Is a Civil Rights Lawsuit by Private Parties a Means to Enforce a Federal Free Choice of Medicaid Provider Provision? A Spending Clause Case with Abortion in the Background | Pullman & Comley, LLC

CASE AT A GLANCE –

In 2018, Planned Parenthood South Atlantic (PPSAT) and one of its patients, Julie Edwards, sued the administrator of South Carolina’s Medicaid program to enforce the “free choice of Medicaid provider” provision of a federal statute. South Carolina had paid for nonabortion physician and pharmacy Medicaid services at PPSAT for decades before executive orders from the governor of South Carolina led to the disqualification of PPSAT as a Medicaid provider. The termination occurred solely because PPSAT also performs abortion services outside of the Medicaid program. Whether PPSAT will remain protected from disqualification by lower court orders will depend on whether the Supreme Court upholds Edwards’ right to sue to enforce the law’s choice of provider promise as allowed by the courts so far. Since the choice of provider right derives from Spending Clause legislation, the Court may disallow the private civil rights action brought by Edwards if it finds that insufficient rights-conferring language exists to justify the lawsuit.

Originally Published by the American Bar Association.