The U.S. Supreme Court recently issued a troubling decision in Medina v. Planned Parenthood South Atlantic, ruling that Medicaid enrollees do not have the right to enforce the Medicaid Act’s “free-choice-of-provider” provision. The decision weakens the legal protections that allow individuals to challenge harmful state policies that cut off access to care.
The case has clear end-of-life care implications. If a state cuts out healthcare providers who offer the full range of end-of-life options from their Medicaid plans, individuals with serious illnesses may not be able to use their Medicaid benefits to get needed end-of-life care from their trusted provider.
Additionally, 7.2 million seniors are enrolled in both Medicare and Medicaid. Those living with serious illnesses, like dementia, may lose access to their provider of choice for some services paid for with Medicaid benefits, such as home care and home health care. Compassion & Choices had previously filed an amicus brief with 28 other non-profit organizations in the case, urging the Supreme Court to maintain the right of harmed individuals to vindicate their rights in court.
“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.
“The Medicare and Medicaid Act established critical civil rights protections ensuring access to healthcare, including for those living with serious illnesses,” Díaz added. “By stripping individuals of the ability to enforce these rights, the Supreme Court risks rendering many of these protections meaningless.”
Justice Ketanji Brown Jackson dissented in the ruling, writing, “Today’s decision is likely to result in tangible harm to real people. At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians – and countless other Medicaid recipients around the country – of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable.’”
“The ability to make decisions about one’s healthcare provider is directly tied to one’s values and priorities,” said Jess Pezley, Senior Staff Attorney with Compassion & Choices. “This decision also has implications specifically for Medicaid recipients seeking autonomy over their end-of-life care. 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.”
“If the free-choice-of-provider provision is not enforceable, individuals may lack a federal remedy when states limit access to preferred hospice or palliative care providers,” Pezley added. “At a time when sweeping cuts in the ‘One Big Beautiful Bill’ threaten vulnerable Americans’ access to Medicaid and Medicare, the Supreme Court’s decision further erodes the protections these programs were meant to provide.”
While Medicaid funding cannot be used for medical aid in dying, the inability to challenge provider exclusions could still restrict a patient’s ability to receive the type of end-of-life care they prefer, undermining personal agency at a critical time.
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