This week, the Center for Medicare Advocacy joined the National Health Law Program and numerous other health organizations in urging the Supreme Court to confirm that individuals may sue to enforce Medicaid’s “free choice of provider” provision. The “freedom of choice” provision establishes beneficiaries’ right to obtain services from any health care provider who is qualified to offer those services and is enrolled in the Medicaid program. The same provision exists for beneficiaries in Medicare. Congress incorporated the right to choose one’s medical provider into Medicare and Medicaid over 50 years ago.
In Medina v. Planned Parenthood of South Atlantic, the U.S. Supreme Court will decide whether Medicaid beneficiaries can enforce the freedom of choice provision in court. The case stems from South Carolina’s attempt to terminate Planned Parenthood from its Medicaid program without cause, thus denying beneficiaries the ability to see qualified Medicaid providers of their choosing. It is being heard after the Fourth Circuit Court of Appeals repeatedly rejected the state’s efforts, and the legal issue the Supreme Court will decide does not concern Planned Parenthood or its services. South Carolina argues that Medicaid beneficiaries simply do not have the right to sue under a federal law known as Section 1983 to enforce the free choice of provider provision. But just recently, in nearly identical circumstances, the Court decided that such rights are enforceable via Section 1983. Health and Hospital Corporation of Marion County v. Talevski held that public nursing home residents can sue under Section 1983 to enforce their rights under the federal Nursing Home Reform Act.
In this case, as in Talevski, the Medicaid statutory provision in question unambiguously confers an individual right. The amicus brief joined by CMA and other advocacy groups explains that Congress’s intent to confer an individual right is unmistakable. When Medicare and Medicaid were first enacted in 1965, Congress included a free-choice-of-provider provision in Medicare, but not in Medicaid. The impetus behind the provision was ensuring that all patients enjoyed the same autonomy in their choice of provider. After it became clear that Medicaid patients were being restricted to receiving care from certain government facilities, Congress added an almost verbatim freedom of choice provision to Medicaid. It was clear that Congress wanted individual beneficiaries to have the right to see the qualified doctor of their choosing. Under the Court’s holding in Talevski, this means that individuals should be able to enforce this right in court.
The Supreme Court will hear argument in Medina on April 2, 2025, with a decision expected by summer.
Read the amicus brief here.
March 13, 2025 – A. Bers