Medina v. Planned Parenthood South Atlantic

(Slip Opinion)              OCTOBER TERM, 2024                                       1

                                       Syllabus

         NOTE: Where it is feasible, a syllabus (headnote) will be released, as is
       being done in connection with this case, at the time the opinion is issued.
       The syllabus constitutes no part of the opinion of the Court but has been
       prepared by the Reporter of Decisions for the convenience of the reader.
       See United States v. Detroit Timber & Lumber Co., 

.


SUPREME COURT OF THE UNITED STATES

                                       Syllabus

      MEDINA, DIRECTOR, SOUTH CAROLINA
DEPARTMENT OF HEALTH AND HUMAN SERVICES
v. PLANNED PARENTHOOD SOUTH ATLANTIC ET AL.

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR
                 THE FOURTH CIRCUIT

       No. 23–1275. Argued April 2, 2025—Decided June 26, 2025


Congress created Medicaid in 1965 to subsidize state healthcare for fam-
  ilies and individuals “whose income and resources are insufficient to
  meet the costs of necessary medical services.” §1396–1. Medicaid of-
  fers States “a bargain”: federal funds in exchange for compliance with
  congressionally imposed conditions. To participate in Medicaid, States
  must submit a “plan for medical assistance” satisfying over 80 condi-
  tions in §1396a(a). If a State fails “to comply substantially” with any
  condition, the Secretary of Health and Human Services may withhold
  federal funding. §1396c. This case involves the any-qualified-provider
  provision in §1396a(a)(23)(A), which requires States to ensure that
  “any individual eligible for medical assistance . . . may obtain” it “from
  any [provider] qualified to perform the service . . . who undertakes to
  provide” it. The provision does not define “qualified,” leaving that to
  States’ traditional authority over health and safety matters. The ques-
  tion is whether individual Medicaid beneficiaries may sue state offi-
  cials under 

 for failing to comply with the any-quali-
  fied-provider provision.
     Planned Parenthood South Atlantic operates two clinics in South
  Carolina, offering a wide range of services to Medicaid and non-Medi-
  caid patients. It also performs abortions. Citing state law prohibiting
  public funds for abortion, South Carolina in July 2018 determined that
  Planned Parenthood could no longer participate in the State’s Medi-
  caid program. At the same time, the State took steps that, it said,
2      MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                                 Syllabus

    would help ensure that other providers would continue offering neces-
    sary medical care and family planning services. Planned Parenthood
    and patient Julie Edwards sued, claiming the exclusion of Planned
    Parenthood violated the any-qualified-provider provision. Edwards al-
    leged she preferred Planned Parenthood for gynecological care but
    needed Medicaid coverage. They brought a §1983 class action “to vin-
    dicate rights secured by the federal Medicaid statutes.”
       Section 1983 allows private parties to sue state actors who violate
    their “rights” under the federal “Constitution and laws.” But federal
    statutes do not automatically confer §1983-enforceable “rights.” This
    is especially true of spending-power statutes like Medicaid, where “the
    typical remedy” for violations is federal funding termination, not pri-
    vate suits. Gonzaga Univ. v. Doe, 

.
       The district court granted summary judgment for plaintiffs and en-
    joined the exclusion. The Fourth Circuit affirmed. This Court then
    granted certiorari, vacated, and remanded in light of Health and Hos-
    pital Corporation of Marion Cty. v. Talevski, 

, which ad-
    dressed whether another spending-power statute created §1983-en-
    forceable rights. On remand, the Fourth Circuit reaffirmed.
Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer
 individual rights enforceable under §1983. Pp. 5–24.
    (a) Congress sometimes allows private enforcement through §1983,
 which authorizes suits against state actors who deprive individuals of
 federal “rights, privileges, or immunities.” But statutes create indi-
 vidual rights only in “atypical case[s].” Talevski, 

.
 Section 1983 provides causes of action for deprivation of “ ‘rights,’ ” not
 mere “ ‘benefits’ or ‘interests.’ ” Gonzaga, 

.
    To prove an enforceable right, plaintiffs must show the statute
 “clear[ly] and unambiguous[ly]” uses “rights-creating terms” with “an
 unmistakable focus” on individuals. 

. This is a “strin-
 gent” and “demanding” test. Talevski, 

. Even
 qualifying statutes may be unenforceable if Congress provided alter-
 native remedies.
    These rules vindicate separation of powers. Courts once assumed
 authority to provide whatever remedies seemed necessary for statu-
 tory purposes. But statutes do not pursue single purposes “at all
 costs,” American Express Co. v. Italian Colors Restaurant, 

, and Congress may not wish to authorize private suits, Her-
 nández v. Mesa, 

, 100. Deciding whether to permit private
 enforcement poses delicate policy questions involving competing costs
 and benefits—decisions for elected representatives, not judges. Pp. 6–
 7.
    (b) Spending-power statutes are especially unlikely to confer en-
 forceable rights. Unlike Commerce Clause or other regulatory powers,
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                               Syllabus

Congress’s spending authority rests on the “Taxing Clause” (Art. I, §8,
cl. 1), which does not expressly authorize regulating conduct or issuing
direct orders to States.
   Early courts described federal grants as contracts, not commands.
Federal-state agreements resemble treaties “between two sovereign-
ties.” Neil, Moore & Co. v. Ohio, 

. Treaties may benefit
citizens but generally do not confer individually enforceable rights
against sovereigns, instead depending on the contracting governments
for enforcement. Thus, “Congress alone has the power to enforce”
grant conditions. Emigrant Co. v. County of Adams, 

.
Pp. 8–10.
   (c) In Pennhurst State School and Hospital v. Halderman, 

, the Court established that spending-power legislation is “much in
the nature of a contract.” 

. The “typical remedy for state
noncompliance” is federal funding termination. 

. Private en-
forcement requires showing States “voluntarily and knowingly” con-
sented to private suits, meaning Congress must “clearly” and “unam-
biguously” alert States that private enforcement was a funding
condition. 

.
   Gonzaga held that spending-power legislation cannot support §1983
suits unless Congress “speaks with a clear voice, and manifests an un-
ambiguous intent to confer individual rights.” 

. Only
“unmistakable” notice suffices. 

 at 286–287, and n. 5
   Talevski reaffirmed that Gonzaga “sets forth [the] established
method.” 

. Statutory provisions must “unambigu-
ously confer individual federal rights”—a “demanding bar” cleared
only in “atypical” cases. 

, 183–184. The statutes there qual-
ified because they “expressly” used clear “rights-creating language.”

 (internal quotation marks omitted).
   Earlier cases like Wilder v. Virginia Hospital Assn., 

,
Wright v. Roanoke Redevelopment and Housing Authority, 

, and Blessing v. Freestone, 

, suggested less demand-
ing standards, but Gonzaga “reject[ed]” any approach permitting “an-
ything short of an unambiguously conferred right.” 

.
Lower courts should not rely on these repudiated precedents. Pp. 10–
15.
   (d) Section 1396a(a)(23)(A) lacks the required clear rights-creating
language. Since Pennhurst, only three sets of spending-power statutes
have been found to confer §1983 rights: those in Wright, Wilder, and
Talevski. Given this Court’s repudiation of Wright and Wilder’s rea-
soning, Talevski provides the only reliable measure.
   Talevski addressed Federal Nursing Home Reform Act provisions
requiring facilities to “protect and promote” residents’ “right to be free
from” restraints and provisions titled “[t]ransfer and discharge rights”
4      MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                                   Syllabus

    in a subsection called “[r]equirements relating to residents’ rights.”
    §1396r(c) (emphasis added).
        The any-qualified-provider provision looks nothing like these. Sec-
    tion 1396a(a)(23)(A) states that Medicaid plans must “provide that . . .
    any individual eligible for medical assistance . . . may obtain such as-
    sistance from any . . . qualified” provider. This language addresses
    state duties and may benefit providers and patients, but lacks
    FNHRA’s clear “rights-creating language,” Talevski, 

    (internal quotation marks omitted).
        Congress knows how to create clear rights, as FNHRA shows by giv-
    ing nursing-home residents “the right to choose a personal attending
    physician.” §1396r(c)(1)(A)(i) (emphasis added). But that is not the
    law here.
        The provision’s exceptions confirm this reading. States may exclude
    providers “convicted of a felony” and “determin[e]” which convictions
    qualify. §1396a(a)(23)(B). This makes sense if the provision addresses
    state duties to the federal government, but creates problems if it also
    confers individual rights—Congress would grant rights in one breath
    while letting States control their scope in the next.
        The statutory context supports this conclusion. The Medicaid Act
    requires only “substantia[l]” compliance, §1396c, suggesting focus on
    “ ‘aggregate’ ” compliance with federal obligations rather than rights
    “ ‘of any particular person.’ ” Gonzaga, 

. The provision
    appears as paragraph 23 of 87 plan requirements directed to the Sec-
    retary, without discernible organizational principle.                   If
    §1396a(a)(23)(A) created individual rights, many similar Medicaid
    provisions would too, making rights-creating provisions the rule ra-
    ther than “atypical” exceptions. Pp. 15–19.
        (e) Four counterarguments are offered. First, the claim that Con-
    gress modeled §1396a(a)(23)(A) on a Medicare provision titled “ ‘Free
    choice by patient guaranteed.’ ” 

, 42 U. S. C. §1395a. But
    no court has addressed whether that Medicare provision creates §1983
    rights. Moreover, while the Medicare provision “guarantee[s]” patient
    “free choice,” the Medicaid provision never uses “guarantee” or “free
    choice”—Congress omitted the very language claimed to create rights.
    Second, the appeal to legislative history suggesting Congress intended
    individual rights. But statutory interpretation focuses on what Con-
    gress enacted, not speculated intentions. For spending-power stat-
    utes, “the key is not what a majority of the Members . . . intend but
    what the States are clearly told.” Arlington Central School Dist. Bd.
    of Ed. v. Murphy, 

. Third, the proposal to remodel
    the established test by arguing that “individual-centric, mandatory
    language” is necessarily “rights-creating” without requiring the “ex-
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                                Syllabus

  plicit rights-creating terms” this Court has long required. This stand-
  ard lacks foundation in precedent and obliterates the distinction be-
  tween mere benefits and enforceable rights. It would make rights-cre-
  ating provisions the rule rather than “atypical” exceptions and leave
  States guessing about their obligations. Fourth, the policy argument
  that only §1983 litigation can effectively enforce the provision, claim-
  ing the federal government lacks capacity or appetite for funding cut-
  offs. This Court has rejected the notion that funding cutoffs are “too
  massive” to be realistic relief. Armstrong v. Exceptional Child Center,
  Inc., 

, 331. Alternative enforcement exists—States have
  administrative processes for provider challenges, reviewable by state
  courts. If existing remedies prove insufficient, Congress can create
  new ones. But balancing enforcement costs and benefits is a policy
  question for Congress, not courts. Pp. 19–24.

, reversed and remanded.

  GORSUCH, J., delivered the opinion of the Court, in which ROBERTS,
C. J., and THOMAS, ALITO, KAVANAUGH, and BARRETT, JJ., joined.
THOMAS, J., filed a concurring opinion. JACKSON, J., filed a dissenting
opinion, in which SOTOMAYOR and KAGAN, JJ., joined.
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                             Opinion of the Court

     NOTICE: This opinion is subject to formal revision before publication in the
     United States Reports. Readers are requested to notify the Reporter of
     Decisions, Supreme Court of the United States, Washington, D. C. 20543,
     pio@supremecourt.gov, of any typographical or other formal errors.


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., 

, 323 (2015). In re-
turn for federal funds, States agree “to spend them in ac-
cordance with congressionally imposed conditions.” 

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, 

 (1997); see also Linder v. United States, 

 (1925); 

(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, 

, 156–157 (CA4 2024). At both locations,
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                      Opinion of the Court

the group offers “a wide range” of services to Medicaid and
non-Medicaid patients. 

 It also performs abortions.

 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.” 

 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. 

 Based on these alle-
gations, Ms. Edwards and Planned Parenthood brought a
putative class action “pursuant to 

 to vin-
dicate rights secured by the federal Medicaid statutes.” 

.
   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
4   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                      Opinion of the Court

and Hospital Corporation of Marion Cty. v. Talevski, 

 (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, 

, 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, 

 (2002) (quoting
Pennhurst State School and Hospital v. Halderman, 

 (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, 

,
448 (SC 2020).
   On appeal, the Fourth Circuit affirmed the district court’s
decision. Planned Parenthood South Atlantic v. Kerr, 

 (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
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                      Opinion of the Court

intervening decision in Talevski, 

, 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, 

 (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, 

, 971
(CA7 2025) (en banc); 

 (Hamilton, J., dissenting);
New York State Citizens’ Coalition for Children v. Poole,

 (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, 

, 350 (CA5 2020) (en
banc); Does v. Gillespie, 

 (CA8 2017).
We agreed to hear the case. 

 (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.
6   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, 

. Still, this Court has emphasized,
statutes create individual rights only in “atypical case[s].”
Talevski, 

. 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, 

.
   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.” 

. In addition, the statute
must display “ ‘an unmistakable focus’ ” on individuals like
the plaintiff. 

 (emphasis deleted); accord, Talev-
ski, 

. We have described this as a “strin-
gent” and “demanding” test. 

; 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, 

 (2005).
   These rules seek to “vindicat[e] the separation of powers.”
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                          Opinion of the Court

Talevski, 

. 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, 

, 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, 

 (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, 

,
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 

 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, 

 (2001);
Gonzaga, 

.1

——————
  1 Cannon v. University of Chicago, 

 (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,

, 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, 

 (1992) (Scalia, J., concurring in judgment); see also Ston-
eridge Investment Partners, LLC v. Scientific-Atlanta, Inc., 

,
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, 

.
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., 

, 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. 

, 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

he denied that those powers included as well “a power to do
whatever else should appear to Congress conducive to the
General Welfare.” 

 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, 

, 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,

 (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, 

, 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. 

 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, 

 (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, 

(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, 

 (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, 

 (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, 

 (1879); see also Mills
County v. Railroad Cos., 

 (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

——————
  2 Much 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, 

 (2008) (quoting 2
Restatement (Third) of Foreign Relations Law of the United States §907,
Comment a, p. 395 (1986); emphasis added).
                    Cite as: 

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                        Opinion of the Court

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, 

 (1937); see also
Massachusetts v. Mellon, 

 (1923); Butler,
297 U. S., at 73–75; Oklahoma v. Civil Serv. Comm’n, 

, 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, 

, 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. 

. 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.” 

. 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.” 

. Given these principles, the Court
reasoned, whether a private party may sue to enforce the
——————
  3 Between 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.

. 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.” 

 (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.” 

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

——————
   4 Beyond 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, 

 (1987); see supra, at 8–9. Second,
grant conditions must relate “to the federal interest in particular na-
tional projects or programs.” Dole, 

 (internal quotation
marks omitted). Third, “other constitutional provisions may provide an
independent bar to the conditional grant of federal funds.” 

.
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, 

, 581–582 (2012) (opinion of
ROBERTS, C. J.); see also id., at 676 (Scalia, Kennedy, THOMAS, and ALITO,
JJ., dissenting).
                      Cite as: 

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                           Opinion of the Court

could not proceed. 

.5
   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,

. 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. 

 (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, 

, 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, 

; 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, 

, and
n. 5; cf. Gregory v. Ashcroft, 

, 460–461 (1991).
14   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                       Opinion of the Court

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.” 

 (1990)
(alteration and internal quotation marks omitted); see
Wright v. Roanoke Redevelopment and Housing Authority,

, 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. 

, 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.” 

. 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. 

.
   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, 

; see 

.
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, 

. To the extent lower courts feel
                     Cite as: 

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                         Opinion of the Court

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, 

.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
——————
  6 As we have seen, the plaintiffs must also show that the provision in

question displays “an unmistakable focus” on individuals like them.
Gonzaga, 

 (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, 

 (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: 

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                      Opinion of the Court

provisions could not have been more different. See 101
Stat. 1330–152; Talevski, 

. 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, 

, ___ (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.’ ” 

. 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,’ ” 

, 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, 

.
   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.
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                           Opinion of the Court

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.” 

 (citing Polk v.
Yee, 

, 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, 

, 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, 

 (2006).7
——————
  7 If 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.’ ” 

, 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: 

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                      Opinion of the Court

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,” 

 (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, 

 (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 

 (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. 

. 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.
——————
   8 We agree with the dissent that we did not grant certiorari to resolve

“whether and to what extent O’Bannon [v. Town Court Nursing Center,

 (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. 

.
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.” 

. 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, 

(1981) (emphasis added).
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                      Opinion of the Court

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, 

.
   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, 

. 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, 

; 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, 

, where the provision
in question “clear[ly]” and “unambiguous[ly]” confers an in-
dividual “right,” Gonzaga, 

. 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.




——————
   9 In 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.
                  Cite as: 

 (2025)             1

                     THOMAS, J., concurring

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 THOMAS, concurring.
   Individual plaintiffs may invoke Rev. Stat. §1979, 

, to sue state or local officials who have de-
prived them of “any rights, privileges, or immunities se-
cured by the Constitution and laws.” In other words, §1983
provides a mechanism for plaintiffs to enforce constitu-
tional or statutory provisions that confer personally held
federal rights. The Court correctly holds today that
§1396a(a)(23)(A) of the Medicaid Act is not such a provision.
Its decision properly limits plaintiffs’ ability to bring §1983
suits premised on conditional spending legislation, and I
join in full. I write separately because it behooves us to
reexamine more broadly this Court’s §1983 jurisprudence,
which bears little resemblance to the statute as originally
understood. In appropriate cases, we should reassess
§1983’s bounds, including its application in the spending
context and our understanding of the “rights” enforceable
under §1983.
                           I
  The history of §1983 makes clear that the statute has ex-
2   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                      THOMAS, J., concurring

ceeded its original limits. Section 1983 originated as a nar-
row, Reconstruction era statute.
                                A
  Congress enacted §1983 as §1 of the Civil Rights Act of
1871, 

. The 1871 Act was designed “to enforce
the Provisions of the Fourteenth Amendment,” ibid., “in re-
sponse to an ongoing pattern of violence and intimidation”
against former slaves, W. Baude, J. Goldsmith, J. Manning,
J. Pfander, & A. Tyler, Hart and Wechsler’s The Federal
Courts and the Federal System 1279 (8th ed. 2025) (Hart &
Wechsler). In its original form, §1983 provided a means by
which private plaintiffs could obtain redress from state and
local officials for certain constitutional violations:
      “Be it enacted . . . That any person who, under color
    of any law, statute, ordinance, regulation, custom, or
    usage of any State, shall subject, or cause to be sub-
    jected, any person within the jurisdiction of the United
    States to the deprivation of any rights, privileges, or
    immunities secured by the Constitution of the United
    States, shall . . . be liable to the party injured in any
    action at law, suit in equity, or other proper proceeding
    for redress . . . .” 

.
   In 1874, Congress extended §1983’s reach to some statu-
tory violations, amending the language on “rights, privi-
leges, or immunities” to encompass “rights . . . secured by
the Constitution and laws.” Rev. Stat. §1979 (emphasis
added). Congress made this change as part of a general
1874 revision that aimed to “simplify, organize, and consol-
idate all federal statutes” into a single volume. Chapman
v. Houston Welfare Rights Organization, 

(1979) (Powell, J., concurring). In undertaking this revi-
sion, Congress “did not intend . . . to alter the content of fed-
eral statutory law,” 

, but only to “reproduc[e]” the
“existing laws,” with “such additions . . . as shall give to
                   Cite as: 

 (2025)              3

                      THOMAS, J., concurring

these provisions their intended effect,” H. R. Misc. Doc. No.
31, 40th Cong., 3d Sess., 2 (1869).
   Section 1983 has remained virtually unchanged, with
only relatively minor revisions. The current provision al-
lows injured parties to sue state and local officials for “the
deprivation of any rights, privileges, or immunities secured
by the Constitution and laws” that they cause “under color
of ” state law.
                                B
   Although the text of §1983 has remained largely con-
stant, the judicial understanding of its scope is an entirely
different matter. At the time of its enactment, Ҥ1983 was
the least controversial provision in the 1871 Act, attracting
little attention or debate.” Crawford-El v. Britton, 

, 829–830 (CADC 1996) (en banc) (Silberman, J., con-
curring). The “provision spawned relatively few cases for
many decades.” Hart & Wechsler 1280. By one count,
“there were only 21 cases decided under §1983 in its first 50
years.” Crawford-El, 

 (Silberman, J., con-
curring).
   When courts did face §1983 cases, they construed the
statute narrowly. This Court early on deemed §1983’s pro-
tection of “rights, privileges, or immunities” to “refer to civil
rights only.” Holt v. Indiana Mfg. Co., 

(1900). The Court “never was precise about what these civil
rights were,” but case law generally focused on “the rights
that Congress had delineated in the Civil Rights Act of
1866,” which “mandated racial equality respecting a citi-
zen’s ability to sue and be a party in state court, to testify,
to make contracts, and to buy, sell, and inherit property.”
M. Collins, “Economic Rights,” Implied Constitutional Ac-
tions, and the Scope of Section 1983, 77 Geo. L. J. 1493,
1500–1501 (1989) (Collins); see 

, as amended, 42
U. S. C. §§1981–1982. Courts later coalesced around then-
Justice Stone’s view that the relevant rights were “one[s] of
4   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                     THOMAS, J., concurring

personal liberty,” such as free speech and assembly, but not
“property rights.” Hague v. Committee for Industrial Or-
ganization, 

 (1939); see Maine v. Thi-
boutot, 

, 27–28, and nn. 17–18 (1980) (Powell, J.,
dissenting) (discussing then-Justice Stone’s “prevailing
view”). The courts also adopted “a restrictive reading of the
statute’s reference to rights ‘secured by’ the Constitution
and laws,” construing that phrase to “exclud[e] rights that
did not . . . take their origin in or derive ‘directly’ from the
Constitution or federal law.” Collins 1502–1503, and nn.
59–60.
   This Court’s §1983 jurisprudence took a sharp turn when
the Court decided Monroe v. Pape, 

 (1961).
Prior to Monroe, §1983 was understood to impose liability
only for actions “taken by officials pursuant to state law.”
Id., at 184; see Crawford-El v. Britton, 

(1998) (Scalia, J., dissenting). But, Monroe held that an of-
ficial acts “under color of law” and becomes subject to the
statute so long as he “is clothed with the authority of state
law,” regardless of whether the State has authorized his ac-
tions. 

 (internal quotation marks
omitted). As a result, individuals can now bring §1983 ac-
tions for “violations committed without the authority of
any” state law or “indeed even . . . violations committed in
stark violation of state civil or criminal law.” Crawford-El,

 (Scalia, J., dissenting). Monroe thus
“breathed new life” into §1983. E. Zagrans, “Under Color
Of ” What Law: A Reconstructed Model of Section 1983 Lia-
bility, 

, 500–501 (1985).
   The Court continued to broaden §1983 in the years that
followed. In Lynch v. Household Finance Corp., 

 (1972), it rejected then-Justice Stone’s exclusion of
“ ‘property’ rights” from the scope of §1983. Id., at 542.
Then, in 1980, the Court recognized for the first time in Thi-
boutot that §1983 could reach statutory violations in addi-
tion to constitutional ones. See 448 U. S., at 4–5; ante, at 6.
                      Cite as: 

 (2025)                      5

                         THOMAS, J., concurring

The upshot of these decisions was that §1983 can reach “any
and all violations” of rights secured by the Constitution or
federal law. Health and Hospital Corporation of Marion
Cty. v. Talevski, 

 (2023) (THOMAS, J., dis-
senting); see Dennis v. Higgins, 

 (1991);
Thiboutot, 448 U. S., at 4–5. Moreover, under the Court’s
modern standard, a right is “secured by” the Constitution
or federal law as long as it “unambiguously confer[s] indi-
vidual rights upon a class of beneficiaries,” and Congress
did not manifest any contrary intent to make §1983 una-
vailable. Talevski, 

 (internal quota-
tion marks omitted). The consequence is that litigants can
now invoke §1983 to challenge myriad “state actions that
have little or nothing to do with” civil rights. Thiboutot, 

 (Powell, J., dissenting).1
   This jurisprudential shift has transformed §1983 litiga-
tion. In 1961, the year the Court issued Monroe, federal
courts heard just 296 civil rights actions. Crawford-El, 

 (Silberman, J., concurring). Post-Monroe,
courts have faced a “deluge” of §1983 filings numbering in
the tens of thousands each year. R. Aldisert, Judicial Ex-
pansion of Federal Jurisdiction: A Federal Judge’s
Thoughts on Section 1983, Comity and the Federal Case-
load, 1973 Law & Social Order 557, 563; see Federal Judi-
cial Center, M. Schwartz, Section 1983 Litigation 4 (3d ed.
2014) (“Each year, the federal courts face dockets filled with
huge numbers of §1983 cases”).2 Section 1983 has become
——————
  1 To be sure, our §1983 jurisprudence is not without guardrails. As

today’s decision emphasizes, few federal laws truly “secure” individual
rights: Our cases in the spending-power context make clear that federal
laws unambiguously confer such rights “only in ‘atypical case[s],’ ” where
a statutory provision meets a “ ‘stringent’ and ‘demanding’ test.” Ante,
at 6 (quoting Health and Hospital Corporation of Marion Cty. v. Talevski,

 (2023)). But, limits like this one do not alter
the overall thrust of our §1983 case law.
  2 In the 12-month period before September 30, 2024, federal district

courts docketed over 65,000 new civil rights actions. See U. S. Courts,
6    MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                          THOMAS, J., concurring

“easily the most important statute authorizing suits
against state officials for violations of the Constitution and
[federal] laws.” Hart & Wechsler 1280. Notwithstanding
its origins as an “extraordinary remedy passed during Re-
construction to protect basic civil rights against oppressive
state action,” §1983 now serves as “simply one more weapon
in the litigant’s arsenal.” Dennis, 

 (Ken-
nedy, J., dissenting).
                               II
   The “scant resemblance” between §1983 today and §1983
as it was traditionally understood creates good reason to
doubt our modern understanding. Crawford-El, 

 (Scalia, J., dissenting). After all, a statute’s meaning
turns on what its words “conveyed to reasonable people at
the time they were written.” A. Scalia & B. Garner, Read-
ing Law 16 (2012). To ensure that we are not “elevat[ing]
demonstrably erroneous decisions” over “duly enacted fed-
eral law,” we should in appropriate cases revisit the proper
bounds of §1983. Gamble v. United States, 

,
711 (2019) (THOMAS, J., concurring). Although the poten-
tial problems are numerous, this case implicates two in par-
ticular: the extension of §1983 into the spending-power con-
text, and an ahistorically modern understanding of the
“rights” protected by §1983.3
——————
U. S. District Courts—Civil Cases Commenced, by Nature of Suit, Dur-
ing the 12-Month Periods Ending Sept. 30, 2020 through 2024 (Table
C–2A), https://uscourts.gov/sites/default/files/2025-01/jb_c2a_0930.2024.
pdf. Although the data is not granular enough to determine the precise
number of §1983 cases within this total, §1983 cases undoubtedly make
up a sizable fraction. Cf. C. Whitman, Constitutional Torts, 

, 6, n. 9 (1980) (“In practice, virtually all civil rights cases filed
against states in federal court include a §1983 claim”).
   3 I have elsewhere identified other questionable aspects of our §1983

jurisprudence. For example, there is reason to doubt the broad reading
of §1983’s “under color of ” language in Monroe v. Pape, 

(1961). See Baxter v. Bracey, 

, ___–___, n. 2 (2020) (THOMAS,
J., dissenting from denial of certiorari) (slip op., at 5–6, n. 2). Given
                     Cite as: 

 (2025)                    7

                        THOMAS, J., concurring

                                A
   As I explained at length in Talevski, this Court has erred
in extending §1983 into the spending-power context. See
599 U. S., at 196–230 (dissenting opinion). Section 1983
provides a means to redress the deprivation of “rights, priv-
ileges, or immunities secured by the Constitution and
laws.” But, legislation enacted under Congress’s spending
power cannot “secure” rights as required by §1983.
   This conclusion flows from a proper understanding of
spending legislation. An exercise of Congress’s power to
spend “is no more than a disposition of funds.” Id., at 196.
That description holds even when Congress imposes condi-
tions on the receipt of federal funds: Conditional spending
legislation amounts to a “contractual offer,” whose condi-
tions “have no effect . . . unless and until they are freely ac-
cepted by the” recipient. Id., at 196, 201. It thus is “ ‘only
the agreement—and not the statute—[that] makes the
terms obligatory on the funds recipient.’ ” Id., at 204.
   In other words, conditional spending legislation does not
itself “secure any rights.” Id., at 201. It cannot “make cer-
tain” or “guarantee” the obligations imposed by the spend-
ing conditions. J. Worcester, A Dictionary of the English
Language 1299 (1860); accord, Webster’s New Interna-
tional Dictionary 1911 (1909). Accordingly, any third par-
ties who benefit from those obligations cannot derive an en-
forceable federal right from the legislation: “[S]uch third-
party rights . . . are ‘secured’ (if at all) . . . only by the con-
tract between the recipient and the United States.” Talev-

——————
§1983’s Reconstruction era context, it also is questionable whether stat-
utory §1983 actions can be based on laws besides those “enacted under
Congress’ Reconstruction Amendments enforcement powers.” Talevski,

 (THOMAS, J., dissenting). And, reexamination
may be warranted as to whether §1983 even supplies a freestanding
cause of action. See Williams v. Reed, 

, ___, n. (2025)
(THOMAS, J., dissenting) (slip op., at 4, n.).
8   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                     THOMAS, J., concurring

ski, 

 (THOMAS, J., dissenting) (some inter-
nal quotation marks omitted).
    Were it otherwise, conditional spending legislation would
be unconstitutional. When the would-be recipient of federal
funds is a State, treating spending conditions as imposing
mandatory obligations “would contradict the bedrock con-
stitutional prohibition against federal commandeering of
the States.” 

. That prohibition protects state sov-
ereignty by barring Congress from “conscript[ing] state gov-
ernments as its agents” or “requir[ing] the States to govern
according to [its] instructions.” New York v. United States,

 (1992). Moreover, the historical rec-
ord makes clear that Congress’s “spending power is the
power to spend only” and does not “carry with it any inde-
pendent regulatory authority.” Talevski, 

 (THOMAS, J., dissenting).
    I therefore continue to think that the Talevski majority
erred “[i]n holding that spending conditions . . . can directly
impose obligations on the States with the force of federal
law.” 

; see 

 at 177–180 (majority opinion).
When “fairly possible,” we ordinarily read statutes “to avoid
. . . the conclusion that [they are] unconstitutional.” United
States v. Jin Fuey Moy, 

 (1916). Yet,
Talevski chose an implausible reading of §1983 that created
constitutional infirmity—and substantial infirmity, at that,
given the frequency with which modern spending legisla-
tion imposes spending conditions. See 

(THOMAS, J., dissenting).
    This case does not present an occasion to remedy our er-
ror because the petitioner did not ask us to revisit our prec-
edents. But, in a case where the issue is properly pre-
sented, I would make clear that spending conditions—
which are by definition conditional—cannot “secure” rights.
                  Cite as: 

 (2025)             9

                     THOMAS, J., concurring

                              B
   Separately, I question whether our current understand-
ing of §1983 is overbroad with respect to the range of
“rights, privileges, or immunities” covered by that statute.
Given the degree to which the judicial conception of “rights”
evolved over the 20th century, I doubt that §1983, as origi-
nally understood, protects the full range of “rights” that
courts now construe it to cover.
   Our cases have glossed over the threshold question of
what constitutes a “right” under §1983. As to constitutional
rights, the Court has simply assumed that the term “rights”
has the same meaning in §1983 as elsewhere. Accordingly,
the Court has allowed §1983 to evolve “into an all-purpose
constitutional litigation statute,” with its reach growing in
proportion to the Court’s recognition of novel constitutional
“rights” in other contexts, without consideration of whether
§1983’s original meaning can be so flexible. Collins 1537;
see Dennis, 

 (“[W]e have rejected attempts
to limit the types of constitutional rights that are encom-
passed [under §1983]”). As to statutory rights, the Court
has essentially collapsed the question whether a “right” ex-
ists into the broader inquiry whether there is a “righ[t] . . .
secured by the Constitution and laws,” as §1983 requires.
Our current test asks whether a law “clearly and unambig-
uously uses rights-creating terms” and displays “an unmis-
takable focus on individuals like the plaintiff.” Ante, at 6
(internal quotation marks and alterations omitted). But,
the test does not consider the meaning of the term “rights”
standing alone.
   Applying these inquiries, the Court has recognized a wide
variety of constitutional and statutory “rights” enforceable
under §1983. Particularly given how broadly the Court has
construed “the due process or cruel and unusual punish-
ment clauses, almost any common law tort committed by a
state officer” now can be “converted into a constitutional vi-
10   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                        THOMAS, J., concurring

olation and thereby made the basis of a section 1983 ac-
tion.” Developments in the Law: Section 1983 and Federal-
ism, 

, 1173 (1977).4 And, the Court
has found a variety of “rights” conferred through statutes
far removed from §1983’s Reconstruction era roots, such as
laws concerning federal entitlement programs. See, e.g.,
Thiboutot, 448 U. S., at 4–6 (Social Security); Talevski, 599
U. S., at 184–186 (Medicaid).
    We should revisit the threshold question of what consti-
tutes a “right” under §1983. Because we interpret statutes
at the time of their enactment, see Loper Bright Enterprises
v. Raimondo, 

 (2024), the answer to that
question turns on how ordinary readers would have under-
stood the phrase “rights, privileges, or immunities” in 1871.
And, it seems more than likely that contemporaneous read-
ers would have understood those terms more narrowly than
our current §1983 doctrine does. For example, such readers
presumably would have read §1983 in light of its Recon-
struction era context, especially given that the provision’s
“ ‘rights, privileges or immunities’ language suggestively
echoed the fourteenth amendment’s ‘privileges or immuni-
ties’ clause.” Collins 1505; cf. Talevski, 

 (THOMAS, J., dissenting) (questioning whether statu-


——————
  4 In one case, the Court even deemed enforceable under §1983 the neg-

ative Commerce Clause “ ‘right’ to engage in interstate trade free from
restrictive state regulation.” Dennis v. Higgins, 

, 448–451
(1991). Setting aside that “[t]he negative Commerce Clause has no basis
in the text of the Constitution,” Camps Newfound/Owatonna, Inc. v.
Town of Harrison, 

 (1997) (THOMAS, J., dissenting), the
holding in Dennis relied on reasoning from our statutory §1983 cases
that we have since repudiated. Compare 498 U. S., at 448–449, with
ante, at 13–14. As the Court emphasizes today, our more recent statu-
tory §1983 case law makes clear that statutes must include “unambigu-
ous rights-creating language” to be enforceable through §1983. Ante, at
19. In an appropriate case, we should at minimum extend similar scru-
tiny to the range of constitutional rights enforceable through §1983.
                      Cite as: 

 (2025)                       11

                          THOMAS, J., concurring

tory §1983 actions should be “confined to laws enacted un-
der Congress’ Reconstruction Amendments enforcement
powers”).
  Even assuming that courts should give the term “rights”
in §1983 the broadest meaning it could have received in
1871, that meaning almost certainly was narrower than our
understanding today. Case law from the period surround-
ing §1983 emphasized a distinction between rights and
mere government benefits. For example, in cases concern-
ing military pensions, this Court made clear that pensions
were simply “bounties of the government,” to which “[n]o
pensioner has a vested legal right.” United States v. Teller,

 (1883); accord, e.g., Frisbie v. United States,

 (1895). Likewise, while serving on the
Massachusetts Supreme Judicial Court, Justice Holmes fa-
mously summarized the once-prevailing understanding of
government employees’ free speech rights when he declared
that “[t]he petitioner may have a constitutional right to talk
politics, but he has no constitutional right to be a police-
man”—that is, he has no right to public employment.
McAuliffe v. Mayor and Bd. of Aldermen of New Bedford,

, 

 (1892). That view re-
mained “unchallenged dogma” for “most of th[e 20th] cen-
tury.” Connick v. Myers, 

 (1983).
  Only in the 1960s and 1970s did the Court replace its tra-
ditional distinction between rights and benefits with a dra-
matically expanded conception of “rights.” Most notably, in
Goldberg v. Kelly, 

 (1970), the Court held that
welfare benefits, previously thought of as gratuities, are in
fact property for purposes of the Fourteenth Amendment’s
Due Process Clause. 

 at 261–262.5 Goldberg and other
——————
  5 As I have previously explained, Goldberg rests on tenuous grounds.

Forgoing “meaningful legal analysis,” the decision “simply highlighted
the social importance of ‘entitlements’ ” in modern America. Williams,
604 U. S., at ___–___, n. (dissenting opinion) (slip op., at 3–4, n.) (quoting
Goldberg, 

, and n. 8); see also Gutierrez v. Saenz, 606
12   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                         THOMAS, J., concurring

contemporaneous cases formed a “due process revolution”
that extended the Due Process Clause to cover traditionally
unprotected categories such as “a government job or bene-
fits.” R. Pierce, The Due Process Counterrevolution of the
1990s? 

, 1974, 1977–1980 (1996).
   The modern §1983 framework developed during the same
period as this rights “revolution,” and the Court’s shift in
cases like Goldberg inevitably influenced the Court’s under-
standing of “rights” in the §1983 context. Plaintiffs now
routinely bring §1983 claims alleging constitutional viola-
tions that would have been unimaginable in 1871. Com-
pare, e.g., Escoe v. Zerbst, 

 (1935) (deem-
ing parole an “act of grace” not protected by the Due Process
Clause), with Wilkinson v. Dotson, 

, 76–77
(2005) (allowing prisoners’ challenges to state parole proce-
dures to proceed under §1983). And, much of our case law
on statutory §1983 actions stems from plaintiffs’ efforts to
enforce so-called rights conferred through entitlement pro-
grams. See, e.g., Thiboutot, 448 U. S., at 2–3. In light of
the distinctly modern nature of our §1983 jurisprudence, I
doubt that we have correctly interpreted the term “rights”
for purposes of §1983.6
                      *     *    *
  The Court properly applies our precedents to resolve the
question presented. As it makes clear, even under current
——————
U. S. ___, ___ –___ (2025) (dissenting opinion) (slip op., at 11–13) (ex-
plaining how Goldberg marked a “radical redefinition of ‘property’ ”
rights).
   6 The dissent questions whether sufficient “research” supports my cur-

rent conclusions. Post, at 20–21 (opinion of JACKSON, J.). But, my point
is precisely that further examination is warranted. Insofar as the dis-
sent highlights the existence of other “historical sources” beyond the
scope of this concurring opinion, the “broader” historical record at which
the dissent gestures only reinforces the need to consider the relationship
(or lack thereof ) between our current §1983 jurisprudence and §1983’s
original meaning. Post, at 21.
                 Cite as: 

 (2025)           13

                    THOMAS, J., concurring

doctrine, courts should not too readily recognize a statutory
right as enforceable under §1983. Ante, at 12–14. But,
given the remarkable gap between the original understand-
ing of §1983 and its current role, a more fundamental reex-
amination of our §1983 jurisprudence is in order.
                  Cite as: 

 (2025)             1

                     JACKSON, J., dissenting

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 JACKSON, with whom JUSTICE SOTOMAYOR and
JUSTICE KAGAN join, dissenting.
   The Civil Rights Act of 1871 was an exercise in grand am-
bition. It had to be. In the wake of the Civil War, the Amer-
ican South was consumed by a wave of terrorist violence
designed to disenfranchise and intimidate the country’s
newly freed citizens and their allies. The threat was exis-
tential—not just for the newly liberated, but for democracy
itself—and required bold intervention. It was precisely be-
cause the goals of the 1871 Act were so ambitious that those
most committed to the structures it targeted, including
many in South Carolina, opposed the measure so vehe-
mently.
   A century and a half later, the project of stymying one of
the country’s great civil rights laws continues. In this latest
chapter, South Carolina urges our Court to adopt a narrow
and ahistorical reading of the 1871 Act’s first section, which
is codified today at 

. That venerable pro-
vision permits any citizen to obtain redress in federal court
for “the deprivation of any rights, privileges, or immunities
secured by the Constitution and laws” of the United States.
South Carolina asks us to hollow out that provision so that
2   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                      JACKSON, J., dissenting

the State can evade liability for violating the rights of its
Medicaid recipients to choose their own doctors. The Court
abides South Carolina’s request. I would not. For that rea-
son, I respectfully dissent.
                                I
   This case concerns South Carolina’s obligations under the
Medicaid Act. Signed into law by President Lyndon B.
Johnson in 1965, the Medicaid Act establishes “a coopera-
tive federal-state program that provides medical care to
needy individuals.” Douglas v. Independent Living Center
of Southern Cal., Inc., 

 (2012). “Like other
Spending Clause legislation, Medicaid offers the States a
bargain: Congress provides federal funds in exchange for
the States’ agreement to spend them in accordance with
congressionally imposed conditions.” Armstrong v. Excep-
tional Child Center, Inc., 

, 323 (2015).
   Any State that wishes to receive federal funds under the
program must submit a proposed Medicaid plan to the De-
partment of Health and Human Services (HHS). 42
U. S. C. §1396–1. If HHS approves the plan, the State will
receive the funding. States enjoy relatively wide discretion
in crafting their Medicaid plans. They have significant con-
trol, for instance, over who is eligible to receive Medicaid
benefits and which types of services are covered. E.g.,
§§1396a(a)(10)(A)(ii), (70), (86).
   Still, the Medicaid Act imposes certain plan requirements
on States as a condition of receiving federal funding. If a
State “fail[s] to comply substantially” with those conditions,
HHS may withhold further funding from that State.
§1396c; see also 

(c) (2023). In practice, how-
ever, HHS rarely invokes its authority to withhold funding
because doing so would inevitably harm the program’s ben-
eficiaries.1
——————
 1 Kaiser Family Foundation, Focus on Health Reform: A Guide to the
                     Cite as: 

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                         JACKSON, J., dissenting

    One of the conditions that the Medicaid Act imposes on
participating States is the requirement that Medicaid re-
cipients be able to choose their own healthcare providers
without government interference. The statute explicitly re-
quires that every State’s Medicaid plan must “provide that
. . . any individual eligible for medical assistance (including
drugs) may obtain such assistance from any institution,
agency, community pharmacy, or person, qualified to per-
form the service or services required.” §1396a(a)(23)(A).
Congress enacted that provision, known as the “free-choice-
of-provider provision,” in order to prevent States from steer-
ing Medicaid recipients to the States’ preferred healthcare
providers. See H. R. Rep. No. 544, 90th Cong., 1st Sess.,
122 (1967).
    The dispute in this case arises from South Carolina’s fail-
ure to comply with that provision. In 2018, the State’s Gov-
ernor issued an executive order deeming all “abortion clin-
ics” unqualified to provide healthcare services and directing
the State’s Department of Health and Human Services to
terminate them from the State’s Medicaid program. App.
to Pet. for Cert. 157a–160a. That executive order would
have forced two clinics operated by Planned Parenthood
South Atlantic (PPSAT)—one in Charleston and one in Co-
lumbia—to stop serving any patients who rely on Medicaid.
    One of those patients is respondent Julie Edwards. Be-
fore she became a PPSAT patient, Edwards had struggled
to find a healthcare provider capable of meeting her needs
as a diabetic whose condition heightened the risks associ-
ated with pregnancy. At PPSAT, she found doctors who
were able to provide her with the services she needed, as
well as a respectful and judgment-free environment to re-
ceive care.

——————
Supreme Court’s Decision on the ACA’s Medicaid Expansion 1 (Aug.
2012), https://www.kff.org/affordable-care-act/issue-brief/a-guide-to-the-
supreme-courts-decision/.
4   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                    JACKSON, J., dissenting

   Edwards filed this lawsuit against state health officials
under §1983 seeking to enjoin PPSAT’s termination from
the Medicaid program. She asserted that the termination
decision violated her rights under the free-choice-of-pro-
vider provision to obtain care from her doctors of choice.
   The District Court entered summary judgment in Ed-
wards’s favor and enjoined the State from terminating
PPSAT from its Medicaid program. Planned Parenthood v.
Baker, 

, 448 (SC 2020). The Fourth Cir-
cuit affirmed. Planned Parenthood v. Kerr, 

,
959 (2022). In a careful opinion authored by Judge Wil-
kinson, the panel held that the free-choice-of-provider pro-
vision conferred an individual right on Medicaid recipients
to select their own healthcare providers and that, as such,
that right was enforceable under §1983. Rejecting South
Carolina’s arguments to the contrary, the court concluded
that the “statutory text . . . unmistakably evinces Con-
gress’s intention to confer on Medicaid beneficiaries a right
to the free choice of their provider.” Id., at 956.
   South Carolina petitioned for certiorari. While its peti-
tion was pending, this Court decided Health and Hospital
Corporation of Marion County v. Talevski, 

(2023), which considered whether a different provision of
the Medicaid Act conferred rights enforceable under §1983.
We therefore granted South Carolina’s petition, vacated the
judgment below, and remanded the case for the Fourth Cir-
cuit to reconsider the parties’ arguments in light of our de-
cision in Talevski. 

 (2023).
   On remand, the Fourth Circuit once again determined
that the free-choice-of-provider provision establishes an in-
dividual right that can be enforced under §1983. Planned
Parenthood South Atlantic v. Kerr, 

, 154
(2024). The panel, in another thoughtful opinion by Judge
Wilkinson, “conclude[d] that Talevski did not change the
law to an extent that would call our previous determina-
tions into question.” 

. It therefore affirmed the
                 Cite as: 

 (2025)            5

                    JACKSON, J., dissenting

District Court’s order granting summary judgment to Ed-
wards and enjoining the State from terminating PPSAT
from its Medicaid program. 

.
                               II
   Two years ago, in Health and Hospital Corporation of
Marion County v. Talevski, 

, this Court out-
lined the test for determining whether a federal statute is
privately enforceable under §1983. The majority accepts
that the touchstone for that inquiry is whether the law in
question “unambiguously confer[s] individual federal
rights.” Id., at 180 (emphasis deleted); see ante, at 13. But
the opinion it hands down today suggests that, as a practi-
cal matter, the character of the law—and, in particular,
whether it was enacted under Congress’s spending power—
is all but dispositive of the required rights determination.
That view distorts the unambiguous-conferral test beyond
recognition and strains our precedential holding that
§1983’s unqualified use of the word “laws” means exactly
what it says. As I explain below, under a faithful applica-
tion of our unambiguous-conferral test, the Medicaid Act’s
free-choice-of-provider provision readily creates an enforce-
able right.
                               A
   The Civil Rights Act of 1871 was designed to bolster the
protections of the Civil War Amendments and earlier Re-
construction statutes, which had failed to “preven[t] post-
bellum state actors from continuing to deprive American
citizens of federally protected rights.” Talevski, 

. White supremacist violence was spreading across
the South, aided at times by state and local officials, and
the mayhem posed a fundamental threat to both public
safety and the rule of law. E. Foner, Reconstruction: Amer-
ica’s Unfinished Revolution 1863–1877, pp. 442–444 (1988).
   The 1871 Act aimed to combat that threat in various
6   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                      JACKSON, J., dissenting

ways. One of them, embedded in the Act’s very first section,
was to “ope[n] the federal courts to private citizens, offering
a uniquely federal remedy against incursions under the
claimed authority of state law upon rights secured by the
Constitution and laws of the Nation.” Mitchum v. Foster,

 (1972).
   The text of that provision, now codified at 

, is straightforward. It authorizes private individuals
to sue state or local officials who deprive them of “any
rights, privileges, or immunities secured by the Constitu-
tion and laws” of the United States. Mindful of the statute’s
ambitious goals, the Court has traditionally “given full ef-
fect to its broad language, recognizing that §1983 ‘pro-
vide[s] a remedy, to be broadly construed, against all forms
of official violation of federally protected rights.’ ” Dennis v.
Higgins, 

 (1991).
   Thus, in Maine v. Thiboutot, 

 (1980), we ex-
pressly rejected a State’s contention that the phrase “and
laws” refers only to civil rights laws enacted under Con-
gress’s Fourteenth Amendment powers. As we explained,
the statute’s “plain language”—and, in particular, the fact
that “Congress attached no modifiers to the phrase”—
makes clear that the word “laws” “means what it says” and
is not “limited to some subset of laws.” 

   At the same time, our cases also recognize that §1983
“speaks in terms of ‘rights, privileges, or immunities,’ not
violations of federal law” more generally. Golden State
Transit Corp. v. Los Angeles, 

 (1989). Ac-
cordingly, we have held that a plaintiff may not prevail un-
der §1983 merely by identifying a violation of any federal
statute; rather, she must identify a violation of a statute
that creates “ ‘rights, privileges, or immunities.’ ” Ibid.
   The test we apply for determining whether a statute cre-
ates such “rights, privileges, or immunities” has gradually
grown more restrictive over the years. During the 1980s
and 1990s, the Court adhered to Thiboutot’s plain-language
                  Cite as: 

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                     JACKSON, J., dissenting

approach to §1983 and thus freely recognized individual
rights in federal “laws,” absent clear congressional intent to
the contrary. E.g., Livadas v. Bradshaw, 

,
132–134 (1994) (holding that employees could use §1983 to
enforce a provision of the National Labor Relations Act);
Wright v. Roanoke Redevelopment and Housing Authority,

, 430–432 (1987) (holding that public-housing
tenants could use §1983 to enforce a provision of the Hous-
ing Act of 1937 capping their rental payments).
   In Wilder v. Virginia Hospital Assn., 

, 509–
510 (1990), for instance, we held that healthcare providers
could use §1983 to enforce a provision of the Medicaid Act
that required States to reimburse them at “reasonable and
adequate” rates. We determined that the provision was en-
forceable because it left “little doubt that health care pro-
viders [were] the intended beneficiaries,” and it was “cast
in mandatory rather than precatory terms.” Id., at 510,
512. We also rejected the defendant’s argument that the
provision’s “reasonable and adequate” mandate was “too
‘vague and amorphous’ to be judicially enforceable,” observ-
ing that the statute provided an “objective benchmark” for
States to judge those criteria. Id., at 519.
   A few years after Wilder, Congress endorsed our holistic
approach to evaluating whether statutes create rights that
are enforceable under §1983. In 1994, it passed a statute
confirming that a provision may create enforceable rights
even if the provision is framed as a directive to States as
part of a federal spending program. §555(a), 

.
Congress enacted that statute in direct response to our de-
cision in Suter v. Artist M., where we had held that a provi-
sion of the Adoption Assistance and Child Welfare Act was
not enforceable under §1983. 

 (1992).
Our decision in that case had relied, in part, on the fact that
the provision at issue appeared in a section of the statute
that required States to submit specific plans to HHS as a
condition of receiving federal funds. 

. Rejecting
8    MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                         JACKSON, J., dissenting

that line of reasoning, Congress adopted what has come to
be called the “Suter fix.” The statute it enacted provides
that a “provision is not to be deemed unenforceable because
of its inclusion in a section of this chapter [of the U. S. Code]
requiring a State plan or specifying the required contents
of a State plan.” §1320a–2.2 The statute explicitly “over-
turn[ed]” any suggestion in Suter that state-plan require-
ments cannot be enforced under §1983—an interpretive ap-
proach that, in Congress’s view, had “not [been] applied in
prior Supreme Court decisions respecting [§1983] enforcea-
bility.” Ibid.
   The Court decided Blessing v. Freestone, 

(1997), three years after Congress adopted the Suter fix.
With no mention of §1320a–2, Blessing summarized how
the Court had previously approached determining whether
a federal law is privately enforceable under §1983. After
surveying our past cases on the subject, we identified three
key factors that bore on “whether a particular statutory
provision gives rise to a federal right.” 520 U. S., at 340.
Those three factors were: (1) whether “Congress . . . in-
tended that the provision in question benefit the plaintiff ”;
(2) whether “the right assertedly protected by the statute”
is “so ‘vague or amorphous’ that its enforcement would
strain judicial competence”; and (3) whether the statute
“unambiguously impose[s] a binding obligation on the
States.” Id., at 340–341.
   Although the Blessing factors aimed merely to synthesize
our past decisions, they also struck a balance between
§1983’s broad remedial goals and our historical concern
that States receive fair notice of their statutory obligations
under federal law. That balance began to shift dramatically
in the years following Blessing.

——————
  2 The law at issue in this case—Medicaid’s free-choice-of-provider pro-

vision, 42 U. S. C. §1396a(a)(23)—is codified in the same chapter of Title
42 as the Suter fix.
                  Cite as: 

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                     JACKSON, J., dissenting

                                B
    In Gonzaga University v. Doe, 

 (2002), the
Court adopted a restrictive test for determining whether a
federal statute creates rights enforceable under §1983.
There, we held that a university student could not use
§1983 to enforce a provision of the Family Educational
Rights and Privacy Act (FERPA)—a statute that directed
the Secretary of Education to withhold federal funds from
schools that had failed to maintain the confidentiality of
their students’ educational records. We suggested that
Blessing had led to “confusion” among some lower courts
about how to determine whether a statute confers rights
that are enforceable under §1983. Id., at 282–283. Citing
a need for greater clarity, Gonzaga stated: “We now reject
the notion that our cases permit anything short of an un-
ambiguously conferred right to support a cause of action
brought under §1983.” Id., at 283.
    To justify that stricter standard, the Court relied heavily
on the fact that Congress had enacted FERPA under its
spending powers. We noted that, in “ ‘legislation enacted
pursuant to the spending power, the typical remedy for
state noncompliance with federally imposed conditions is
. . . action by the Federal Government to terminate funds.’ ”
Id., at 280 (quoting Pennhurst State School and Hospital v.
Halderman, 

 (1981)). For that reason, we
explained, recipients of federal funds must have clear notice
that their failure to comply with a particular funding con-
dition might “subjec[t] them to private suits for money dam-
ages” under §1983. 536 U. S., at 286–287, n. 5. We thus
concluded that “if Congress wishes to create new rights en-
forceable under §1983, it must do so in clear and unambig-
uous terms.” Id., at 290. And we held that FERPA flunked
that test because its confidentiality mandate—which was
framed principally as a directive to the Secretary of Educa-
tion—“lack[ed] the sort of ‘rights-creating’ language critical
10   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                      JACKSON, J., dissenting

to showing the requisite congressional intent to create new
rights.” Id., at 287.
   But while Gonzaga made the test for evaluating the en-
forceability of statutory rights under §1983 more stringent,
it did not close the door on §1983 enforcement altogether.
Just two years ago, in Talevski, we applied Gonzaga’s ana-
lytical framework and held that a pair of Medicaid provi-
sions created individual rights. 

. There,
we determined that plaintiffs could use §1983 to enforce
two provisions of the Federal Nursing Home Reform Act, or
FNHRA—one imposing certain predischarge-notice re-
quirements on nursing facilities and the other barring those
facilities from using unnecessary chemical restraints on
their residents. Id., at 171.
   Talevski’s analysis began by restating “the Gonzaga test.”
Id., at 183 (citing Gonzaga, 

). As we
recounted, that test asks whether “the provision in question
is ‘ “phrased in terms of the persons benefited” ’ and con-
tains ‘rights-creating,’ individual-centric language with an
‘ “unmistakable focus on the benefited class.” ’ ” 

 (quoting Gonzaga, 

). Although
we recognized that this test was “stringent,” we held that
the two FNHRA provisions at issue satisfied it. 

. We cited the fact that both provisions appeared in
a list of “[r]equirements ‘relating to residents’ rights.’ ” 

. And we outlined how the text of each provision “un-
ambiguously confer[red] rights upon the residents of nurs-
ing-home facilities ”: The unnecessary-restraint provision
required nursing homes to “protect and promote . . . [t]he
right to be free from . . . any physical or chemical restraints”
not needed for treatment, while the predischarge-notice
provision referred to “ ‘transfer and discharge rights’ ” and
stated that nursing homes “ ‘must not transfer or discharge
[a] resident’ ” without notice. 

 at 184–185.
   Perhaps most importantly, our opinion in Talevski also
squarely rejected the defendant’s argument that “§1983
                     Cite as: 

 (2025)                   11

                        JACKSON, J., dissenting

contains an implicit carveout for laws that Congress enacts
via its spending power.” 

. The defendant, an In-
diana hospital system, had argued that “ ‘Spending Clause
statutes do not give rise to privately enforceable rights un-
der Section 1983’ ” because such statutes operate like con-
tracts, which “were not ‘generally’ enforceable by third-
party beneficiaries at common law.” 

 at 178 (quoting
defendant’s brief ). In rejecting that attempt to dilute
§1983’s power, we affirmed once again that “ ‘[l]aws’ means
‘laws,’ no less today than in the 1870s.” Id., at 172. Our
decision thus preserved §1983’s central remedial aims, even
as it faithfully applied Gonzaga’s “demanding” test for
whether statutes “unambiguously confer individual federal
rights.” 

.3
                                   C
   Medicaid’s free-choice-of-provider provision easily satis-
fies the unambiguous-conferral test. To start, the text of
the provision is plainly “ ‘ “phrased in terms of the persons
benefited” ’ ”—namely, Medicaid recipients. 

. The
provision states that every Medicaid plan “must . . . provide
that . . . any individual eligible for medical assistance (in-
cluding drugs) may obtain such assistance from any insti-
tution, agency, community pharmacy, or person, qualified
to perform the service or services required.”
§1396a(a)(23)(A) (emphasis added). This “individual-cen-
tric” formulation reflects an “ ‘ “unmistakable focus on the
benefited class.” ’ ” Talevski, 

 (quoting Gon-
zaga, 

).

——————
   3 Talevski also recognized that “[e]ven if a statutory provision unam-

biguously secures rights, a defendant ‘may defeat t[he] presumption by
demonstrating that Congress did not intend’ that §1983 be available to
enforce those rights.” 

. South Carolina has not invoked
that proposition here as a basis for arguing that Medicaid’s free-choice-
of-provider provision is not enforceable under §1983.
12   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                         JACKSON, J., dissenting

  Congress also used rights-creating language in the head-
ing of the provision when it enacted the original session
law.     The provision was entitled: “FREE CHOICE BY
INDIVIDUALS ELIGIBLE FOR MEDICAL ASSISTANCE,” 

 (emphasis added).4 This phrasing indisputably invokes
language classically associated with establishing rights.
E.g., U. S. Const., Amdt. 1 (protecting the “free exercise” of
religion); Faretta v. California, 

, 833–834
(1975) (“[W]hatever else may be said of those who wrote the
Bill of Rights, surely there can be no doubt that they under-
stood the inestimable worth of free choice”). And Congress
reinforced its rights-creating intent by making the provi-
sion mandatory—it specifically inserted the word “must”
into the statute—to make clear that the obligation imposed
on the States was binding. If Congress did not want to pro-
tect Medicaid recipients’ freedom to choose their own pro-
viders, it would have likely avoided using a combination of
classically compulsory language and explicit individual-
centric terminology. As the Fourth Circuit rightly put it, it
is “difficult to imagine a clearer or more affirmative di-
rective.” Planned Parenthood v. Baker, 

, 694
(2019).
  The provision’s history confirms what the text makes ev-
ident: that Congress intended the provision to be binding.
Congress enacted the free-choice-of-provider provision in

——————
   4 The majority seeks to downplay the title Congress assigned to the

free-choice-of-provider provision by noting that a title “by itself ” cannot
confer rights. Ante, at 21. But the majority does not appear to dispute
that statutory titles offer at least some insight into Congress’s intent, as
evidenced by the majority’s own reliance on statutory titles elsewhere in
its opinion. See ante, at 15 (highlighting the title of one of FNHRA’s
subprovisions); ante, at 18 (citing the title of §1396a(a)). In any event,
as the rest of the discussion above illustrates, Congress’s decision to use
the “free choice” language in its session-law heading is not the only evi-
dence of its rights-creating intent with respect to the provision at issue
here.
                     Cite as: 

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                        JACKSON, J., dissenting

1967—just two years after the original Medicaid Act—in di-
rect response to efforts by some jurisdictions to steer Medi-
caid beneficiaries to specific providers. See H. R. Rep. No.
544, at 122. To prevent States from interfering with Medi-
caid recipients’ freedom to choose their own providers, Con-
gress adopted nearly identical language from a provision of
the Medicare Act that—in both purpose and effect—had
guaranteed that right to Medicare beneficiaries. §1395a(a).
In other words, Congress made a deliberate choice to pro-
tect Medicaid recipients’ ability to choose their own provid-
ers by employing statutory language that it knew, based on
its Medicare experience, would achieve that end. Con-
gress’s intent could not have been clearer.
   That clarity is perhaps why, in the only other case where
we have had occasion to construe the free-choice-of-provider
provision, we repeatedly used the word “right” to describe
the protection it confers. In O’Bannon v. Town Court Nurs-
ing Center, 

 (1980), a group of elderly Medicaid
recipients sought to leverage the provision to assert “a con-
stitutional right to a hearing” before Medicaid officials
could strip their nursing home of funding. 

. In
rejecting the recipients’ understanding of the provision, we
explained what the provision does protect. As we put it,
Ҥ1396a(a)(23) . . . gives recipients the right to choose
among a range of qualified providers, without government
interference.” Id., at 785 (first emphasis added; citation
omitted). We used the word “right” again in the next sen-
tence to elaborate on that description: “By implication,” we
said, the provision “also confers an absolute right to be free
from government interference with the choice to remain in
a home that continues to be qualified.” Ibid. (emphasis
added).5

——————
  5 In their certiorari-stage briefs, the parties disputed whether and to

what extent O’Bannon bears on the scope of the free-choice-of-provider
provision. We declined to grant certiorari on that question. 

   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                         JACKSON, J., dissenting

  Although O’Bannon was not a case about §1983 enforce-
ability, our description of the free-choice-of-provider provi-
sion confirms that the most natural and obvious way to read
the provision’s individual-centric, mandatory language is
as “rights-creating.”
                                    III
   The majority’s effort to resist the natural and obvious
rights-creating reading of the Medicaid Act’s free-choice-of-
provider provision is, ultimately, unpersuasive. The Court
holds that the provision does not confer any individual
rights on Medicaid recipients, but reaches that conclusion
by applying a version of the unambiguous-conferral test
that we did not endorse in Talevski or Gonzaga. In doing
so, the Court adopts an approach to §1983 that not only un-
dermines the statute’s core function but also stretches our
doctrine beyond anything that can be justified as a matter
of text, precedent, or first principles.
——————
___ (2024) (limiting our grant of certiorari to only the first question pre-
sented in the petition). Undeterred by that choice, the majority proceeds
to address the question we took off the table: It suggests that O’Bannon
is inapposite because our opinion in that case purportedly rejected the
particular right that respondent has asserted here. Ante, at 22, n. 8. But
the question of how broadly to construe the rights conferred by the free-
choice-of-provider provision is distinct from the question of whether the
provision creates rights in the first place. And as to that latter ques-
tion—the sole question presented in this case—O’Bannon’s repeated use
of the word “right” to describe the provision’s protections underscores
how the provision’s text is naturally read to create rights. What is more,
the majority has quoted the O’Bannon passage completely out of context;
when read in its entirety, the quoted passage has little bearing on this
case. The full sentence states that the free-choice-of-provider provision
“clearly does not confer a right on a recipient to enter an unqualified
home and demand a hearing to certify it, nor does it confer a right on a
recipient to continue to receive benefits for care in a home that has been
decertified.” 

. This language does not come close to
suggesting that the free-choice-of-provider provision does not confer a
right to choose one’s provider (i.e., the right respondent has asserted
here), as the majority suggests.
                  Cite as: 

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                     JACKSON, J., dissenting

                                A
   The approach that the Court follows today differs conspic-
uously from the approach we developed in Gonzaga and re-
affirmed in Talevski. To see how, start by observing that
the majority chooses not to frame its analysis around the
question that guided our thinking in those cases: namely,
whether “the provision in question is ‘ “phrased in terms of
the persons benefited” ’ and contains ‘rights-creating,’ indi-
vidual-centric language with an ‘ “unmistakable focus on
the benefited class.” ’ ” Taleveski, 

 (quoting
Gonzaga, 

). Instead, the Court builds
its analysis around the simplistic premise that Medicaid’s
free-choice-of-provider provision “looks nothing like th[e]
FNHRA provisions” we upheld in Talevski. Ante, at 15–16.
   That approach warps our reasoning in Talevski. No-
where in our opinion did we single out FNHRA as the sole
or definitive model for conferring individual rights. To the
contrary, the reason we went out of our way to reaffirm “the
Gonzaga test” was to remove any doubts about “our estab-
lished method for ascertaining unambiguous conferral.”

. Talevski was merely an application of
that methodology to the statutory provision at issue in that
case.
   Yet, now, the majority disregards the established method
and, in its place, looks to FNHRA itself as “the only reliable
yardstick against which to measure whether spending-
power legislation confers a privately enforceable right.”
Ante, at 15. In short, the majority construes our require-
ment that Congress “manifes[t] an ‘unambiguous’ intent to
confer individual rights,” Gonzaga, 

, as a
requirement that Congress manifest an unambiguous in-
tent to imitate FNHRA.
   The majority’s hyperfocus on FNHRA also widens the gap
between our Gonzaga test and the text of §1983 itself. As
noted, §1983 protects against deprivations of “any rights,
16   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                        JACKSON, J., dissenting

privileges, or immunities secured by the . . . laws” of the
United States—not just the specific rights secured by
FNHRA. (Emphasis added.) It is therefore strange to treat
FNHRA as the “only reliable yardstick,” ante, at 15, for as-
sessing whether a statute unambiguously creates enforcea-
ble rights per Gonzaga. Cf. Dennis, 

 (“[W]e
have rejected attempts to limit the types of constitutional
rights that are encompassed within the phrase ‘rights, priv-
ileges, or immunities’ ”). Put simply, the fact that FNHRA
happens to be the subject of one of the few cases this Court
has opted to review concerning §1983 enforceability does
not lend it talismanic status.
   The majority’s FNHRA-or-bust approach makes even less
sense when framed against the Court’s concerns about en-
suring that States have fair notice of their statutory obliga-
tions. As the majority recognizes, the whole reason we re-
quire clear rights-creating language in spending statutes is
because “[o]nly that kind of ‘unmistakable’ notice . . . suf-
fices to alert grantees” that they might be sued under
§1983. Ante, at 12. But focusing myopically on a given stat-
ute’s resemblance to FNHRA does little to advance the goal
of providing fair notice to federal grantees. That is because,
as we have often recognized, Congress “need not use magic
words in order to speak clearly.” Henderson v. Shinseki,

 (2011).
   Indeed, if actual notice were the touchstone, this would
be an easy case: By the time South Carolina chose to termi-
nate PPSAT as a Medicaid provider in 2018, the State had
ample reason to know that it could be sued under §1983—
even beyond the clarity of the free-choice-of-provider provi-
sion’s text. By that point, the Federal Government had long
taken the position that the free-choice-of-provider provision
was privately enforceable via §1983.6 Our decision in
——————
  6 See Brief for United States as Amicus Curiae 4, n. 1 (citing amicus

briefs filed by the Government, across multiple administrations, in cases
                     Cite as: 

 (2025)                    17

                         JACKSON, J., dissenting

O’Bannon had also explicitly described the provision as
“giv[ing] recipients the right to choose” their providers
“without government interference.” 

 (em-
phasis added). And Congress itself had reaffirmed, via the
Suter fix, that the Medicaid Act’s “State plan requirements”
could create enforceable rights. §1320a–2. Our Wilder de-
cision had long since held that a similarly structured provi-
sion of the Medicaid Act—codified in the same section as
the free-choice-of-provider provision—was enforceable un-
der §1983. 

. With all that information,
South Carolina could not reasonably claim surprise that its
decision to restrict Medicaid recipients’ access to particular
healthcare providers might trigger a §1983 suit under the
free-choice-of-provider provision.7
   In any event, the majority’s FNHRA-centric approach to
fair notice fails on its own terms. The free-choice-of-pro-
vider provision mirrors the FNHRA provisions from Talev-
ski in all respects that matter: both employ individual-cen-
tric language that focuses on the relevant beneficiaries and
combine it with mandatory language directed at the rele-
vant grant recipients. The provision also employs rights-
——————
dating back to 2005).
  7 The Court’s repudiation of Wilder today does not alter any of those

historical facts. Indeed, prior to this Court’s attempt to disavow Wilder
in a footnote in Armstrong v. Exceptional Child Center, Inc., 

, 330, n. (2015), it was widely accepted—not just by the Government,
but by every Circuit to consider the question—that the free-choice-of-pro-
vider provision conferred privately enforceable rights. See Planned
Parenthood Ariz. Inc. v. Betlach, 

 (CA9 2013); Planned
Parenthood of Ind., Inc. v. Commissioner of Ind. State Dept. of Health,

 (CA7 2012); Harris v. Olszewski, 

(CA6 2006). South Carolina accepted Medicaid funding for years with
knowledge of those facts. Only recently—in its brief in this case—has
the Federal Government changed its longstanding position. That the
Court has now succeeded in injecting ambiguity where none previously
existed underscores the extent to which the Court’s practical concerns
about fair notice to grantees seem to have been displaced by a general
aversion to recognizing individual rights.
18   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                         JACKSON, J., dissenting

creating language: As explained above, Congress explicitly
used the words “free choice” in the provision’s original head-
ing—words that plainly reflect rights-creating intent. See
Part II–C, supra. The fact that the provision does not spe-
cifically use the word “right” is not dispositive. We have
never required Congress to use specific verbiage to estab-
lish individual rights. And forcing Congress to use the spe-
cific word “right” would make little sense in this context an-
yway in light of §1983’s more capacious phrase “rights,
privileges, or immunities.” Nor does it matter that FNHRA
contains its own free-choice provision protecting the “ ‘right
to choose a personal attending physician.’ ” Ante, at 16
(quoting §1396r(c)(1)(A)(i)). If anything, that Congress
chose to use “Free choice” in the heading of both provisions
reflects its understanding that the two provisions would
have the same rights-protecting effect.8
   Congress ultimately has wide discretion to use whatever
language it wishes to create individual rights. We require
only that it do so unambiguously. As the court below aptly
put it, it is not our role “to limit Congress to a thin thesau-
rus of our own design.” 95 F. 4th, at 166.
                                    B
  In typical parade-of-horribles-like fashion, the majority
also expresses the concern that, if the Court were to hold
that the free-choice-of-provider provision confers an indi-
vidual right, it would mean that “[m]any other Medicaid
plan requirements would likely do the same.” Ante, at 18.

——————
  8 Compare §1396r(c)(1)(A)(i) (“Free choice” (boldface deleted)) with

§227, 

 (“Free choice by individuals eligible for medical assis-
tance” (some capitalization omitted)). Notably, the same omnibus legis-
lation that included the FNHRA free-choice provision also included an
amendment to the original free-choice-of-provider provision that ap-
peared under the heading “Freedom of choice,” further reinforcing the
view that the provision is rights creating. §4113(c), 101 Stat. 1330–152
(some capitalization omitted).
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                     JACKSON, J., dissenting

But case law from the lower courts demonstrates that this
fear is unfounded. Those courts have recognized only a tiny
handful of the nearly 90 provisions contained in the Medi-
caid Act’s list of state-plan requirements as actually confer-
ring individual rights. See Brief for National Health Law
Program et al. as Amici Curiae 18–24 (highlighting the
small number of provisions in §1396a(a) that lower courts
have found to confer individual rights and noting the near
unanimity of the Circuits as to each provision’s enforceabil-
ity). And the lower courts have consistently refused to rec-
ognize individual rights in the Medicaid Act’s various other
state-plan provisions. Ibid.
   Meanwhile, the vast majority of the provisions on the
Medicaid Act’s list of state-plan requirements have never
generated any §1983 litigation whatsoever. There is thus
little reason to think that a decision holding that the free-
choice-of-provider provision confers individual rights would
unleash a sudden torrent of §1983 suits under the Act’s
other state-plan provisions. Indeed, recent history confirms
as much: Prior to 2017, every Circuit to consider the ques-
tion had held that the free-choice-of-provider provision con-
fers an individual right enforceable under §1983. See n. 7,
supra. But those decisions did not spawn a bevy of §1983
suits seeking to enforce other state-plan provisions.
   Nor were the floodgates opened by this Court’s decisions
in Wilder, Blessing, or any other cases that predate the re-
strictive test for §1983 enforceability that this Court
adopted in Gonzaga. As the majority readily acknowledges,
prior to Gonzaga, the Court “experimented with a different
approach.” Ante, at 13. Indeed, in Gonzaga itself, the Court
rationalized its newly restrictive approach to §1983 enforce-
ability by indicating that some lower courts had become too
permissive in recognizing enforceable statutory rights. 

. Yet, even during the pre-Gonzaga period,
there is no evidence that lower courts treated the Medicaid
Act—which spans multiple volumes of the U. S. Code—as a
20   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                        JACKSON, J., dissenting

wellspring of generally enforceable rights. Rather, the
state of affairs before our tightening of the test reinforces
that the free-choice-of-provider provision is, in fact, the
“atypical” spending statute that creates individual rights,
Talevski, 599 U. S., at 183—contrary to the majority’s as-
sertions otherwise. Ante, at 18, 21.
                               C
   Finally, JUSTICE THOMAS’s concurrence calls for a “fun-
damental reexamination of our §1983 jurisprudence” based
on his view that the “history of §1983 makes clear that the
statute has exceeded its original limits.” Ante, at 1–2, 13.
Because his opinion is not tethered to the specific facts or
arguments presented in this case, an extensive response is
not necessary here. But it is worth pausing briefly to think
about whether the historical account he offers reflects the
level of depth, nuance, or context needed to support the
wholesale reappraisal he is envisioning.
   Take his observation that courts decided relatively few
cases under §1983 during its first several decades. Ante, at
3. Like other §1983 skeptics, JUSTICE THOMAS seems to
view the paucity of early §1983 lawsuits as evidence that
the statute was originally understood to do very little. But
other explanations come to mind, too—such as the fact that
filing civil rights lawsuits during the Jim Crow era could be
quite perilous, especially for the people whom the statute
was originally meant to benefit. Many would-be plaintiffs
had reason to fear that filing a lawsuit would lead to phys-
ical or economic reprisals.9 Add to that the difficulty of find-
ing a lawyer, prevailing before often-hostile juries, and (if
——————
  9 See, e.g., M. Klarman, From Jim Crow to Civil Rights: The Supreme

Court and the Struggle for Racial Equality 49 (2004) (Klarman) (explain-
ing that, “[b]y the 1890s, southern black challenges to segregation would
have invited physical retaliation and perhaps even lynching”); Equal
Justice Initiative, Bob Hudson Lynched and Wife Beaten in Weakley
County, Tennessee (last visited June 15, 2025), https://calendar.eji.org/
racial-injustice/oct/9 (recounting the lynching of a Black man whose wife
                     Cite as: 

 (2025)                    21

                         JACKSON, J., dissenting

successful) enforcing a judgment, and it is not hard to im-
agine that the dearth of §1983 lawsuits in the wake of Re-
construction might have myriad alternative explanations.10
  JUSTICE THOMAS also suggests that the word “rights,” as
used in §1983, was originally understood more narrowly
than it is today. Ante, at 8–12. But his support for that
claim is limited to a handful of late-19th-century cases,
mostly about government pensions and employment. If “a
statute’s meaning turns on what its words ‘conveyed to rea-
sonable people at the time they were written,’ ” ante, at 6, a
broader—and more inclusive—survey of historical sources
would seem to be in order.11
  All of which is to say: more caution (and more research)
may be warranted before our longstanding precedents in
this area can be seriously scrutinized or attacked—espe-
cially in cases where no party has made such a claim or pre-
sented any such argument.
                         *    *     *
  Congress enacted the Medicaid Act’s free-choice-of-pro-
vider provision to ensure that Medicaid recipients have the
right to choose their own doctors. The Court’s decision to
foreclose Medicaid recipients from using §1983 to enforce
that provision thwarts Congress’s will twice over: once, in
dulling the tool Congress created for enforcing all federal
rights, and again in vitiating one of those rights altogether.
  The Court’s decision today is not the first to so weaken
——————
had filed a civil suit against a White man).
   10 See Klarman 48–49 (describing the dearth of lawyers willing to liti-

gate civil rights cases, the lack of sympathy among southern juries, and
the unlikelihood that local authorities would be willing to enforce judg-
ments obtained by certain civil rights plaintiffs).
   11 E.g., Colored People’s Convention of the State of South Carolina

(1865, Charleston, SC), Colored Conventions Project Digital Records
(last visited June 15, 2025), https://omeka.coloredconventions.org/items/
show/570 (“ ‘Right’ is defined to be the just claim, ownership, or lawful
title which a person has to anything”).
22   MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC

                     JACKSON, J., dissenting

the landmark civil rights protections that Congress enacted
during the Reconstruction Era. See, e.g., Civil Rights
Cases, 

 (1883); United States v. Cruikshank, 

 (1876); Blyew v. United States, 

(1872). That means we do have a sense of what comes next:
as with those past rulings, today’s decision is likely to result
in tangible harm to real people. At a minimum, it will de-
prive Medicaid recipients in South Carolina of their only
meaningful way of enforcing a right that Congress has ex-
pressly granted to them. And, more concretely, it will strip
those South Carolinians—and countless other Medicaid re-
cipients around the country—of a deeply personal freedom:
the “ability to decide who treats us at our most vulnerable.”
Kerr, 95 F. 4th, at 169. The Court today disregards Con-
gress’s express desire to prevent that very outcome.