In this case, the court considered this issue: Does the Medicaid Act’s “any qualified provider” provision unambiguously confer a private right upon a Medicaid beneficiary to choose a specific provider?

The case was decided on June 26, 2025.

The Supreme Court held that Section 1396a(a)(23)(A) of the Medicaid Act does not clearly and unambiguously confer individual rights enforceable under 42 U-S-C § 1983. Justice Neil Gorsuch authored the 6-3 majority opinion of the Court.

Federal statutes create individual rights only in “atypical cases,” and 42 U-S-C § 1983 provides causes of action for deprivation of “rights,” not mere “benefits” or “interests.” To prove an enforceable right, plaintiffs must show the statute clearly and unambiguously uses “rights-creating terms” with “an unmistakable focus” on individuals. This is a “stringent” and “demanding” test that spending-power statutes are especially unlikely to satisfy because spending-power legislation is “much in the nature of a contract” requiring States’ voluntary and knowing consent to private suits.

Section 1396a(a)(23)(A) lacks the required clear rights-creating language. The provision states that Medicaid plans must “provide that…any individual eligible for medical assistance…may obtain such assistance from any…qualified” provider. This language addresses state duties and may benefit providers and patients, but lacks the clear “rights-creating language” found in the Federal Nursing Home Reform Act provisions upheld in Talevski. Congress knows how to create clear rights, as FNHRA shows by giving nursing-home residents “the right to choose a personal attending physician.” The any-qualified-provider provision contains no such language. The provision’s exceptions confirm this reading—States may exclude providers “convicted of a felony” and “determine” which convictions qualify, which makes sense if the provision addresses state duties to the federal government but creates problems if it confers individual rights.

Justice Clarence Thomas authored a concurring opinion arguing that the Court should reexamine more broadly its § 1983 jurisprudence, which, he claimed, bears little resemblance to the statute as originally understood.

Justice Ketanji Brown Jackson authored a dissenting opinion, joined by Justices Sonia Sotomayor and Elena Kagan, arguing that the any-qualified-provider provision readily creates an enforceable right under a faithful application of the Court’s unambiguous-conferral test. She criticized the majority’s requirement that Congress mirror the specific language of the Federal Nursing Home Reform Act rather than apply the established test for whether a statute unambiguously confers rights, and she warned that the decision continues a pattern of weakening Reconstruction-era civil rights protections.

The opinion is presented here in its entirety, but with citations omitted. If you appreciate this episode, please subscribe. Thank you.