not.
Notable, too, is where Congress placed the any-qualified
provider provision. It appears in a subsection titled “Con
tents.” §1396a(a). That subsection outlines scores of things
a state plan must include to qualify for federal funding.
Ibid. Those requirements do not appear in any discernible
order, and the any-qualified-provider provision does not
crop up until paragraph 23 of 87. All of §1396a(a)’s require
ments are directed to the Secretary of Health and Human
Services, who must “approve any plan” that meets them.
§1396a(b); see Armstrong, 575 U. S., at 331–332 (plurality
opinion). None of this may suffice to prove that the any
qualified-provider provision is unenforceable under §1983.
See §1320a–2. But it does show, once more, that the statute
before us stands in stark contrast to the ones we faced in
Talevski, where Congress set its rights-creating provisions
apart from others and, in doing so, helped alert grantees
that accepting federal funds comes with a duty to answer
private suits.
Observe, as well, what it would mean if §1396a(a)(23)(A)
did create an individually enforceable right. Many other
Medicaid plan requirements would likely do the same. And
instead of remaining “atypical” exceptions, as our cases
have said they are, rights-creating provisions might more
nearly become the rule. Talevski, 599 U. S., at 183.
Take one example. See Brief for United States as Amicus
Curiae 27–29 (offering others). Section 1396a(a)(32) follows
several paragraphs down from the any-qualified-provider
provision. It requires state Medicaid plans to “provide,”
with certain exceptions, “that no payment under the plan
for any care or service provided to an individual shall be
made to anyone other than such individual or the person or
institution providing such care or service.” As the plaintiffs
acknowledge, this provision “uses language with some sim
ilarities to” §1396a(a)(23)(A). Brief for Respondents 38–39.
Cite as: 606 U. S. ____ (2025)
Opinion of the Court
19
Both speak in mandatory terms (“must . . . provide”;
“shall”). Both discuss “individual[s].” Neither mentions
“rights.” Yet, while the plaintiffs insist that paragraph
(23)(A) clearly and unambiguously creates an individual
right, they suggest that a court could reasonably “deter
mine” that paragraph (32) “does not.” Ibid. (citing Polk v.
Yee, 36 F. 4th 939, 945–946 (CA9 2022)). Rather than try
to square that circle, we think the better course is the one
our precedents suggest: Neither paragraph uses clear and
unambiguous rights-creating language, so neither supports
a private suit under §1983.
IV
Seeking to persuade us otherwise, the plaintiffs and dis
sent offer four principal counterarguments.
First, the plaintiffs and dissent appeal to legislative his
tory.
The hearings and committee reports leading to
§1396a(a)(23)(A)’s adoption, they say, reveal that Congress
meant for the statute to secure an individual right. See
Brief for Respondents 30–32; see also post, at 3, 13
(JACKSON, J., dissenting). But that does not move the nee
dle. When it comes to interpreting the law, speculation
about what Congress may have intended matters far less
than what Congress actually enacted. See Epic Systems
Corp. v. Lewis, 584 U. S. 497, 523 (2018) (“[L]egislative his
tory is not the law”). And that goes double for spending
power statutes, where “the key is not what a majority of the
Members of both Houses intend but what the States are
clearly told.” Arlington Central School Dist. Bd. of Ed. v.
Murphy, 548 U. S. 291, 304 (2006).7
——————
7If anything, the legislative history of the any-qualified-provider pro
vision illustrates the pitfalls of trying to equate an unenacted legislative
record with the law. On the plaintiffs’ telling, Congress first enacted the
any-qualified-provider provision “to prevent [the] second-class treat
ment” of Medicaid patients, as exemplified by Puerto Rico’s policy of re
quiring them “to be treated only at designated government facilities.”
20 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
Second, the plaintiffs and dissent contend, Congress mod
eled §1396a(a)(23)(A) on a Medicare provision titled “‘Free
choice by patient guaranteed.’” 79 Stat. 291, 42 U. S. C.
§1395a. It reads: “Any individual entitled to insurance ben
efits under this subchapter may obtain health services from
any . . . person qualified to participate under this subchap
ter if such . . . person undertakes to provide him such ser
vices.” §1395a(a). And because that Medicare provision
“confer[s] an individual right,” the plaintiffs and dissent
reason, its Medicaid offshoot must as well. Brief for Re
spondents 34; see post, at 13 (JACKSON, J., dissenting).
This argument stumbles out of the gate. Its premise—
that §1395a(a) confers an enforceable right—is questiona
ble.
As the plaintiffs admit, “[n]o court has addressed
whether a Medicare beneficiary can enforce this provision
under Section 1983.” Brief for Respondents 34, n. 7. Even
overlooking that deficiency, another quickly emerges.
While the title of §1395a(a) “guarantee[s]” a patient’s “free
choice” of provider—and while the plaintiffs and dissent in
sist this language can create a right—the any-qualified-
provider provision never uses “guarantee” or its equivalent.
So if the comparison between the Medicaid and Medicare
provisions reveals anything, it is that Congress did not in
clude in §1396a(a)(23)(A) the language from §1395a that
the plaintiffs and dissent think most likely to confer en
forceable rights.
Third, instead of grappling meaningfully with the test
our precedents provide, the dissent proposes to rewrite it.
——————
Brief for Respondents 30 (citing Hearing on H. R. 5710 before the House
Committee on Ways and Means, 90th Cong., 1st Sess., pt. 4, pp. 2273,
2301 (1967)). And yet §1396a(a)(23), as it stands today, expressly ex
cludes Puerto Rican beneficiaries from its protections.
See
§1396a(a)(23)(B) (“[T]his paragraph shall not apply in the case of Puerto
Rico, the Virgin Islands, and Guam”).
Cite as: 606 U. S. ____ (2025)
Opinion of the Court
21
In the dissent’s view, a statute confers a privately enforce
able right whenever it uses “compulsory” and “individual
centric terminology,” as long as it also evokes “language
classically associated with establishing rights.” Post, at 12
(opinion of JACKSON, J.). When it comes to that last require
ment, the dissent reasons this way: Congress enacted
§1396a(a)(23)(A) under the title “free choice by individuals
eligible for medical assistance,” 81 Stat. 903 (capitalization
omitted); the phrase “free choice” calls to the dissent’s mind
a phrase from the First Amendment (“free exercise” of reli
gion); that Amendment declares rights; so §1396a(a)(23)(A)
likely must as well. Post, at 12 (opinion of JACKSON, J.).
Our precedents do not authorize anything like the dis
sent’s approach—and for good reasons. To start, while a
title may underscore that the statutory text creates a right,
“[i]t has long been established that the title of an Act cannot
enlarge or confer powers” by itself. Pennhurst, 451 U. S., at
19, n. 14 (internal quotation marks omitted); see A. Scalia
& B. Garner, Reading Law: The Interpretation of Legal
Texts 221–224 (2012). That must be especially so where, as
here, Congress chose not to enact into the U. S. Code the
very title on which the dissent relies. See 81 Stat. 903 (en
acting the title of a different section, but not “free choice by
individuals eligible for medical assistance,” into the U. S.
Code (capitalization omitted)).
Even beyond that, the dissent’s test would risk obliterat
ing the longstanding line between mere benefits and en
forceable rights. See supra, at 6, 13, 15. If, as the dissent
says, §1396a(a)(23)(A) creates an enforceable right because
it contains “compulsory” and “individual-centric terminol
ogy” plus an iffy analogy to the Bill of Rights, then many
other provisions (in Medicaid and elsewhere) previously
thought to confer only benefits would suddenly create rights
instead. Supra, at 18–19. All despite Talevski’s insight just
two Terms ago that, while many statutes supply benefits,
only “atypical” statutes confer enforceable rights under
22 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
§1983. 599 U. S., at 183. To be sure, the dissent assures us
that other Medicaid provisions are distinguishable from
this one. Post, at 19 (opinion of JACKSON, J.). How? Not
based on their text (which the dissent never addresses) but,
it seems, based on an unspoken judicial intuition that the
provision before us is just more important than others. So,
on top of all its other flaws, the dissent’s approach would
leave States guessing about the terms of their deals with
the federal government and invite courts to revive their
long-abandoned approach of usurping Congress’s role in
creating rights and remedies. Supra, at 7.8
Fourth and finally, the plaintiffs and dissent advance a
policy argument. Only §1983 litigation, they submit, can
give the any-qualified-provider provision the teeth it needs.
——————
8We agree with the dissent that we did not grant certiorari to resolve
“whether and to what extent O’Bannon [v. Town Court Nursing Center,
447 U. S. 773 (1980)] bears on the scope of ” §1396a(a)(23)(A). Post, at
14, n. 5. But since the dissent relies heavily on that decision, post, at 13–
14, we should make plain that we read it as consistent with all we have
said. O’Bannon held only that residents of a nursing facility had no right
under the Due Process Clause to a hearing before a State ended that
facility’s participation in its Medicaid program. 447 U. S., at 775, 790.
To the extent O’Bannon addressed any right, then, it was an asserted
property right under the Due Process Clause, not a clear and unambigu
ous statutory right under §1983. Id., at 779. Notably, too, O’Bannon
expressly recognized that 42 U. S. C. §1396a(a)(23) “does not confer a
right on a recipient . . . to continue to receive benefits for care [from a
provider] that has been decertified.” 447 U. S., at 785. And that is pre
cisely the right the plaintiffs assert here.
Separately, the dissent suggests that amicus briefs the government
filed in other cases might suffice to supply States with notice of a condi
tion attached to federal funding. Post, at 16–17, and n. 6 (opinion of
JACKSON, J.). But, as this case attests, the government’s views can shift
from administration to administration. And our decisions have never
suggested that anything less than clear statutory language can supply
States with the unambiguous notice required. Instead, given the sepa
ration of powers and federalism concerns we have outlined, our decisions
have always “insist[ed] that Congress speak with a clear voice.”
Pennhurst State School and Hospital v. Halderman, 451 U. S. 1, 17
(1981) (emphasis added).
Cite as: 606 U. S. ____ (2025)
Opinion of the Court
23
Yes, they acknowledge, the federal government can audit
States’ compliance with §1396a(a)(23)(A) and withhold
some or all Medicaid funds from noncompliant States. Brief
for Respondents 44. But, the plaintiffs and dissent insist,
the federal government has neither the capacity nor the ap
petite for taking that “drastic step.” Ibid.; see Tr. of Oral
Arg. 110; see also post, at 2–3 (JACKSON, J., dissenting).
This argument suffers from a number of problems. For
one, this Court has specifically rejected the notion that “the
cut-off of funding” is “too massive” a remedy “to be a realis
tic source of relief ” for violations of §1396a(a) provisions.
Armstrong, 575 U. S., at 331. To the contrary, this Court
has called funding cutoffs “the typical remedy” when a
grant recipient violates the terms of spending-power legis
lation. Pennhurst, 451 U. S., at 17.
For another, funding cutoffs may not be the only way to
enforce §1396a(a)(23)(A). Like other States, South Carolina
has an administrative process that lets providers challenge
their exclusion from the State’s Medicaid program. See
Brief for United States as Amicus Curiae 30; Gillespie, 867
F. 3d, at 1038. That process can culminate with state judi
cial review—and, if necessary, with a petition for certiorari
to this Court. See S. C. Code Ann. §1–23–380 (Cum. Supp.
2024). Indeed, Planned Parenthood itself pursued just such
an administrative claim at one point. See App. 61–63.
For another thing still, if existing remedies prove insuffi
cient, Congress can create new ones. So, for example, it
might do as it did in FNHRA and revise §1396a(a)(23)(A) to
provide States with clear and unambiguous notice of an in
dividually enforceable right. Of course, as we have ob
served, a decision like that comes with tradeoffs. At their
best, individual suits under §1983 can vindicate plaintiffs’
rights while pushing States to fulfill their obligations. But
private enforcement does not always benefit the public, not
least because it requires States to divert money and atten
tion away from social services and toward litigation. And
24 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC
Opinion of the Court
balancing those costs and benefits poses a question of public
policy that, under our system of government, only Congress
may answer. See Sandoval, 532 U. S., at 286; Gonzaga, 536
U. S., at 285–286.9
*
Section 1983 permits private plaintiffs to sue for viola
tions of federal spending-power statutes only in “atypical”
situations, Talevski, 599 U. S., at 183, where the provision
in question “clear[ly]” and “unambiguous[ly]” confers an in
dividual “right,” Gonzaga, 536 U. S., at 290. Section
1396a(a)(23)(A) is not such a statute. Because the Fourth
Circuit concluded otherwise, its judgment is reversed and
the case is remanded for further proceedings consistent
with this opinion.
It is so ordered.
——————
9In the end, the dissent resorts to the extravagant charge that our de
cision represents the “latest chapter” in a “project of stymying . . . civil
rights.” Post, at 1 (opinion of JACKSON, J.); see also post, at 22. As we
have explained at length, our decision simply applies the same test this
Court applied in Gonzaga and again in Talevski (with the support of to
day’s dissenters). And in doing so, we reach the unsurprising conclusion
that it generally belongs to the federal government to supervise compli
ance with its own spending programs. As the dissenters themselves put
it in Talevski, spending-power legislation creates privately enforceable
rights only in “atypical case[s].” 596 U. S., at 183. Our decision merely
recognizes that this case is not an atypical one.
Thank you for reading Von’s Substack. I would love it if you commented! I love hearing from readers, especially critical comments. I would love to start more letter exchanges, so if there’s a subject you’re interested in, get writing and tag me!Thank you for reading Von’s Substack. I would love it if you commented! I love hearing from readers, especially critical comments. I would love to start more letter exchanges, so if there’s a subject you’re interested in, get writing and tag me!
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