In a recent decision that could have far-reaching consequences for people facing serious illness, the U.S. Supreme Court ruled against the rights of Medicaid enrollees to challenge harmful restrictions on their healthcare options. The case, Medina v. Planned Parenthood South Atlantic, centered on whether individuals have the ability to enforce the Medicaid Act’s “free-choice-of-provider” provision in court. In a 6-3 decision, the Court said they do not.
This ruling may sound technical—but its impact is deeply personal.
Imagine needing hospice or home health care, only to learn that your trusted provider is no longer covered by Medicaid, and that you have no legal recourse to challenge the change. That’s what’s now at stake for millions of Americans, especially those who rely on Medicaid for care at the end of life.
The decision threatens access to essential services for people living with serious illnesses, such as dementia, cancer, or ALS—many of whom are dually enrolled in Medicare and Medicaid. Over 7 million seniors fall into this category. For these individuals, Medicaid often pays for services like home care and palliative support. If a state chooses to cut certain providers from its Medicaid plan, patients could be left without access to care that aligns with their values and priorities.
Compassion & Choices, along with 28 other nonprofit organizations, filed a legal brief in the case urging the Court to preserve the rights of individuals to challenge these types of state-level exclusions. Unfortunately, the Court chose not to listen.
“The Medina majority opinion rewrites history and claims courts have been confused about how to respond when individuals sue to enforce their rights to choose a provider who offers care that aligns with their values and priorities,” said Kevin Díaz, President and CEO of Compassion & Choices. “By stripping individuals of the ability to enforce these rights, the Supreme Court risks rendering many of these protections meaningless.”
Justice Ketanji Brown Jackson, writing in dissent, said:
“Today’s decision is likely to result in tangible harm to real people… It will strip… countless… Medicaid recipients around the country – of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable.’”
Jess Pezley, Senior Staff Attorney with Compassion & Choices, echoed this concern:
“The ability to make decisions about one’s healthcare provider is directly tied to one’s values and priorities… This decision also has implications specifically for Medicaid recipients seeking autonomy over their end-of-life care.”
Medicaid covers many forms of end-of-life care, like hospice and palliative services. Without the ability to challenge provider exclusions, patients may no longer be able to receive care from professionals who understand and honor their wishes.
Pezley warns that the decision opens the door to broader government overreach:
“Beyond the free-choice-of-provider provision, this decision has the potential to more broadly affect the ability of everyday Americans to hold the government accountable for civil rights violations.”
At a time when federal and state debates are already threatening funding for Medicare and Medicaid, this ruling represents another setback—one that chips away at the freedom to choose how, where, and by whom we are cared for at the end of life.
Now more than ever, we must remain vigilant in protecting the dignity, autonomy, and access to care that every person deserves. Compassion & Choices is dedicated to leading efforts in the courts to ensure everyone gets the care they deserve at the end of life. Follow along with our work on social medi and at the End-of-Life Justice Center at Compassion & Choices.
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