Medina v. Planned Parenthood South Atlantic

P R E L I M I N A R Y P R I N T
Volume 606 U. S. Part 1
Pages 357–418
OFFICIAL REPORTS
OF
T H E S U P R E M E C O U R T
June 26, 2025
REBECCA A. WOMELDORF
reporter of decisions
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OCTOBER
TERM, 2024
357
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MEDINA, DIRECTOR, SOUTH CAROLINA DE-
P
ARTMENT OF HEALTH AND HUMAN SER-
VICES 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 fami-
lies and individuals “whose income and resources are insuffcient to
meet the costs of necessary medical services.” 42 U. S. C. § 1396–1.
Medicaid offers States “a bargain”: federal funds in exchange for compli-
ance w ith congressi ona l ly i mposed conditi ons. To par ticipate i n
Medicaid, States must submit a “plan for medical assistance” satisfying
over 80 conditions in § 1396a(a). If a State fails “to comply substan-
tially” with any condition, the Secretary of Health and Human Services
may withhold federal funding. § 1396c. This case involves the any-
qualifed-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] qualifed to perform the service . . . who
undertakes to provide” it. The provision does not defne “qualifed,”
leaving that to States' traditional authority over health and safety mat-
ters. The question is whether individual Medicaid benefciaries may
sue state offcials under 42 U. S. C. § 1983 for failing to comply with the
any-qualifed-provider provision.
Planned Parenthood South Atlantic operates two clinics in South Car-
olina, offering a wide range of services to Medicaid and non-Medicaid
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 Medicaid
program. At the same time, the State took steps that, it said, would
help ensure that other providers would continue offering necessary
medical care and family planning services. Planned Parenthood and
patient Julie Edwards sued, claiming the exclusion of Planned Parent-
hood violated the any-qualifed-provider provision. Edwards alleged
she preferred Planned Parenthood for gynecological care but needed
Medicaid coverage. They brought a § 1983 class action “to vindicate
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
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358 MEDIN
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Syllabus
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 private
suits. Gonzaga Univ. v. Doe, 536 U. S. 273, 280.
The district court granted summary judgment for plaintiffs and en-
joined the exclusion. The Fourth Circuit affrmed. This Court then
granted certiorari, vacated, and remanded in light of Health and Hospi-
tal Corporation of Marion Cty. v. Talevski, 599 U. S. 166, which
addressed whether another spending-power statute created § 1983-
enforceable rights. On remand, the Fourth Circuit reaffrmed.
Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer
individual rights enforceable under § 1983. Pp. 367–386.
(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 individ-
ual rights only in “atypical case[s].” Talevski, 599 U. S., at 183. Sec-
tion 1983 provides causes of action for deprivation of “ `rights,' ” not
mere “ `benefts' or `interests.' ” Gonzaga, 536 U. S., at 283.
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. Id., at 284, 290. This is a “strin-
gent” and “demanding ” test. Talevski, 599 U. S., at 180, 186. Even
qualifying statutes may be unenforceable if Congress provided alterna-
tive remedies.
These rules vindicate separation of powers. Courts once assumed
authority to provide whatever remedies seemed necessary for statutory
purposes. But statutes do not pursue single purposes “at all costs,”
American Express Co. v. Italian Colors Restaurant, 570 U. S. 228, 234,
and Congress may not wish to authorize private suits, Hernández v.
Mesa, 589 U. S. 93, 100. Deciding whether to permit private enforce-
ment poses delicate policy questions involving competing costs and ben-
efts—decisions for elected representatives, not judges. Pp. 367–369.
(b) Spending-power statutes are especially unlikely to confer enforce-
able rights. Unlike Commerce Clause or other regulatory powers, Con-
gress'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, 3 How. 720, 742. Treaties may bene-
ft citizens but generally do not confer individually enforceable rights

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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, 100 U. S. 61, 69.
Pp. 369–372.
(c) In Pennhurst State School and Hospital v. Halderman, 451 U. S.
1, the Court established that spending-power legislation is “much in
the nature of a contract.” Id., at 17. The “typical remedy for state
noncompliance” is federal funding termination. Id., at 28. Private en-
forcement requires showing States “voluntarily and knowingly” con-
sented to private suits, meaning Congress must “clear[ ly]” and “unam-
biguously” alert States that private enforcement was a funding
condition. Id., at 17.
Gonzaga held that spending-power legislation cannot support § 1983
suits unless Congress “speaks with a clear voice, and manifests an unam-
biguous intent to confer individual rights.” 536 U. S., at 280. Only
“unmistakable” notice suffces. Id., at 286–287, and n. 5.
Talevski reaffrmed that Gonzaga “sets forth [the] established
method.” 599 U. S., at 183. Statutory provisions must “unambigu-
ously confer individual federal rights”—a “demanding bar” cleared only
in “atypical” cases. Id., at 180, 183–184. The statutes there qualifed
because they “expressly” used clear “rights-creating language.” Id., at
184, 186 (internal quotation marks omitted).
Earlier cases like Wilder v. Virginia Hospital Assn., 496 U. S. 498,
Wright v. Roanoke Redevelopment and Housing Authority, 479 U. S.
418, and Blessing v. Freestone, 520 U. S. 329, suggested less demanding
standards, but Gonzaga “reject[ed]” any approach permitting “anything
short of an unambiguously conferred right.” 536 U. S., at 283. Lower
courts should not rely on these repudiated precedents. Pp. 372–376.
(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 re-
quiring facilities to “protect and promote” residents' “right to be free
from” restraints and provisions titled “[t]ransfer and discharge rights”
in a subsection called “[r]equirements relating to residents' rights.”
§ 1396r(c) (emphasis added).
The any-qualifed-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 assist-
ance from any . . . qualifed” provider. This language addresses state
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duties and may beneft providers and patients, but lacks FNHRA's clear
“r
ights-creating language,” Talevski, 599 U. S., at 186 (internal quota-
tion 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 confrm 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, 536 U. S., at 288. The pro-
vision appears as paragraph 23 of 87 plan requirements directed to
the Secret ary, w ithout discer nible organi zati ona l pr i nciple. If
§ 1396a(a)(23)(A) created individual rights, many similar Medicaid pro-
visions would too, making rights-creating provisions the rule rather
than “atypical” exceptions. Pp. 376–380.
(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.' ” 79 Stat. 291, 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 statutes,
“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, 548 U. S. 291, 304. Third, the proposal to remodel the estab-
lished test by arguing that “individual-centric, mandatory language” is
necessarily “rights-creating ” without requiring the “explicit rights-
creating terms” this Court has long required. This standard lacks foun-
dation in precedent and obliterates the distinction between mere bene-
fts and enforceable rights. It would make rights-creating 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, claiming the federal gov-
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361
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ernment lacks capacity or appetite for funding cutoffs. This Court has
re
jected the notion that funding cutoffs are “too massive” to be realistic
relief. Armstrong v. Exceptional Child Center, Inc., 575 U. S. 320, 331.
Alternative enforcement exists—States have administrative processes
for provider challenges, reviewable by state courts. If existing reme-
dies prove insuffcient, Congress can create new ones. But balancing
enforcement costs and benefts is a policy question for Congress, not
courts. Pp. 380–385.
95 F. 4th 152, 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., fled a concurring opinion, post, p. 386. Jackson, J., fled a
dissenting opinion, in which Sotomayor and Kagan, JJ., joined, post,
p. 397.
John J. Bursch argued the cause for petitioner. With him
on the briefs were James A. Campbell, Erin M. Hawley,
Christopher P. Schandevel, Caroline C. Lindsay, Kelly M.
Jolley, and Ariail B. Kirk.
Kyle D. Hawkins argued the cause for the United States
as amicus curiae urging reversal. On the brief were Acting
Solicitor General Harris, Acting Assistant Attorney Gen-
eral Shumate, Deputy Solicitor General Kneedler, Zoe A.
Jacoby, Joshua M. Salzman, and Laura E. Myron.
Nicole A. Saharsky argued the cause for respondents.
With her on the brief were Miriam R. Nemetz, Minh Nguyen-
Dang, Carmen Longoria-Green, Jennifer Sandman, and
Hannah Swanson.*
*Briefs of amici curiae urging reversal were fled for the State of Kan-
sas et al. by Kris W. Kobach, Attorney General of Kansas, Anthony J.
Powell, Solicitor General, Erin B. Gaide, Assistant Attorney General, and
John Guard, Acting Attorney General of Florida, and by the Attorneys
General for their respective States as follows: Steve Marshall of Alabama,
Treg Taylor of Alaska, Tim Griffn of Arkansas, Christopher M. Carr of
Georgia, Raúl Labrador of Idaho, Brenna Bird of Iowa, Theodore E. Rok-
ita of Indiana, Russell Coleman of Kentucky, Liz Murrill of Louisiana,
Lynn Fitch of Mississippi, Andrew Bailey of Missouri, Austin Knudsen
of Montana, Drew H. Wrigley of North Dakota, Gentner Drummond of
Oklahoma, Marty Jackley of South Dakota, and John B. McCuskey of

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362 MEDIN
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Opinion of the Court
Justice Gorsuch delivered the opinion of the Court.
Medicaid
offers States “a bargain.” Armstrong v. Excep-
tional Child Center, Inc., 575 U. S. 320, 323 (2015). In re-
West Virginia; for the American Association of Pro-Life Obstetricians and
Gynecologists et al. by Christopher E. Mills; for the American Center for
Law and Justice by Jay Alan Sekulow, Stuart J. Roth, Jordan A. Sekulow,
Colby M. May, and Laura B. Hernandez; for Americans United for Life
by Steven H. Aden; for America's Future et al. by William J. Olson, Jere-
miah L. Morgan, Patrick M. McSweeney, Joseph W. Miller, and Kerry L.
Morgan; for the Eagle Forum Education & Legal Defense Fund by Law-
rence J. Joseph; for the Family Policy Alliance et al. by Randall L. Wenger,
Janice L. Martino-Gottshall, and Jeremy L. Samek; for Heartbeat Inter-
national, Inc., by Adam F. Mathews; for Liberty Counsel by Mathew D.
Staver, Anita L. Staver, and Horatio G. Mihet; for South Carolina Medic-
aid Practitioners by Thomas M. Fisher and Bryan G. Cleveland; for the
Southeastern Legal Foundation by Braden H. Boucek; for U. S. Senators
et al. by Thomas R. McCarthy and Tiffany H. Bates; for World Faith
Foundation et al. by James L. Hirsen, Deborah J. Dewart, and Tami Fitz-
gerald; for Gov. Henry Dargan McMaster by Thomas A. Limehouse, Jr.,
Wm. Grayson Lambert, Erica W. Shedd, and Tyra S. McBride; for 46
South Carolina State Legislators by Timothy J. Newton; and for 311 State
Legislators by Kristine L. Brown.
Briefs of amici curiae urging affrmance were fled for the Common-
wealth of Massachusetts et al. by Andrea Joy Campbell, Attorney General
of Massachusetts, and Gerard J. Cedrone, Deputy State Solicitor, and by
the Attorneys General for their respective jurisdictions as follows: Rob
Bonta of California, Philip J. Weiser of Colorado, Kathleen Jennings of
Delaware, Brian L. Schwalb of the District of Columbia, Anne E. Lopez
of Hawaii, Anthony G. Brown of Maryland, Dana Nessel of Michigan,
Keith Ellison of Minnesota, Aaron D. Ford of Nevada, Matthew J. Platkin
of New Jersey, Raúl Torrez of New Mexico, Letitia James of New York,
Jeff Jackson of North Carolina, Dan Rayfeld of Oregon, Peter F. Neronha
of Rhode Island, and Nicholas W. Brown of Washington; for the American
Cancer Society Cancer Action Network et al. by Thomas W. Curvin, John
H. Fleming, and Mary Rouvelas; for the American College of Obstetri-
cians and Gynecologists et al. by Janice Mac Avoy and Francisco Negrón,
Jr.; for Former Senior Offcials of the Dept. of Health and Human Services
by Skye L. Perryman and Stephen I. Vladeck; for Health Policy Scholars
by Carolyn F. Corwin; for the Information Society Project at Yale Law
School by Priscilla J. Smith; for Local Governments et al. by Jonathan
B. Miller, Cheran Ivery, Christian D. Menefee, David J. Hackett, John

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as: 606 U. S. 357 (2025)
363
Opinion of the Court
turn for federal funds, States agree “to spend them in ac-
cordance
with congressionally imposed conditions.” Ibid.
Should a State fail to comply substantially with those condi-
tions, the Secretary of Health and Human Services can with-
hold some or all of its federal Medicaid funding. This case
poses the question whether, in addition to that remedy, indi-
vidual Medicaid benefciaries may sue state offcials for fail-
ing 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-
for ts to prov ide hea lthcare to fami lies and i ndiv idua ls
“ `whose income and resources are insuffcient to meet the
costs of necessary medical services.' ” Armstrong, 575
U. S., at 323 (quoting § 1396–1). Today, all 50 States partici-
pate in Medicaid. Congressional Research Service, Medic-
aid: 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 fowing to help the State
execute it. Of course, States must contribute their own
P. Markovs, Lyndsey M. Olson, David Chiu, Meredith A. Johnson, and
Rachel A. Neil; for Medicaid Benefciaries C. M. et al. by Ian Heath Gersh-
engorn; for the National Health Law Program et al. by Donald B. Verrilli,
Jr., and Jane Perkins; for Organizations Advancing Reproductive Rights,
Health, and Justice by Autumn Katz and Amy Myrick; for Religious Or-
ganizations et al. by Jaime A. Santos and Amelia Brown; for the Women's
Bar Association of the District of Columbia et al. by Heather Richardson;
for 7 South Carolina Healthcare Policy Experts et al. by Jessica L. Ells-
worth; and for 238 Members of Congress by Christopher E. Babbitt.
Briefs of amici curiae were fled for the American Public Health Associ-
ation et al. by Thomas Barker; for the Life Legal Defense Foundation by
Catherine Short and Sheila A. Green; and for 138 Women Hurt by Planned
Parenthood Abortions et al. by Allan E. Parker, Jr., Mary Browning, and
R. Clayton Trotter.
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Opinion of the Court
money, too. See § 1396d(b). Historically, the federal gov-
er
nment 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 i n § 1396a(a)(23)(A), Medicaid's any-
qua lified-prov ider prov isi on, as it is someti mes ca l led,
requires States to ensure that “any individual eligible for
medical assistance . . . may obtain” it “from any [provider]
qualifed to perform the service . . . who undertakes to pro-
vide” it. The provision does not defne the term “qualifed,”
perhaps because States have traditionally exercised primary
responsibility over “matters of health and safety,” including
the regulation of the practice of medicine. De Buono v.
NYSA–ILA Medical and Clinical Services Fund, 520 U. S.
806, 814 (1997); see also Linder v. United States, 268 U. S. 5,
18 (1925); 42 CFR § 431.51(c)(2) (2024). But everyone ac-
knowledges that, if a State fails “to comply substantially”
with this (or any) congressionally specifed condition, the
Secretary may withhold some or all of the State's federal
funding until he is “satisfed 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, 95 F. 4th 152, 156–157 (CA4 2024). At both locations,
the group offers “a wide range” of services to Medicaid and
non-Medicaid patients. Ibid. It also performs abortions.
Ibid. 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-
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365
Opinion of the Court
ties and governmental agencies” would continue to provide
“access
to necessary medical care and important women's
health and family planning services.” Id., at 158a. Accord-
ing to the State, it has “140 [other] federally qualifed health
clinics and pregnancy centers, not counting the numerous
private health providers who accept Medicaid.” Brief for
Petitioner 9.
In response to the State's announcement, Planned Parent-
hood 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-
qualifed-provider provision. Specifcally, Ms. Edwards al-
leged that, while she regularly visits other medical care pro-
viders, she has had especially positive experiences with
Planned Parenthood and would like “to shift all [her] gyneco-
logical and reproductive health care there.'' App. 32, 33.
But none of that will be possible, she continued, unless
Medicaid covers those services. Ibid. Based on these alle-
gations, Ms. Edwards and Planned Parenthood brought a
putative class action “pursuant to 42 U.S.C. § 1983 to vindi-
cate rights secured by the federal Medicaid statutes.” Id.,
at 1.
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” enforce-
able under § 1983 “as a matter of course.” Health and Hos-
pital Corporation of Marion Cty. v. Talevski, 599 U. S. 166,
183 (2023). That is particularly true of statutes, like Medic-
aid, 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,
483 U. S. 203, 207–208 (1987). But when a State violates
those conditions, “ `the typical remedy' ” is not a private en-
forcement suit “ `but rather action by the Federal Govern-
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Opinion of the Court
ment to terminate funds to the State.' ” Gonzaga Univ. v.
Doe
, 536 U. S. 273, 280 (2002) (quoting Pennhurst State
School and Hospital v. Halderman, 451 U. S. 1, 28 (1981)).
Appreciating all this, the plaintiffs argued that their case
implicated an exception to the usual rule. The any-
qualifed-provider provision, they said, is among those rare
federal spending-power statutes that confer individual rights
enforceable under § 1983. And, they submitted, South Caro-
lina 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' as-
sessment, the district court granted summary judgment to
them and entered a permanent injunction preventing the
State from excluding Planned Parenthood from its Medicaid
program. Planned Parenthood South Atlantic v. Baker,
487 F. Supp. 3d 443, 448 (SC 2020).
On appeal, the Fourth Circuit affrmed the district court's
decision. Planned Parenthood South Atlantic v. Kerr, 27
F. 4th 945 (2022). Writing separately, Judge Richardson ex-
pressed “confusion and uncertainty” about this Court's direc-
tions addressing when spending-power legislation creates
enforceable rights under § 1983. Id., at 959 (opinion concur-
ring in judgment). And he voiced “hop[e]” that we might
provide “clarity . . . soon.” Ibid.
Seeking review of the Fourth Circuit's decision, the State
fled a petition for certiorari in this Court. In light of our
intervening decision in Talevski, 599 U. S. 166, in which we
addressed whether another spending-power statute created
§ 1983-enforceable rights, we granted the State's petition, va-
cated the decision of the court of appeals, and remanded the
case for further proceedings. Kerr v. Planned Parenthood
South Atlantic, 599 U. S. 909 (2023).
On remand, the court of appeals reaffrmed its earlier deci-
sion. 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
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as: 606 U. S. 357 (2025)
367
Opinion of the Court
to determine when a federal spending-power statute creates
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, 132 F. 4th 962, 971 (CA7
2025) (en banc); id., at 982 (Hamilton, J., dissenting); New
York State Citizens' Coalition for Children v. Poole, 935
F. 3d 56, 60 (CA2 2019) (Livingston, J., dissenting from denial
of rehearing en banc).
In response to the Fourth Circuit's latest decision, the
State fled another petition for certiorari. In it, South Caro-
lina 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, 981 F. 3d 347, 350 (CA5 2020) (en
banc); Does v. Gillespie, 867 F. 3d 1034, 1037 (CA8 2017).
We agreed to hear the case. 604 U. S. 1071 (2024).
II
To resolve the circuits' disagreement and address our
lower court colleagues' calls for clarifcation, we begin by
outlining how to determine whether a statute confers an in-
dividually enforceable right under § 1983.
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
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368 MEDIN
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Opinion of the Court
to pursue violations of their federal statutory rights. Maine
v
. Thiboutot, 448 U. S. 1. Still, this Court has emphasized,
statutes create individual rights only in “atypical case[s].”
Talevski, 599 U. S., at 183. Routinely, of course, federal leg-
islation seeks to beneft 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 “ `benefts' or `interests.' ” Gonzaga, 536 U. S.,
at 283.
To prove that a statute secures an enforceable right, privi-
lege, or immunity, and does not just provide a beneft or
protect an interest, a plaintiff must show that the law
in question “clear[ly] and unambiguous[ly]” uses “rights-
creating terms.” Id., at 284, 290. In addition, the statute
must display “ `an unmistakable focus' ” on individuals like
the plaintiff. Id., at 284 (emphasis deleted); accord, Talev-
ski, 599 U. S., at 183. We have described this as a “strin-
gent” and “demanding ” test. Id., at 180, 186; accord, post,
at 405 (Jackson, J., dissenting) (describing Gonzaga as set-
ting forth “a restrictive test”). And even for the rare stat-
ute that satisfes it, this Court has said, a § 1983 action still
may not be available if Congress has displaced § 1983's gen-
eral cause of action with a more specifc remedy. Rancho
Palos Verdes v. Abrams, 544 U. S. 113, 120 (2005).
These rules seek to “vindicat[e] the separation of powers.”
Talevski, 599 U. S., at 183. 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, 582 U. S. 120, 131–132 (2017) (internal quo-
tation marks omitted). But, as this Court has since come to
appreciate, no statute pursues any single “purpos[e] at all
costs.” American Express Co. v. Italian Colors Restau-
rant, 570 U. S. 228, 234 (2013) (internal quotation marks
omitted). And, often enough, Congress may “not wish to
pursue [a] provision's purpose to the extent of authorizing
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private suits.” Hernández v. Mesa, 589 U. S. 93, 100 (2020).
Af
ter all, the decision whether to let private plaintiffs en-
force a new statutory right poses delicate questions 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 public serv-
ices and spend it instead on litigation. See ibid. The job
of resolving how best to weigh those competing costs and
benefts belongs to the people's elected representatives, not
unelected judges charged with applying the law as they fnd
it. See Alexander v. Sandoval, 532 U. S. 275, 286 (2001);
Gonzaga, 536 U. S., at 285.
1
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 be-
tween the States or outlawing piracy, it can point for author-
ity 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
1
Cannon v. University of Chicago, 441 U. S. 677, 691 (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 “ratifed Cannon's holding,” Sandoval,
532 U. S., at 280, the Court has retreated from Cannon's reasoning, which
“exemplifed” an “expansive rights-creating approach” that later decisions
“abandoned,” Franklin v. Gwinnett County Public Schools, 503 U. S. 60,
77 (1992) (Scalia, J., concurring in judgment); see also Stoneridge Invest-
ment Partners, LLC v. Scientifc-Atlanta, Inc., 552 U. S. 148, 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 emphasized
that the decision's “language” no longer controls. Sandoval, 532 U. S.,
at 282.
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conduct. But when Congress distributes money, its author-
ity
rests on a different footing.
The Constitution has no “Spending Clause,” strictly speak-
ing. 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, Imposts and
Excises, to pay the Debts and provide for the common De-
fence and general Welfare of the United States.” Unlike
other enumerated powers, this provision does not expressly
endow Congress with the power to regulate conduct. Nor
does it include “the power to issue direct orders to the gov-
ernments of the States.” Murphy v. National Collegiate
Athletic Assn., 584 U. S. 453, 471 (2018).
As the Court observed in United States v. Butler, the
meaning of Article I's “general welfare” language provoked
ferce debate right from the start. 297 U. S. 1, 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 he de-
nied that those powers included as well “a power to do what-
ever else should appear to Congress conducive to the General
Welfare.” Ibid. James Madison advanced a narrower posi-
tion still. As he saw it, the language authorized Congress
to spend money only in support of its other enumerated pow-
ers. A. LaCroix, The Interbellum Constitution: Federalism
in the Long Founding Moment, 67 Stan. L. Rev. 397, 407
(2015) (LaCroix).
Over time, Hamilton's view gained ground. So, for exam-
ple, as Justice Story saw it, Congress may raise and “appro-
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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 specifc powers” elsewhere
in Article I would be rendered largely pointless, and the Na-
tion would trade a limited federal government for “an unlim-
ited” one. 2 id., §§ 904, 906, pp. 367, 369; see also Butler,
297 U. S., at 66 (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 Con-
gress—Apropos the Maternity Act, 36 Harv. L. Rev. 548,
564–566 (1923).
Consistent with this understanding, early courts described
federal grants not as commands but as contracts. Consider,
for example, how this Court approached a dispute concerning
the frst major federal highway. The Cumberland 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 Constitutional
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. Id., at 96–98.
When a disagreement arose about the scope of that toll ex-
emption, this Court looked to “the expectations of the par-
ties,” a familiar feature of contract law, to resolve it. Neil,
Moore & Co. v. Ohio, 3 How. 720, 741 (1845). In doing so, the
Court emphasized that it was enforcing requirements “well
known” to the parties when the “compact was made.” Ibid.;
see also McGee v. Mathis, 4 Wall. 143, 155 (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

372 MEDIN
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same as contrac ts “ between i ndiv idua ls. ” Sear i gh t v.
St
okes, 3 How. 151, 167 (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 beneft
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, 112 U. S. 580, 598 (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,
100 U. S. 61, 69 (1879); see also Mills County v. Railroad
Cos., 107 U. S. 557, 566 (1883).
C
For much of the Nation's history, the Court had little occa-
sion to employ these ideas. Congress rarely granted money
to States and, when it did, those grants rarely came with
many conditions. See D. Currie, The Constitution in Con-
gress: 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 re-
turned 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, 301 U. S. 548, 590 (1937); see also Massachusetts v.
Mellon, 262 U. S. 447, 480 (1923); Butler, 297 U. S., at 73–75;
Oklahoma v. Civil Serv. Comm'n, 330 U. S. 127, 143–144
2
Much the same holds true today. While treaties may beneft individu-
als 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, 552 U. S. 491, 506, n. 3 (2008) (quoting 2 Re-
statement (Third) of Foreign Relations Law of the United States § 907,
Comment a, p. 395 (1986); emphasis added).
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(1947). The same analogies guided the Court, too, after fed-
era
l grants exploded in the 1960s, generating “an unprece-
dented” wave of litigation in which private parties sought to
challenge state compliance with federal grant conditions. E.
Tomlinson & J. Mashaw, The Enforcement of Federal Stand-
ards in Grant-In-Aid Programs: Suggestions for Benefciary
Involvement, 58 Va. L. Rev. 600, 630 (1972).
3
Take Pennhurst. There, private plaintiffs sought to sue
the Commonwealth of Pennsylvania for failing to fulfll the
terms of a federal healthcare grant. 451 U. S., at 6. In as-
sessing whether the suit could proceed, the Court began by
observing that “legislation enacted pursuant to the spending
power is much in the nature of a contract: in return for fed-
eral funds, the States agree to comply with federally im-
posed conditions.” Id., at 17. 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.” Id., at 28. Given these principles, the Court
reasoned, whether a private party may sue to enforce the
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. Id., at
17. 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
3
Between 1940 and 2023, federal outlays to state and local governments
increased by more than 50 times in constant dollars. Offce of Manage-
ment and Budget, Historical Tables, Budget of the United States Govern-
ment, 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.
4
Beyond the rule that Congress must clearly and unambiguously alert
States to conditions associated with federal funding, our cases have articu-
lated other limits on spending-power legislation. First, as previously ob-
served, “the exercise of the spending power must be in pursuit of `the

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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 individ-
ual rights.” 536 U. S., at 280 (alteration and internal quota-
tion marks omitted). Only that kind of “unmistakable” no-
tice, the Court said, suffces to alert grantees that they might
be subject “to private suits . . . whenever they fail to comply
with a federal funding condition.” Id., at 286–287, and n. 5
(internal quotation marks omitted). And, the Court con-
cluded, because the statute at issue before it did not clearly
and unambiguously confer a “right to support a cause of ac-
tion brought under § 1983,” the plaintiff's suit could not pro-
ceed. Id., at 283, 290.
5
general welfare,' ” rather than private or merely local interests. South
Dakota v. Dole, 483 U. S. 203, 207 (1987); see supra, at 370. Second, grant
conditions must relate “to the federal interest in particular national proj-
ects or programs.” Dole, 483 U. S., at 207 (internal quotation marks omit-
ted). Third, “other constitutional provisions may provide an independent
bar to the conditional grant of federal funds.” Id., at 208. Finally,
spending-power conditions are legitimate only if the State's acceptance of
them is in fact voluntary. National Federation of Independent Business
v. Sebelius, 567 U. S. 519, 581–582 (2012) (opinion of Roberts, C. J.); see
also id., at 676 ( joint dissent of Scalia, Kennedy, Thomas, and Alito, JJ.).
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. Pre-
mier Rehab Keller, 596 U. S. 212, 219–220 (2022). Whether a State or
private recipient is involved, after all, § 1983 actions to enforce federal
statutes 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
benefciaries” suffcient to support a cause of action. See Gonzaga, 536
U. S., at 285; Part II–A, supra. And grants to private parties can risk
altering the Constitution's balance of federal-state authority, too, by ex-
panding federal regulation beyond Congress's enumerated powers and into
areas traditionally reserved for the States. See Gonzaga, 536 U. S., at
286, and n. 5; cf. Gregory v. Ashcroft, 501 U. S. 452, 460–461 (1991).

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Just two Terms ago, we reaffrmed these points. In Ta-
l
evski, the Court faced another private § 1983 suit alleging
that recipients of federal funding had violated grant condi-
tions. To decide whether the plaintiffs could proceed, we
turned to Gonzaga, recognizing that it “sets forth our estab-
lished method” for analyzing suits like that. Talevski, 599
U. S., at 183. In doing so, we reiterated that the relevant
“[s]tatutory provisions must unambiguously confer individ-
ual federal rights” before a § 1983 claim might proceed. Id.,
at 180. That standard, we emphasized, is a “demanding
bar” and a “signifcant 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 satisfed it pre-
cisely because they “expressly” employed the sort of clear
and unambiguous “rights-creating language” Gonzaga de-
mands. 599 U. S., at 184, 186 (internal quotation marks
omitted).
Admittedly, this Court briefy experimented with a differ-
ent approach, and that fact has given rise to some confusion
in the lower courts. For a time, as we have seen, the Court
sometimes took an expansive view of its power to imply pri-
vate causes of action to enforce federal laws. See Part II–
A, supra. Moved by the same spirit, the Court sometimes
took a broad view of its authority to confer new rights under
spending-power statutes that did not expressly provide
them. In Wilder v. Virginia Hospital Association, for ex-
ample, the Court suggested that spending-power legislation
can give rise to an enforceable right under § 1983 so long as
the legislation is “intended to beneft the putative plaintiff ”
and the plaintiff 's interest in the statute is not “too vague
and amorphous.” 496 U. S. 498, 509 (1990) (alteration and
internal quotation marks omitted); see Wright v. Roanoke
Redevelopment and Housing Authority, 479 U. S. 418, 423–
424, 431–432 (1987). Building on those same ideas in Bless-
ing v. Freestone, the Court outlined a three-factor test for
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340–341 (1997). Some lower court judges, including in this
case
, still consult Wilder, Wright, and Blessing when asking
whether a spending-power statute creates an enforceable in-
dividual 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.” 536 U. S., at 283. Armstrong “re-
pudiate[d]” any other approach. 575 U. S., at 330, n. And
Talevski reaffrmed that “Gonzaga sets forth our established
method” for determining whether a spending-power statute
confers individual rights. 599 U. S., at 183.
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, 451 U. S., at 17; see id., at 28. And
that consent cannot be fairly inferred if the federal spending-
power statute fails to provide “clear and unambiguous” no-
tice that it creates a personally enforceable right. Gonzaga,
536 U. S., at 290. To the extent lower courts feel 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-qualifed-provider provision. To
succeed, they must show, at a minimum, that § 1396a(a)
(23)(A) does not just seek to beneft them or serve their
interests but “clear[ly] and unambiguous[ly]” gives them
individual federal rights. Gonzaga, 536 U. S., at 290.
6
6
As we have seen, the plaintiffs must also show that the provision in
question displays “an unmistakable focus” on individuals like them. Gon-
zaga, 536 U. S., at 284 (emphasis deleted; internal quotation marks omit-

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Since Pennhurst, this Court has identifed only three sets
of
spending-power statutes that confer enforceable rights
under § 1983—those at issue in Wright, Wilder, and Talevski.
But given this Court's longstanding repudiation of Wright
and Wilder's reasoning, the statutes at issue in Talevski sup-
ply the only reliable yardstick against which to measure
whether spending-power legislation confers a privately en-
forceable right.
Talevski addressed two provisions of the Federal Nursing
Home Reform Act (FNHRA). See 599 U. S., at 181–182.
The frst 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 r ights. ” § 1396r(c)(2)(A)
(emphasis added). And both provisions sat in a subsection
ca l led “ [r]equirements relati ng to residents' r i gh t s. ”
§ 1396r(c) (emphasis added).
The any-qualifed-provider provision before us looks noth-
ing like those FNHRA provisions. Section 1396a(a)(23)(A)
indicates that state Medicaid plans must “provide that . . .
any individual eligible for medical assistance (including
drugs) may obtain such assistance from any institution,
agency, community pharmacy, or person, qualifed to perform
the service or services required . . . who undertakes to pro-
vide him such services.” Doubtless, this language speaks to
what a State must do to participate in Medicaid, and a State
that fails to fulfll its duty might lose federal funding.
Doubtless, too, this provision seeks to beneft both providers
and patients. But missing from § 1396a(a)(23)(A) is any-
thing like FNHRA's clear and unambiguous “rights-creating
ted). And even then, a § 1983 action may not be available if Congress has
displaced that general cause of action with a more specifc remedy. See
supra, at 368. To resolve this case, however, we need not reach those
questions.
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language.” Talevski, 599 U. S., at 186 (internal quotation
marks
omitted).
To be sure, Congress could have taken a different ap-
proach when drafting § 1396a(a)(23)(A). In fact, FNHRA
offers an example almost perfectly on point. One of its pro-
visions 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) Specifed rights
“A nursing facility must protect and promote the
rights of each resident, including each of the following
rights:
“(i) Free choice
“The right to choose a personal attending physician
. . . .” § 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
provisions could not have been more different. See 101
Stat. 1330–152; Talevski, 599 U. S., at 181, n. 10. 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, 605 U. S. 38, 46 (2025).
The remainder of § 1396a(a)(23) only serves to confrm our
conclusion. After announcing that state Medicaid plans
must allow individuals to obtain care from any qualifed pro-
vider, the provision proceeds to carve out various exceptions
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]”
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wh ich felony conv ic ti ons qua l i fy for that exclusi on.
§
1396a(a)(23)(B). Al l that makes per fec t sense i f
§ 1396a(a)(23)(A) speaks only to a State's duties to the federal
government. But it is an arrangement a good deal harder
to understand if § 1396a(a)(23)(A) also confers an individually
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 surround-
ing statutory context yields similar clues. To continue re-
ceiving federal funding, the Medicaid Act says, a State need
only “comply substantially” with the any-qualifed-provider
mandate. § 1396c. And, as this Court recognized in Gon-
zaga, that focus on “ `aggregate' ” compliance suggests that a
statute addresses a State's obligations to the federal govern-
ment, not the rights “ `of any particular person.' ” 536 U. S.,
at 288. Sometimes, we appreciate, a provision may over-
come this weighty statutory evidence. In Talevski, after
all, the Court found two FNHRA provisions to confer indi-
vidual rights even though that statute also speaks of “sub-
stantial compliance.” See Brief for Respondents 35–36.
But, at risk of repetition, the provisions at issue there
employed explicit and unmistakable “ `rights-creating lan-
guage,' ” 599 U. S., at 186, and § 1396a(a)(23)(A) does not.
Notable, too, is where Congress placed the any-qualifed-
prov ider prov isi on. It appears i n a subsec ti on titled
“Contents.” § 1396a(a). That subsection outlines scores of
things a state plan must include to qualify for federal fund-
ing. Ibid. Those requirements do not appear in any dis-
cernible order, and the any-qualifed-provider provision does
not crop up until paragraph 23 of 87. All of § 1396a(a)'s re-
quirements 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 (plu-
rality opinion). None of this may suffce to prove that
the any-qualifed-provider provision is unenforceable under
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§ 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, 599 U. S., at 183.
Take one example. See Brief for United States as Ami-
cus Curiae 27–29 (offering others). Section 1396a(a)(32) fol-
lows several paragraphs down from the any-qualifed-
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 similarities to” § 1396a(a)(23)(A). Brief for Re-
spondents 38–39. Both speak in mandatory terms (“must
. . . provide”; “shall”). Both discuss “individual[s].” Nei-
ther mentions “rights.” Yet, while the plaintiffs insist that
paragraph (23)(A) clearly and unambiguously creates an indi-
vidual right, they suggest that a court could reasonably “de-
termine” that paragraph (32) “does not.” Ibid. (citing Polk
v. Yee, 36 F. 4th 939, 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.
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First, the plaintiffs and dissent appeal to legislative his-
t
ory. The hear i ngs and committee repor ts leadi ng 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 399, 408–409
(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, 584 U. S. 497, 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, 548 U. S. 291, 304 (2006).
7
Second, the plaintiffs and dissent contend, Congress mod-
eled § 1396a(a)(23)(A) on a Medicare provision titled “ `Free
choice by patient guaranteed.' ” 79 Stat. 291, 42 U. S. C.
§ 1395a. It reads: “Any individual entitled to insurance ben-
efts under this subchapter may obtain health services from
any . . . person qualifed to participate under this subchapter
if such . . . person undertakes to provide him such services.”
§ 1395a(a). And because that Medicare provision “confer[s]
an individual right,” the plaintiffs and dissent reason, its
7
If anything, the legislative history of the any-qualifed-provider provi-
sion illustrates the pitfalls of trying to equate an unenacted legislative
record with the law. On the plaintiffs' telling, Congress frst enacted the
any-qualifed-provider provision “to prevent [the] second-class treatment”
of Medicaid patients, as exemplifed by Puerto Rico's policy of requiring
them “to be treated only at designated government facilities.” 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 excludes Puerto Rican
benefciaries from its protections. See § 1396a(a)(23)(B) (“[T]his para-
graph shall not apply in the case of Puerto Rico, the Virgin Islands, and
Guam”).
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Medicaid offshoot must as well. Brief for Respondents 34;
see
post, at 409 (Jackson, J., dissenting).
This argument stumbles out of the gate. Its premise—
that § 1395a(a) confers an enforceable right—is questionable.
As the plaintiffs admit, “[n]o court has addressed whether a
Medicare benefciary can enforce this provision under Sec-
tion 1983.” Brief for Respondents 34, n. 7. Even overlook-
ing that defciency, another quickly emerges. While the title
of § 1395a(a) “guarantee[s]” a patient's “free choice” of pro-
vider—and while the plaintiffs and dissent insist this lan-
guage can create a right—the any-qualifed-provider provi-
sion never uses “guarantee” or its equivalent. So if the
comparison between the Medicaid and Medicare provisions
reveals anything, it is that Congress did not include in
§ 1396a(a)(23)(A) the language from § 1395a that the plaintiffs
and dissent think most likely to confer enforceable rights.
Third, instead of grappling meaningfully with the test our
precedents provide, the dissent proposes to rewrite it. In
the dissent's view, a statute confers a privately enforceable
right whenever it uses “compulsory” and “individual-centric
terminology,” as long as it also evokes “language classically
associated with establishing rights.” Post, at 408 (opinion
of Jackson, J.). When it comes to that last requirement, the
dissent reasons this way: Congress enacted § 1396a(a)(23)(A)
under the title “free choice by individuals eligible for medical
assistance,” 81 Stat. 903 (capitalization omitted); the phrase
“free choice” calls to the dissent's mind a phrase from the
First Amendment (“free exercise” of religion); that Amend-
ment declares rights; so § 1396a(a)(23)(A) likely must as well.
Post, at 408 (opinion of Jackson, J.).
Our precedents do not authorize anything like the dissent'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, 451 U. S., at 19,
n. 14 (internal quotation marks omitted); see A. Scalia & B.
Garner, Reading Law: The Interpretation of Legal Texts
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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 81 Stat. 903 (enacting the
title of a different section, but not “free choice by individuals
eligible for medical assistance,” into the U. S. Code (capital-
ization omitted)).
Even beyond that, the dissent's test would risk obliterat-
ing the longstanding line between mere benefts and enforce-
able rights. See supra, at 368, 375, 376. If, as the dissent
says, § 1396a(a)(23)(A) creates an enforceable right because it
contains “compulsory” and “individual-centric terminology”
plus an iffy analogy to the Bill of Rights, then many other
provisions (in Medicaid and elsewhere) previously thought to
confer only benefts would suddenly create rights instead.
Supra, at 380. All despite Talevski's insight just two Terms
ago that, while many statutes supply benefts, only “atypical”
statutes confer enforceable rights under § 1983. 599 U. S., at
183. To be sure, the dissent assures us that other Medicaid
provisions are distinguishable from this one. Post, at 414–
415 (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
faws, 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 369.
8
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,
447 U. S. 773 (1980)] bears on the scope of ” § 1396a(a)(23)(A). Post, at 409–
410, n. 5. But since the dissent relies heavily on that decision, post, at 409–
410, 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. 447 U. S., at 775, 790. To the ex-
tent O'Bannon addressed any right, then, it was an asserted property
right under the Due Process Clause, not a clear and unambiguous statu-
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Fourth and fnally, the plaintiffs and dissent advance a pol-
icy
argument. Only § 1983 litigation, they submit, can give
the any-qualifed-provider provision the teeth it needs. 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 Re-
spondents 44. But, the plaintiffs and dissent insist, the fed-
eral government has neither the capacity nor the appetite
for taking that “drastic step.” Ibid.; see Tr. of Oral Arg.
110; see also post, at 398–399 (Jackson, J., dissenting).
This argument suffers from a number of problems. For
one, this Court has specifcally 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 legislation.
Pennhurst, 451 U. S., at 17, 28.
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, 867
tory 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 benefts for care [from a provider] that
has been decertifed.” 447 U. S., at 785. And that is precisely the right
the plaintiffs assert here.
Separately, the dissent suggests that amicus briefs the government fled
in other cases might suffce to supply States with notice of a condition
attached to federal funding. Post, at 412, and n. 6 (opinion of Jackson,
J.). But, as this case attests, the government's views can shift from ad-
ministration 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 separation of pow-
ers and federalism concerns we have outlined, our decisions have always
“insist[ed] that Congress speak with a clear voice.” Pennhurst State
Schoo l and Hosp i tal v. Ha lder man, 451 U. S. 1, 17 (1981) (emphasis
added).
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F. 3d, at 1038. That process can culminate with state judi-
cia
l 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 insuff-
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
individually 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 fulfll their obligations. But
private enforcement does not always beneft the public, not
least because it requires States to divert money and atten-
tion away from social services and toward litigation. And
balancing those costs and benefts poses a question of public
policy that, under our system of government, only Congress
may answer. See Sandoval, 532 U. S., at 286; Gonzaga, 536
U. S., at 285–286.
9
*
Section 1983 permits private plaintiffs to sue for violations
of federal spending-power statutes only in “atypical” situa-
tions, Talevski, 599 U. S., at 183, where the provision in ques-
tion “clear[ly]” and “unambiguous[ly]” confers an individual
“right,” Gonzaga, 536 U. S., at 290. Section 1396a(a)(23)(A)
is not such a statute. Because the Fourth Circuit concluded
9
In the end, the dissent resorts to the extravagant charge that our deci-
sion represents the “latest chapter” in a “project of stymying . . . civil
rights.” Post, at 397 (opinion of Jackson, J.); see also post, at 418. 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].” 599 U. S., at 183. Our decision merely
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386 MEDIN
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Thomas, J., concurring
otherwise, its judgment is reversed and the case is remanded
for
further proceedings consistent with this opinion.
It is so ordered.
Justice Thomas, concurring.
Individual plaintiffs may invoke Rev. Stat. § 1979, 42
U. S. C. § 1983, to sue state or local offcials who have de-
prived them of “any rights, privileges, or immunities secured
by the Constitution and laws.” In other words, § 1983 pro-
vides a mechanism for plaintiffs to enforce constitutional 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 deci-
sion 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, in-
cluding its application in the spending context and our under-
standing of the “rights” enforceable under § 1983.
I
The history of § 1983 makes clear that the statute has
exceeded its original limits. Section 1983 originated as a
narrow, Reconstruction era statute.
A
Congress enacted § 1983 as § 1 of the Civil Rights Act of
1871, 17 Stat. 13. 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 &
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Wechsler). In its original form, § 1983 provided a means by
wh
ich private plaintiffs could obtain redress from state and
local offcials 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 . . . .” 17 Stat. 13.
In 1874, Congress extended § 1983's reach to some statu-
tory violations, amending the language on “rights, privileges,
or immunities” to encompass “rights . . . secured by the Con-
stitution and laws.” Rev. Stat. § 1979 (emphasis added).
Congress made this change as part of a general 1874 revision
that aimed to “simplify, organize, and consolidate all federal
statutes” into a single volume. Chapman v. Houston Wel-
fare Rights Organization, 441 U. S. 600, 624 (1979) (Powell,
J., concurring). In undertaking this revision, Congress “did
not intend . . . to alter the content of federal statutory law,”
id., at 625, but only to “reproduc[e]” the “existing laws,” with
“such additions . . . as shall give to 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 allows in-
jured parties to sue state and local offcials for “the depriva-
tion 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 constant,
the judicial understanding of its scope is an entirely different
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matter. At the time of its enactment, Ҥ 1983 was the least
controversia
l provision in the 1871 Act, attracting little at-
tention or debate.” Crawford-El v. Britton, 93 F. 3d 813,
829–830 (CADC 1996) (en banc) (Silberman, J., concurring).
The “provision spawned relatively few cases for many dec-
ades.” Hart & Wechsler 1280. By one count, “there were
only 21 cases decided under § 1983 in its frst 50 years.”
Crawford-El, 93 F. 3d, at 830 (Silberman, J., concurring).
When courts did face § 1983 cases, they construed the stat-
ute narrowly. This Court early on deemed § 1983's protec-
tion of “rights, privileges, or immunities” to “refer to civil
rights only.” Holt v. Indiana Mfg. Co., 176 U. S. 68, 72
(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 citizen'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 Actions,
and the Scope of Section 1983, 77 Geo. L. J. 1493, 1500–1501
(1989) (Collins); see 14 Stat. 27, 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 personal
liberty,” such as free speech and assembly, but not “property
rights.” Hague v. Committee for Industrial Organization,
307 U. S. 496, 527, 531 (1939); see Maine v. Thiboutot, 448
U. S. 1, 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 ref-
erence to rights `secured by' the Constitution and laws,” con-
struing 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, 365 U. S. 167 (1961).
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Prior to Monroe, § 1983 was understood to impose liability
only
for actions “taken by offcials pursuant to state law.”
Id., at 184; see Crawford-El v. Britton, 523 U. S. 574, 611
(1998) (Scalia, J., dissenting). But, Monroe held that an of-
fcial 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. 365 U. S., at 184, 187 (internal quotation marks omit-
ted). As a result, individuals can now bring § 1983 actions
for “violations committed without the authority of any” state
law or “indeed even . . . violations committed in stark viola-
tion of state civil or criminal law.” Crawford-El, 523 U. S.,
at 611 (Scalia, J., dissenting). Monroe thus “breathed new
life” into § 1983. E. Zagrans, “Under Color Of ” What Law:
A Reconstructed Model of Section 1983 Liability, 71 Va.
L. Rev. 499, 500–501 (1985).
The Court continued to broaden § 1983 in the years that
followed. In Lynch v. Household Finance Corp., 405 U. S.
538 (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 frst time in Thi-
boutot that § 1983 could reach statutory violations in addition
to constitutional ones. See 448 U. S., at 4–5; ante, at 367–
368. 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, 599 U. S. 166, 225 (2023) (Thomas, J., dis-
senting); see Dennis v. Higgins, 498 U. S. 439, 445 (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] individual
rights upon a class of benefciaries,” and Congress did not
manifest any contrary intent to make § 1983 unavailable.
Talevski, 599 U. S., at 183, 186 (internal quotation marks
omitted). The consequence is that litigants can now invoke
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§ 1983 to challenge myriad “state actions that have little or
noth
ing to do with” civil rights. Thiboutot, 448 U. S., at 25
(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, 93
F. 3d, at 830 (Silberman, J., concurring). Post-Monroe,
courts have faced a “deluge” of § 1983 flings numbering in
the tens of thousands each year. R. Aldiser t, Judicia l
Expansi on of Federa l Jur isdic ti on: A Federa l Judge's
Thoughts on Section 1983, Comity and the Federal Caseload,
1973 Law & Social Order 557, 563; see Federal Judicial Cen-
ter, M. Schwartz, Section 1983 Litigation 4 (3d ed. 2014)
(“Each year the federal courts face dockets flled with huge
numbers of § 1983 cases”).
2
Section 1983 has become “easily
the most important statute authorizing suits against state
offcials for violations of the Constitution and [federal] laws.”
Hart & Wechsler 1280. Notwithstanding its origins as an
“extraordinary remedy passed during Reconstruction to pro-
tect basic civil rights against oppressive state action,” § 1983
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 368 (quoting Health and Hospital Corporation of Marion Cty. v. Talev-
ski, 599 U. S. 166, 180, 183, 186 (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,
U. S. District Courts—Civil Cases Commenced, by Nature of Suit, During
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. Al-
though the data is not granular enough to determine the precise number
of § 1983 cases within this total, § 1983 cases undoubtedly make up a siz-
able fraction. Cf. C. Whitman, Constitutional Torts, 79 Mich. L. Rev. 5,
6, n. 9 (1980) (“In practice, virtually all civil rights cases fled against
states in federal court include a § 1983 claim”).
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now serves as “simply one more weapon in the litigant's arse-
na
l.” Dennis, 498 U. S., at 465 (Kennedy, 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, 523 U. S.,
at 611 (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, 587 U. S. 678,
711 (2019) (Thomas, J., concurring). Although the potential
problems are numerous, this case implicates two in particu-
lar: the extension of § 1983 into the spending-power context,
and an ahistorically modern understanding of the “rights”
protected by § 1983.
3
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 pro-
vides a means to redress the deprivation of “rights, privi-
leges, or immunities secured by the Constitution and laws.”
3
I have elsewhere identifed 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, 365 U. S. 167
(1961). See Baxter v. Bracey, 590 U. S. –––, ––– – –––, n. 2 (2020)
(Thomas, J., dissenting from denial of certiorari). Given § 1983's Recon-
struction era context, it also is questionable whether statutory § 1983 ac-
tions can be based on laws besides those “enacted under Congress' Recon-
struction Amendments enforcement powers.” Talevski, 599 U. S., at 225,
n. 12 (Thomas, J., dissenting). And, reexamination may be warranted as
to whether § 1983 even supplies a freestanding cause of action. See Wil-
liams v. Reed, 604 U. S. 168, 182, n. (2025) (Thomas, J., dissenting).
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But, legislation enacted under Congress's spending power
cannot
“secure” rights as required by § 1983.
This conclusion fows 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 conditions
“have no effect . . . unless and until they are freely accepted
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 spending
conditions. J. Worcester, A Dictionary of the English Lan-
guage 1299 (1860); accord, Webster's New International Dic-
tionary 1911 (1909). Accordingly, any third parties who ben-
eft from those obligations cannot derive an enforceable
federal right from the legislation: “[S]uch third-party rights
. . . are `secured' (if at all) . . . only by the contract between
the recipient and the United States.” Talevski, 599 U. S., at
205 (Thomas, J., dissenting) (some internal 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 consti-
tutional prohibition against federal commandeering of the
States.” Id., at 196. That prohibition protects state sover-
eignty 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,
505 U. S. 144, 162, 178 (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-
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Thomas, J., concurring
pendent regulatory authority.” Talevski, 599 U. S., at 206,
224
(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.” Id., at 229; see id., 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, 241 U. S. 394, 401 (1916). Yet, Ta-
levski chose an implausible reading of § 1983 that created
constitutional infrmity—and substantial infrmity, at that,
given the frequency with which modern spending legisla-
tion imposes spending conditions. See 599 U. S., at 202
(Thomas, J., dissenting).
This case does not present an occasion to remedy our error
because the petitioner did not ask us to revisit our prece-
dents. But, in a case where the issue is properly presented,
I would make clear that spending conditions—which are by
defnition conditional—cannot “secure” rights.
B
Separately, I question whether our current understanding
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
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§ 1983's original meaning can be so fexible. Collins 1537;
see
Dennis, 498 U. S., at 445 (“[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 unambigu-
ously uses rights-creating terms” and displays “an unmistak-
able focus on individuals like the plaintiff.” Ante, at 368 (in-
ternal 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 punishment
clauses, almost any common law tort committed by a state
offcer” now can be “converted into a constitutional violation
and thereby made the basis of a section 1983 action.” De-
velopments in the Law: Section 1983 and Federalism, 90
Harv. L. Rev. 1133, 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 concern-
4
In one case, the Court even deemed enforceable under § 1983 the nega-
tive Commerce Clause “ `right' to engage in interstate trade free from
restrictive state regulation.” Dennis v. Higgins, 498 U. S. 439, 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, 520 U. S. 564, 610 (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 375–376.
As the Court emphasizes today, our more recent statutory § 1983 case
law makes clear that statutes must include “unambiguous rights-creating
language” to be enforceable through § 1983. Ante, at 380. In an appro-
priate case, we should at minimum extend similar scrutiny to the range of
constitutional rights enforceable through § 1983.
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395
Thomas, J., concurring
ing 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, 603 U. S. 369, 400 (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 Reconstruc-
ti on era context, especia l ly g iven that the prov isi on's
“ `rights, privileges or immunities' language suggestively
echoed the fourteenth amendment's `privileges or immuni-
ties' clause.” Collins 1505; cf. Talevski, 599 U. S., at 225,
n. 12 (Thomas, J., dissenting) (questioning whether statutory
§ 1983 actions should be “confned to laws enacted under Con-
gress' 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 under-
standing today. Case law from the period surrounding
§ 1983 emphasized a distinction between rights and mere
government benefts. For example, in cases concerning mil-
itary pensions, this Court made clear that pensions were
simply “bounties of the government,” to which “[n]o pen-
sioner has a vested legal right.” United States v. Teller, 107
U. S. 64, 68 (1883); accord, e. g., Frisbie v. United States, 157
U. S. 160, 166 (1895). Likewise, while serving on the Massa-
chusetts Supreme Judicial Court, Justice Holmes famously
summarized the once-prevailing understanding of govern-
ment employees' free speech rights when he declared that
“[t]he petitioner may have a constitutional right to talk poli-
tics, but he has no constitutional right to be a policeman”—
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that is, he has no right to public employment. McAuliffe v.
Mayo
r and Bd. of Aldermen of New Bedford, 155 Mass. 216,
220, 29 N. E. 517 (1892). That view remained “unchallenged
dogma” for “most of th[e 20th] century.” Connick v. Myers,
461 U. S. 138, 143 (1983).
Only in the 1960s and 1970s did the Court replace its tradi-
tional distinction between rights and benefts with a dramat-
ically expanded conception of “rights.” Most notably, in
Goldberg v. Kelly, 397 U. S. 254 (1970), the Court held that
welfare benefts, previously thought of as gratuities, are in
fact property for purposes of the Fourteenth Amendment's
Due Process Clause. Id., at 261–262.
5
Goldberg and other
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-
fts.” R. Pierce, The Due Process Counterrevolution of the
1990s? 96 Colum. L. Rev. 1973, 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 infuenced 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. Compare,
e. g., Escoe v. Zerbst, 295 U. S. 490, 492 (1935) (deeming parole
an “act of grace” not protected by the Due Process Clause),
with Wilkinson v. Dotson, 544 U. S. 74, 76–77 (2005) (allow-
ing prisoners' challenges to state parole procedures to pro-
ceed under § 1983). And, much of our case law on statutory
§ 1983 actions stems from plaintiffs' efforts to enforce so-
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 182, n. (dissenting opinion) (quoting Goldberg, 397 U. S., at 262,
and n. 8); see also Gutierrez v. Saenz, 606 U. S. 305, 334 (2025) (dissenting
opinion) (explaining how Goldberg marked a “radical redefnition of `prop-
erty' ” rights).
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called rights conferred through entitlement programs. 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
doctrine, courts should not too readily recognize a statutory
right as enforceable under § 1983. Ante, at 374–376. 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.
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
American South was consumed by a wave of terrorist vio-
lence 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 vehemently.
A century and a half later, the project of stymying one of
the country's great civil rights laws continues. In this latest
6
The dissent questions whether suffcient “research” supports my cur-
rent conclusions. Post, at 416–417 (opinion of Jackson, J.). But, my
point is precisely that further examination is warranted. Insofar as the
dissent 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 417.
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chapter, South Carolina urges our Court to adopt a narrow
and
ahistorical reading of the 1871 Act's frst section, which
is codifed today at 42 U. S. C. § 1983. That venerable provi-
sion 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
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
reason, 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 cooperative
federal-state program that provides medical care to needy
individuals.” Douglas v. Independent Living Center of
Southern Cal., Inc., 565 U. S. 606, 610 (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 congres-
sionally imposed conditions.” Armstrong v. Exceptional
Child Center, Inc., 575 U. S. 320, 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 signifcant control,
for instance, over who is eligible to receive Medicaid bene-
fts 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,
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399
Jackson, J., dissenting
HHS may w ithhold fur ther fundi ng from that St ate.
§
1396c; see also 42 CFR § 430.12(c) (2024). In practice, how-
ever, HHS rarely invokes its authority to withhold funding
because doing so would inevitably harm the program's
benefciaries.
1
One of the conditions that the Medicaid Act imposes on
participating States is the requirement that Medicaid recipi-
ents be able to choose their own healthcare providers with-
out 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, qualifed to perform
the service or services required.” § 1396a(a)(23)(A). Con-
gress enacted that provision, known as the “free-choice-of-
provider provision,” in order to prevent States from steering
Medicaid recipients to the States' preferred healthcare pro-
viders. 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” unqualifed 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 At-
lantic (PPSAT)—one in Charleston and one in Columbia—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
fnd a healthcare provider capable of meeting her needs as a
1
Kaiser Family Foundation, Focus on Health Reform: A Guide to the
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/.
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Jackson, J., dissenting
diabetic whose condition heightened the risks associated
w
ith 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 receive care.
Edwards fled this lawsuit against state health offcials
under § 1983 seeking to enjoin PPSAT's termination from the
Medicaid program. She asserted that the termination deci-
sion violated her rights under the free-choice-of-provider
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
South Atlantic v. Baker, 487 F. Supp. 3d 443, 448 (SC 2020).
The Fourth Circuit affrmed. Planned Parenthood South At-
lantic v. Kerr, 27 F. 4th 945, 959 (2022). In a careful opinion
authored by Judge Wilkinson, the panel held that the free-
choice-of-provider provision 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 Congress's intention to confer on Medicaid benefci-
aries 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, 599 U. S. 166
(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 deci-
sion in Talevski. 599 U. S. 909 (2023).
On remand, the Fourth Circuit once again determined that
the free-choice-of-provider provision establishes an individ-
ual right that can be enforced under § 1983. Planned Par-
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Jackson, J., dissenting
enthood South Atlantic v. Kerr, 95 F. 4th 152, 154 (2024).
The
panel, in another thoughtful opinion by Judge Wilkinson,
“conclude[d] that Talevski did not change the law to an ex-
tent that would call our previous determinations into ques-
tion.” Id., at 159. It therefore affrmed the District
Court's order granting summary judgment to Edwards and
enjoining the State from terminating PPSAT from its Medic-
aid program. Id., at 170.
II
Two years ago, in Health and Hospital Corporation of
Marion County v. Talevski, 599 U. S. 166, this Court outlined
the test for determining whether a federal statute is pri-
vately enforceable under § 1983. The majority accepts that
the touchstone for that inquiry is whether the law in ques-
tion “unambiguously confer[s] individual federal rights.”
Id., at 180 (emphasis deleted); see ante, at 375. But the opin-
ion it hands down today suggests that, as a practical matter,
the character of the law—and, in particular, whether it was
enacted under Congress's spending power—is all but disposi-
tive of the required rights determination. That view dis-
torts the unambiguous-conferral test beyond recognition and
strains our precedential holding that § 1983's unqualifed use
of the word “laws” means exactly what it says. As I explain
below, under a faithful application of our unambiguous-
conferral test, the Medicaid Act's free-choice-of-provider
provision readily creates an enforceable right.
A
The Civil Rights Act of 1871 was designed to bolster the
protections of the Civil War Amendments and earlier Recon-
struction statutes, which had failed to “preven[t] postbellum
state actors from continuing to deprive American citizens
of federally protected rights.” Talevski, 599 U. S., at 176.
White supremacist violence was spreading across the South,
aided at times by state and local offcials, and the mayhem
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Jackson, J., dissenting
posed a fundamental threat to both public safety and the
r
ule of law. E. Foner, Reconstruction: America's Unfnished
Revolution 1863–1877, pp. 442–444 (1988).
The 1871 Act aimed to combat that threat in various ways.
One of them, embedded in the Act's very frst 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,
407 U. S. 225, 239 (1972).
The text of that provision, now codifed at 42 U. S. C.
§ 1983, is straightforward. It authorizes private individuals
to sue state or local offcials who deprive them of “any rights,
privileges, or immunities secured by the Constitution and
laws” of the United States. Mindful of the statute's ambi-
tious goals, the Court has traditionally “given full effect to
its broad language, recognizing that § 1983 `provide[s] a rem-
edy, to be broadly construed, against all forms of offcial vio-
lation of federally protected rights.' ” Dennis v. Higgins,
498 U. S. 439, 445 (1991).
Thus, in Maine v. Thiboutot, 448 U. S. 1, 4 (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 modifers to the phrase”—makes
clear that the word “laws” “means what it says” and is not
“limited to some subset of laws.” Ibid.
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, 493 U. S. 103, 106 (1989). Ac-
cordingly, we have held that a plaintiff may not prevail under
§ 1983 merely by identifying a violation of any federal stat-
ute; rather, she must identify a violation of a statute that
creates “ `rights, privileges, or immunities.' ” Ibid.
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Jackson, J., dissenting
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
approach to § 1983 and thus freely recognized individual
rights in federal “laws,” absent clear congressional intent to
the contrary. E. g., Livadas v. Bradshaw, 512 U. S. 107, 132–
134 (1994) (holding that employees could use § 1983 to en-
force a provision of the National Labor Relations Act);
Wright v. Roanoke Redevelopment and Housing Authority,
479 U. S. 418, 430–432 (1987) (holding that public-housing
tenants could use § 1983 to enforce a provision of the Housing
Act of 1937 capping their rental payments).
In Wilder v. Virginia Hospital Assn., 496 U. S. 498, 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 provid-
ers [were] the intended benefciaries,” and it was “cast in
mandatory rather than precatory terms.” Id., at 510, 512.
We also rejected the defendant's argument that the provi-
sion's “reasonable and adequate” mandate was “too `vague
and amorphous' to be judicially enforceable,” observing 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
confrming 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), 108 Stat. 4057.
Congress enacted that statute in direct response to our deci-
sion in Suter v. Artist M., where we had held that a provision
of the Adoption Assistance and Child Welfare Act was not
enforceable under § 1983. 503 U. S. 347, 363 (1992). Our

404 MEDIN
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Jackson, J., dissenting
decision in that case had relied, in part, on the fact that the
prov
ision at issue appeared in a section of the statute that
required States to submit specifc plans to HHS as a condi-
tion of receiving federal funds. Id., at 358. Rejecting that
line of reasoning, Congress adopted what has come to be
called the “Suter fx.” 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] enforce-
ability.” § 1320–2.
The Court decided Blessing v. Freestone, 520 U. S. 329
(1997), three years after Congress adopted the Suter fx.
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 sur-
veying our past cases on the subject, we identifed three key
factors that bore on “whether a particular statutory provi-
sion gives rise to a federal right.” 520 U. S., at 340. Those
three factors were: (1) whether “Congress . . . intended that
the provision in question beneft the plaintiff”; (2) whether
“the right assertedly protected by the statute” is “so `vague
and 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
2
The law at issue in this case—Medicaid's free-choice-of-provider provi-
sion, 42 U. S. C. § 1396a(a)(23)—is codifed in the same chapter of Title 42
as the Suter fx.
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§ 1983's broad remedial goals and our historical concern that
St
ates receive fair notice of their statutory obligations under
federal law. That balance began to shift dramatically in the
years following Blessing.
B
In Gonzaga University v. Doe, 536 U. S. 273 (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 confdentiality of their students' educa-
tional records. We suggested that Blessing had led to “con-
fusion” among some lower courts about how to determine
whether a statute confers rights that are enforceable under
§ 1983. 536 U. S., at 282–283. Citing a need for greater
clarity, Gonzaga stated: “We now reject the notion that our
cases permit anything short of an unambiguously 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. Halder-
man, 451 U. S. 1, 28 (1981)). For that reason, we explained,
recipients of federal funds must have clear notice that their
failure to comply with a particular funding condition might
“subjec[t] them to private suits for money damages” under
§ 1983. 536 U. S., at 286–287, n. 5. We thus concluded that
“if Congress wishes to create new rights enforceable under
§ 1983, it must do so in clear and unambiguous terms.” Id.,
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at 290. And we held that FERPA funked that test because
its
confdentiality mandate—which was framed principally as
a directive to the Secretary of Education—“lack[ed] the sort
of `rights-creating ' language critical 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 analyt-
ical framework and held that a pair of Medicaid provisions
created individual rights. 599 U. S., at 183. There, we de-
termined that plaintiffs could use § 1983 to enforce two pro-
visions of the Federal Nursing Home Reform Act, or
FNHRA—one imposing certain predischarge-notice require-
ments on nursing facilities and the other barring those facili-
ties from using unnecessary chemical restraints on their resi-
dents. Id., at 171.
Talevski's analysis began by restating “the Gonzaga test.”
Id., at 183 (citing Gonzaga, 536 U. S., at 284, 287). As we
recounted, that test asks whether “the provision in question
is ` “phrased in terms of the persons benefted” ' and contains
`rights-creating,' individual-centric language with an ` “un-
mistakable focus on the benefted class.” ' ” 599 U. S., at 183
(quoting Gonzaga, 536 U. S., at 284, 287). Although we rec-
ognized that this test was “stringent,” we held that the two
FNHRA provisions at issue satisfed it. 599 U. S., at 186.
We cited the fact that both provisions appeared in a list of
“ `[r]equirements relating to residents' rights.' ” Id., at 184.
And we outlined how the text of each provision “unambigu-
ously confer[red] rights upon the residents of nursing-home
facilities”: The unnecessary-restraint provision required nurs-
ing 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
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Jackson, J., dissenting
nursing homes “ `must not transfer or discharge [a] resident' ”
w
ithout notice. Id., at 184–185.
Perhaps most importantly, our opinion in Talevski also
squarely rejected the defendant's argument that Ҥ 1983 con-
tains an implicit carveout for laws that Congress enacts via
its spending power.” Id., at 171. The defendant, an Indi-
ana hospital system, had argued that “ `Spending Clause stat-
utes do not give rise to privately enforceable rights under
Section 1983' ” because such statutes operate like contracts,
which “were not `generally' enforceable by third-party bene-
fciaries at common law.” Id., at 178 (quoting defendant's
brief ). In rejecting that attempt to dilute § 1983's power,
we affrmed 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
“unamb i guously confer individual federal rights. ” 599
U. S., at 180.
3
C
Medicaid's free-choice-of-provider provision easily satisfes
the unambiguous-conferral test. To start, the text of the
provision is plainly “ ` “phrased in terms of the persons bene-
fted” ' ”—namely, Medicaid recipients. Id., at 183. 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 institu-
tion, agency, community pharmacy, or person, qualifed to
perform the service or services required.” § 1396a(a)(23)(A)
(emphasis added). This “individual-centric” formulation re-
3
Talevski also recognized that “[e]ven if a statutory provision unambig-
uously secures rights, a defendant `may defeat t[he] presumption by dem-
onstrating that Congress did not intend' that § 1983 be available to enforce
those rights.” 599 U. S., at 186. 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.
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fects an “ ` “unmistakable focus on the benefted class.” ' ”
T
alevski, 599 U. S., at 183 (quoting Gonzaga, 536 U. S., at
284).
Congress also used rights-creating language in the head-
ing of the provision when it enacted the original session law.
The provision was entitled: “F
REE CHOICE by individuals
eligible for medical assistance,” 81 Stat. 903 (emphasis
added).
4
This phrasing indisputably invokes language clas-
sica lly associated w ith establishing rights. E. g., U. S.
Const., Amdt. 1 (protecting the “free exercise” of religion);
Faretta v. California, 422 U. S. 806, 833–834 (1975) (“[W]hat-
ever else may be said of those who wrote the Bill of Rights,
surely there can be no doubt that they understood the inesti-
mable worth of free choice”). And Congress reinforced its
rights-creating intent by making the provision mandatory—
it specifcally 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 protect Medicaid re-
cipients' freedom to choose their own providers, it would
have likely avoided using a combination of classically compul-
sory language and explicit individual-centric terminology.
As the Fourth Circuit rightly put it, it is “diffcult to imagine
a clearer or more affrmative directive.” Planned Parent-
hood South Atlantic v. Baker, 941 F. 3d 687, 694 (2019).
The provision's history confrms what the text makes evi-
dent: 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 382. But the majority does not appear to dispute that
statutory titles offer at least some insight into Congress's intent, as evi-
denced by the majority's own reliance on statutory titles elsewhere in its
opinion. See ante, at 377 (highlighting the title of one of FNHRA's sub-
provisions); ante, at 379–380 (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 evidence
of its rights-creating intent with respect to the provision at issue here.
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1967—just two years after the original Medicaid Act—in di-
rec
t response to efforts by some jurisdictions to steer Medic-
aid benefciaries to specifc providers. See H. R. Rep. No.
544, at 122. To prevent States from interfering with Medic-
aid 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 benefciaries. § 1395a(a).
In other words, Congress made a deliberate choice to protect
Medicaid recipients' ability to choose their own providers by
employing statutory language that it knew, based on its
Medicare experience, would achieve that end. Congress'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 Nur-
sing Center, 447 U. S. 773 (1980), a group of elderly Medicaid
recipients sought to leverage the provision to assert “a con-
stitutional right to a hearing ” before Medicaid offcials could
strip their nursing home of funding. Id., at 775. In reject-
ing the recipients' understanding of the provision, we ex-
plained what the provision does protect. As we put it,
Ҥ 1396a(a)(23) gives recipients the right to choose among a
range of qualifed providers, without government interfer-
ence.” Id., at 785 (frst emphasis added; citation omitted).
We used the word “right” again in the next sentence to elab-
orate on that description: “By implication,” we said, the pro-
vision “also confers an absolute right to be free from govern-
ment interference with the choice to remain in a home that
continues to be qualifed.” 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
prov isi on. We decli ned to grant cer ti orar i on that questi on. 604
U. S. 1071 (2024) (limiting our grant of certiorari to only the frst question
presented in the petition). Undeterred by that choice, the majority pro-
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Although O'Bannon was not a case about § 1983 enforce-
abi
lity, our description of the free-choice-of-provider provi-
sion confrms 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 apply-
ing 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 undermines the
statute's core function but also stretches our doctrine beyond
anything that can be justifed as a matter of text, precedent,
or frst principles.
ceeds to address the question we took off the table: It suggests that
O'Bannon is inapposite because our opinion in that case purportedly re-
jected the particular right that respondent has asserted here. Ante, at
383–389, 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 frst place. And
as to that latter question—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 cre-
ate 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 unqualifed home and demand a hearing to certify it, nor does
it confer a right on a recipient to continue to receive benefts for care in a
home that has been decertifed.” 447 U. S., at 785. 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.
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A
The
approach that the Court follows today differs conspic-
uously from the approach we developed in Gonzaga and reaf-
frmed in Talevski. To see how, start by observing that the
majority chooses not to frame its analysis around the ques-
tion that guided our thinking in those cases: namely, whether
“the provision in question is ` “phrased in terms of the
persons benefted” ' and contains `rights-creating,' individual-
centric language with an ` “unmistakable focus on the bene-
fted class.” ' ” Taleveski, 599 U. S., at 183 (quoting Gon-
zaga, 536 U. S., at 284, 287). Instead, the Court builds its
analysis around the simplistic premise that Medicaid's free-
choice-of-prov ider prov isi on “ looks noth i ng l ike th[e]
FNHRA provisions” we upheld in Talevski. Ante, at 377.
That approach warps our reasoning in Talevski. No-
where in our opinion did we single out FNHRA as the sole
or defnitive model for conferring individual rights. To the
contrary, the reason we went out of our way to reaffrm “the
Gonzaga test” was to remove any doubts about “our estab-
lished method for ascertaining unambiguous conferral.” 599
U. S., at 183. 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
377. In short, the majority construes our requirement that
Congress “manifes[t] an `unambiguous' intent to confer indi-
vidual rights,” Gonzaga, 536 U. S., at 280, as a requirement
that Congress manifest an unambiguous intent 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,
privileges, or immunities secured by the . . . laws” of the
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United States—not just the specifc rights secured by
FNHRA.
(Emphasis added.) It is therefore strange to
treat FNHRA as the “only reliable yardstick,” ante, at 377,
for assessing whether a statute unambiguously creates en-
forceable rights per Gonzaga. Cf. Dennis, 498 U. S., at 445
(“[W]e have rejected attempts to limit the types of constitu-
tional rights that are encompassed within the phrase `rights,
privileges, 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 enforceabil-
ity 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 ensur-
ing that States have fair notice of their statutory obligations.
As the majority recognizes, the whole reason we require
clear rights-creating language in spending statutes is be-
cause “[o]nly that kind of `unmistakable' notice . . . suffces
to alert grantees” that they might be sued under § 1983.
Ante, at 374. But focusing myopically on a given statute'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,
562 U. S. 428, 436 (2011).
Indeed, if actual notice were the touchstone, this would be
an easy case: By the time South Carolina chose to terminate
PPSAT as a Medicaid provider in 2018, the State had ample
reason to know that it could be sued under § 1983—even be-
yond the clarity of the free-choice-of-provider provision'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
O'Bannon had also explicitly described the provision as “giv-
6
See Brief for United States as Amicus Curiae 4, n. 1 (citing amicus
briefs fled by the Government, across multiple administrations, in cases
dating back to 2005).
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Jackson, J., dissenting
[ing] recipients the right to choose” their providers “without
gover
nment interference.” 447 U. S., at 785 (emphasis
added). And Congress itself had reaffrmed, via the Suter
fx, that the Medicaid Act's “State plan requirements” could
create enforceable rights. § 1320a–2. Our Wilder decision
had long since held that a similarly structured provision of
the Medicaid Act—codifed in the same section as the free-
choice-of-provider provision—was enforceable under § 1983.
496 U. S., at 524. With all that information, South Carolina
could not reasonably claim surprise that its decision to re-
strict 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-
provider provision mirrors the FNHRA provisions from Ta-
levski in all respects that matter: both employ individual-
centric language that focuses on the relevant benefciaries
and combine it with mandatory language directed at the rele-
vant grant recipients. The provision also employs rights-
creating language: As explained above, Congress explicitly
used the words “free choice” in the provision's original head-
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., 575 U. S.
320, 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-
provider provision conferred privately enforceable rights. See Planned
Parenthood Ariz. Inc. v. Betlach, 727 F. 3d 960, 963 (CA9 2013); Planned
Parenthood of Ind., Inc. v. Commissioner of Ind. State Dept. of Health,
699 F. 3d 962, 974 (CA7 2012); Harris v. Olszewski, 442 F. 3d 456, 461
(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.
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Jackson, J., dissenting
ing—words that plainly refect rights-creating intent. See
Par
t II–C, supra. The fact that the provision does not spe-
cifcally use the word “right” is not dispositive. We have
never required Congress to use specifc verbiage to establish
individual rights. And forcing Congress to use the specifc
word “right” would make little sense in this context anyway
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 378 (quoting
§ 1396r(c)(1)(A)(i)). If anything, that Congress chose to use
“Free choice” in the heading of both provisions refects 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 thesaurus
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 individ-
ual right, it would mean that “[m]any other Medicaid plan
requirements would likely do the same.” Ante, at 380. But
case law from the lower courts demonstrates that this fear
is unfounded. Those courts have recognized only a tiny
8
Compare § 1396r(c)(1)(A)(i) (“Free choice” (boldface deleted)) with
§ 227, 81 Stat. 903 (“Free choice by individuals eligible for medical assist-
ance” (some capitalization omitted)). Notably, the same omnibus legisla-
tion that included the FNHRA free-choice provision also included an
amendment to the original free-choice-of-provider provision that appeared
under the heading “Freedom of choice,” further reinforcing the view that
the provision is rights creating. § 4113(c), 101 Stat. 1330–152 (some capi-
talization omitted).
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Jackson, J., dissenting
handful of the nearly 90 provisions contained in the Medicaid
A
ct's list of state-plan requirements as actually conferring
individual rights. See Brief for National Health Law Pro-
gram 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 unanim-
ity of the Circuits as to each provision's enforceability).
And the lower courts have consistently refused to recognize
individual rights in the Medicaid Act's various other state-
plan provisions. Ibid.
Meanwhile, the vast majority of the provisions on the Med-
icaid Act's list of state-plan requirements have never gener-
ated 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 confrms as much:
Prior to 2017, every Circuit to consider the question had held
that the free-choice-of-provider provision confers an individ-
ual 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 foodgates 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 375. Indeed, in Gonzaga itself, the
Court rationalized its newly restrictive approach to § 1983
enforceability by indicating that some lower courts had be-
come too permissive in recognizing enforceable statutory
rights. 536 U. S., at 283. 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 wellspring of generally enforceable rights.
Rather, the state of affairs before our tightening of the test
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416 MEDIN
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Jackson, J., dissenting
reinforces that the free-choice-of-provider provision is, in
fac
t, the “atypical” spending statute that creates individual
rights, Talevski, 599 U. S., at 183—contrary to the majority's
assertions otherwise. Ante, at 380, 383.
C
Finally, Justice Thomas's concurrence calls for a “funda-
mental reexamination of our § 1983 jurisprudence” based on
his view that the “history of § 1983 makes clear that the stat-
ute has exceeded its original limits.” Ante, at 386, 397.
Because his opinion is not tethered to the specifc facts or
arguments presented in this case, an extensive response is
not necessary here. But it is worth pausing briefy to think
about whether the historical account he offers refects 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 frst several decades. Ante, at
387–388. 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
fling civil rights lawsuits during the Jim Crow era could be
quite perilous, especially for the people whom the statute
was originally meant to beneft. Many would-be plaintiffs
had reason to fear that fling a lawsuit would lead to physical
or economic reprisals.
9
Add to that the diffculty of fnding
a lawyer, prevailing before often-hostile juries, and (if suc-
9
See, e. g., M. Klarman, From Jim Crow to Civil Rights: The Supreme
Court and the Struggle for Racial Equality 49 (2004) (Klarman) (explaining
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, Ten-
nessee (last visited June 15, 2025), https://calendar.eji.org/racial-injustice/
oct/9 (recounting the lynching of a Black man whose wife had fled a civil
suit against a White man).
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Jackson, J., dissenting
cessful) enforcing a judgment, and it is not hard to imagine
that
the dearth of § 1983 lawsuits in the wake of Reconstruc-
tion 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 393–397. 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 391,
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—especially in
cases where no party has made such a claim or presented
any such argument.
***
Congress enac ted the Medicaid Ac t's free-choice-of-
provider 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 frst to so weaken
the landmark civil rights protections that Congress enacted
10
See Klarman 48–49 (describing the dearth of lawyers willing to litigate
civil rights cases, the lack of sympathy among southern juries, and the
unlikelihood that local authorities would be willing to enforce judgments
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 defned to be the just claim, ownership, or lawful title which a
person has to anything ”).
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during the Reconstruction Era. See, e. g., Civil Rights
C
ases, 109 U. S. 3 (1883); United States v. Cruikshank, 92
U. S. 542 (1876); Blyew v. United States, 13 Wall. 581 (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 tangi-
ble harm to real people. At a minimum, it will deprive Med-
icaid 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.” Kerr, 95
F. 4th, at 169. The Court today disregards Congress's ex-
press desire to prevent that very outcome.
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Reporter’s Note
The attached opinion has been revised to refect the usual publication
and citation style of the United States Reports. The revised pagination
makes available the offcial United States Reports citation in advance of
publication. The syllabus has been prepared by the Reporter of Decisions
for the convenience of the reader and constitutes no part of the opinion of
the Court. A list of counsel who argued or fled briefs in this case, and
who were members of the bar of this Court at the time this case was
argued, has been inserted following the syllabus. Other revisions may
include adjustments to formatting, captions, citation form, and any errant
punctuation. The following additional edits were made:
p. 374, line 14: “brought” is inserted before “under”
p. 404, line 6 from bottom: “or” is changed to “and”