Medina v. Planned Parenthood South Atlantic

Justice Gorsuch delivered the opinion of the Court.¶

Medicaid offers States “a bargain.” Armstrong v. Exceptional 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, Jeremiah L. Morgan, Patrick M. McSweeney, Joseph W. Miller, and Kerry L. Morgan ; for the Eagle Forum Education & Legal Defense Fund by Lawrence J. Joseph ; for the Family Policy Alliance et al. by Randall L. Wenger, Janice L. Martino-Gottshall, and Jeremy L. Samek ; for Heartbeat International, Inc., by Adam F. Mathews ; for Liberty Counsel by Mathew D. Staver, Anita L. Staver, and Horatio G. Mihet ; for South Carolina Medicaid 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 Fitzgerald ; 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 affirmance were filed for the Commonwealth 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 Obstetricians and Gynecologists et al. by Janice Mac Avoy and Francisco Negrón, Jr. ; for Former Senior Officials 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 turn for federal funds, States agree “to spend them in accordance with congressionally imposed conditions.” Ibid. Should a State fail to comply substantially with those conditions, the Secretary of Health and Human Services can withhold some or all of its federal Medicaid funding. This case poses the question whether, in addition to that remedy, individual Medicaid beneficiaries may sue state officials for failing to comply with one funding condition spelled out in 42 U. S. C. § 1396a(a)(23)(A).¶

I¶

Congress created Medicaid in 1965 to subsidize state efforts to provide healthcare to families and individuals “ `whose income and resources are insufficient to meet the costs of necessary medical services.' ” Armstrong , 575 U. S., at 323 (quoting § 1396–1). Today, all 50 States participate in Medicaid. Congressional Research Service, Medicaid: An Overview 1 (2025) (CRS). In order to do so, a State must submit to the Secretary a “plan for medical assistance.” § 1396a(a); see also § 1396–1. To win the Secretary's approval, that plan must satisfy more than 80 separate conditions Congress has set out in § 1396a(a). Once the Secretary approves a plan, federal funds begin flowing to help the State execute it. Of course, States must contribute their own¶

P. Markovs, Lyndsey M. Olson, David Chiu, Meredith A. Johnson, and Rachel A. Neil ; for Medicaid Beneficiaries C. M. et al. by Ian Heath Gershengorn ; 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 Organizations 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. Ellsworth ; and for 238 Members of Congress by Christopher E. Babbitt.¶

Briefs of amici curiae were filed for the American Public Health Association 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.¶

money, too. See § 1396d(b). Historically, the federal government has provided on average about 57% of the funds required to implement Medicaid, and States have supplied the balance. CRS 21.¶

This case concerns one of the conditions state plans must meet. Located in § 1396a(a)(23)(A), Medicaid's anyqualified-provider provision, as it is sometimes called, requires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. The provision does not define the term “qualified,” 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 acknowledges that, if a State fails “to comply substantially” with this (or any) congressionally specified condition, the Secretary may withhold some or all of the State's federal funding until he is “satisfied that there will no longer be any such failure to comply.” § 1396c.¶

The parties' dispute concerns whether, in addition to that remedy, the law recognizes another. The dispute arose this way. Planned Parenthood South Atlantic operates two clinics 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 entities and governmental agencies” would continue to provide “access to necessary medical care and important women's health and family planning services.” Id ., at 158a. According to the State, it has “140 [other] federally qualified 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 Parenthood and one of its patients, Julie Edwards, sued the director of the State's Department of Health and Human Services. They argued that South Carolina's exclusion of Planned Parenthood from its Medicaid program violated the anyqualifed-provider provision. Specifically, Ms. Edwards alleged that, while she regularly visits other medical care providers, she has had especially positive experiences with Planned Parenthood and would like “to shift all [her] gynecological and reproductive health care there.'' App. 32, 33. But none of that will be possible, she continued, unless Medicaid covers those services. Ibid . Based on these allegations, Ms. Edwards and Planned Parenthood brought a putative class action “pursuant to 42 U.S.C. § 1983 to vindicate 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” enforceable under § 1983 “as a matter of course.” Health and Hospital Corporation of Marion Cty. v. Talevski , 599 U. S. 166, 183 (2023). That is particularly true of statutes, like Medicaid, enacted pursuant to Congress's spending power. The spending power allows Congress to offer funds to States that agree to certain conditions. See, e . g ., South Dakota v. Dole , 483 U. S. 203, 207–208 (1987). But when a State violates those conditions, “ `the typical remedy' ” is not a private enforcement suit “ `but rather action by the Federal Government 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 anyqualifed-provider provision, they said, is among those rare federal spending-power statutes that confer individual rights enforceable under § 1983. And, they submitted, South Carolina violated Ms. Edwards's rights under that provision when it denied her the opportunity to select Planned Parenthood as her healthcare provider. Agreeing with the plaintiffs' assessment, the district court granted summary judgment to them and entered a permanent 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 affirmed the district court's decision. Planned Parenthood South Atlantic v. Kerr , 27 F. 4th 945 (2022). Writing separately, Judge Richardson expressed “confusion and uncertainty” about this Court's directions addressing when spending-power legislation creates enforceable rights under § 1983. Id ., at 959 (opinion concurring in judgment). And he voiced “hop[e]” that we might provide “clarity . . . soon.” Ibid.¶

Seeking review of the Fourth Circuit's decision, the State filed a petition for certiorari in this Court. In light of our 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, vacated 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 reaffirmed its earlier decision. 95 F. 4th, at 153. And, once more, Judge Richardson wrote separately. Even after Talevski , he said, lower courts “continue[d] to lack the guidance” they need from this Court to determine when a federal spending-power statute 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 filed another petition for certiorari. In it, South Carolina 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 clarification, we begin by outlining how to determine whether a statute confers an individually enforceable right under § 1983.¶

A¶

The Constitution charges the Executive Branch with enforcing 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 individuals to sue anyone who, under color of state law, deprives them of “rights, privileges, or immunities secured by the Constitution and laws” of the United States.¶

Historically, individuals brought § 1983 suits to vindicate rights protected by the Constitution. But, in 1980, this Court recognized that § 1983 also authorizes private parties to pursue violations of their federal statutory rights. Maine v. Thiboutot , 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 legislation seeks to benefit one group or another. (Why pass legislation otherwise?) But § 1983 provides a cause of action “only for the deprivation of `rights, privileges, or immunities,' ” not “ `benefits' or `interests.' ” Gonzaga , 536 U. S., at 283.¶

To prove that a statute secures an enforceable right, privilege, or immunity, and does not just provide a benefit or protect an interest, a plaintiff must show that the law in question “clear[ly] and unambiguous[ly]” uses “rightscreating 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, Talevski , 599 U. S., at 183. We have described this as a “stringent” and “demanding” test. Id. , at 180, 186; accord, post , at 405 ( Jackson, J., dissenting) (describing Gonzaga as setting forth “a restrictive test”). And even for the rare statute that satisfies it, this Court has said, a § 1983 action still may not be available if Congress has displaced § 1983's general cause of action with a more specific remedy. Rancho Palos Verdes v. Abrams , 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 quotation 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 Restaurant , 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 private suits.” Hernández v. Mesa , 589 U. S. 93, 100 (2020). After all, the decision whether to let private plaintiffs enforce 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 services and spend it instead on litigation. See ibid . The job of resolving how best to weigh those competing costs and benefits belongs to the people's elected representatives, not unelected judges charged with applying the law as they find it. See Alexander v. Sandoval , 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 enforceable right, spending-power statutes like Medicaid are especially unlikely to do so. The reasons why take a little unpacking.¶

When Congress passes a law, say, regulating commerce between the States or outlawing piracy, it can point for authority 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 “ratified Cannon 's holding,” Sandoval , 532 U. S., at 280, the Court has retreated from Cannon 's reasoning, which “exemplified” an “expansive rights-creating approach” that later decisions “abandoned,” Franklin v. Gwinnett County Public Schools , 503 U. S. 60, 77 (1992) (Scalia, J., concurring in judgment); see also Stoneridge Investment Partners, LLC v. Scientific-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.¶

conduct. But when Congress distributes money, its authority rests on a different footing.¶

The Constitution has no “Spending Clause,” strictly speaking. Instead, we usually trace Congress's spending power to Article I, section eight, clause one, which gives Congress the “Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence 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 governments 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 fierce 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 Manufactures (Dec. 5, 1791), in 10 Papers of Alexander Hamilton 230, 303–304 (H. Syrett ed. 1966) (emphasis deleted). But he denied that those powers included as well “a power to do whatever else should appear to Congress conducive to the General Welfare.” Ibid . James Madison advanced a narrower position still. As he saw it, the language authorized Congress to spend money only in support of its other enumerated powers. 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 example, as Justice Story saw it, Congress may raise and “appropriat[e] . . . money” to advance the “general welfare.” 3 J. Story, Commentaries on the Constitution of the United States § 1269, p. 150 (1833). But nothing in Article I, section eight, clause one endows Congress with a power to regulate, for if it did, the “enumeration of specific powers” elsewhere in Article I would be rendered largely pointless, and the Nation would trade a limited federal government for “an unlimited” 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 Congress—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 first 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 exemption, this Court looked to “the expectations of the parties,” 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 same as contracts “between individuals.” Searight v. Stokes , 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 benefit the citizens of the compacting nations, they generally do not confer individually enforceable rights against a sovereign, but “depen[d] for the enforcement of [their] provisions on . . . the governments which are parties to” them. Head Money Cases , 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 occasion 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 Congress: Democrats and Whigs, 1829–1861, pp. 42–45 (2005). But that began to change during the New Deal. And when disputes about those grant conditions arose, this Court returned to the old contract and treaty analogies to ensure that spending-power legislation did not pass the “point at which pressure turns into compulsion.” Steward Machine Co. v. Davis , 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 benefit individuals 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 Restatement (Third) of Foreign Relations Law of the United States § 907, Comment a , p. 395 (1986); emphasis added).¶

(1947). The same analogies guided the Court, too, after federal grants exploded in the 1960s, generating “an unprecedented” wave of litigation in which private parties sought to challenge state compliance with federal grant conditions. E. Tomlinson & J. Mashaw, The Enforcement of Federal Standards in Grant-In-Aid Programs: Suggestions for Beneficiary Involvement, 58 Va. L. Rev. 600, 630 (1972). 3¶

Take Pennhurst . There, private plaintiffs sought to sue the Commonwealth of Pennsylvania for failing to fulfill the terms of a federal healthcare grant. 451 U. S., at 6. In assessing 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 federal funds, the States agree to comply with federally imposed 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 voluntarily 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. Office of Management and Budget, Historical Tables, Budget of the United States Government, Summary Comparison of Total Outlays for Grants to State and Local Governments: 1940–2029 (2024) (Table 12.1), https://www.govinfo .gov/app/details/BUDGET-2025-TAB/BUDGET-2025-TAB-13-1.¶

4 Beyond the rule that Congress must clearly and unambiguously alert States to conditions associated with federal funding, our cases have articulated other limits on spending-power legislation. First, as previously observed, “the exercise of the spending power must be in pursuit of `the¶

In Gonzaga , the Court restated these principles and explored how they interact with § 1983. Spending-power legislation, the Court explained, cannot provide the basis for a § 1983 enforcement suit unless Congress “speaks with a clear voice, and manifests an unambiguous intent to confer individual rights.” 536 U. S., at 280 (alteration and internal quotation marks omitted). Only that kind of “unmistakable” notice, the Court said, suffices to alert grantees that they might be subject “to private suits . . . whenever they fail to comply with a federal funding condition.” Id ., at 286–287, and n. 5 (internal quotation marks omitted). And, the Court concluded, because the statute at issue before it did not clearly and unambiguously confer a “right to support a cause of action brought under § 1983,” the plaintiff's suit could not proceed. 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 projects or programs.” Dole , 483 U. S., at 207 (internal quotation marks omitted). 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 S calia, 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. Premier 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 beneficiaries” sufficient 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 expanding 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).¶

Just two Terms ago, we reaffirmed these points. In Talevski , the Court faced another private § 1983 suit alleging that recipients of federal funding had violated grant conditions. To decide whether the plaintiffs could proceed, we turned to Gonzaga , recognizing that it “sets forth our established method” for analyzing suits like that. Talevski , 599 U. S., at 183. In doing so, we reiterated that the relevant “[s]tatutory provisions must unambiguously confer individual federal rights” before a § 1983 claim might proceed. Id., at 180. That standard, we emphasized, is a “demanding bar” and a “significant hurdle” that will be cleared only in the “atypical case.” Id ., at 180, 183–184. And, applying that test, we found the statutes in question satisfied it precisely because they “expressly” employed the sort of clear and unambiguous “rights-creating language” Gonzaga demands. 599 U. S., at 184, 186 (internal quotation marks omitted).¶

Admittedly, this Court briefly experimented with a different 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 private causes of action to enforce federal laws. See Part IIA, 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 example, the Court suggested that spending-power legislation can give rise to an enforceable right under § 1983 so long as the legislation is “intended to benefit the putative plaintiff ” and the plaintiff 's interest in the statute is not “too vague and amorphous.” 496 U. S. 498, 509 (1990) (alteration and internal quotation marks omitted); see Wright v. Roanoke Redevelopment and Housing Authority , 479 U. S. 418, 423424, 431–432 (1987). Building on those same ideas in Blessing v. Freestone , the Court outlined a three-factor test for recognizing new privately enforceable rights. 520 U. S. 329,¶

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 individual right. See, e . g ., 95 F. 4th, at 163–165; id ., at 170 (Richardson, J., concurring in judgment).¶

They should not. Gonzaga “reject[ed]” any reading of our prior cases that would “permit anything short of an unambiguously conferred right to support a cause of action brought under § 1983.” 536 U. S., at 283. Armstrong “repudiate[d]” any other approach. 575 U. S., at 330, n. And Talevski reaffirmed 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. Because spending-power legislation is “in the nature of a contract,” 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 spendingpower statute fails to provide “clear and unambiguous” notice 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-qualified-provider provision. To succeed, they must show, at a minimum, that § 1396a(a) (23)(A) does not just seek to benefit them or serve their interests but “clear[ly] and unambiguous[ly]” gives them individual federal rights. Gonzaga , 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. Gonzaga , 536 U. S., at 284 (emphasis deleted; internal quotation marks omit-¶

Since Pennhurst , this Court has identified only three sets of spending-power statutes that confer enforceable rights under § 1983—those at issue in Wright , Wilder , and Talevski . But given this Court's longstanding repudiation of Wright and Wilder 's reasoning, the statutes at issue in Talevski supply the only reliable yardstick against which to measure whether spending-power legislation confers a privately enforceable right.¶

Talevski addressed two provisions of the Federal Nursing Home Reform Act (FNHRA). See 599 U. S., at 181–182. The first obliged nursing-home facilities to “protect and promote” residents' “ right to be free from” unnecessary “physical or chemical restraints.” 42 U. S. C. § 1396r(c)(1)(A)(ii) (emphasis added). The second appeared in a subparagraph titled “[t]ransfer and discharge rights . ” § 1396r(c)(2)(A) (emphasis added). And both provisions sat in a subsection called “[r]equirements relating to residents' rights . ” § 1396r(c) (emphasis added).¶

The any-qualified-provider provision before us looks nothing 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, qualified to perform the service or services required . . . who undertakes to provide him such services.” Doubtless, this language speaks to what a State must do to participate in Medicaid, and a State that fails to fulfill its duty might lose federal funding. Doubtless, too, this provision seeks to benefit both providers and patients. But missing from § 1396a(a)(23)(A) is anything like FNHRA's clear and unambiguous “rights-creating language.” Talevski , 599 U. S., at 186 (internal quotation marks omitted).¶

ted). And even then, a § 1983 action may not be available if Congress has displaced that general cause of action with a more specific remedy. See supra, at 368. To resolve this case, however, we need not reach those questions.¶

To be sure, Congress could have taken a different approach when drafting § 1396a(a)(23)(A). In fact, FNHRA offers an example almost perfectly on point. One of its provisions gives nursing-home residents the right to choose their own attending physicians. Here is the provision in context:¶

“ (c) Requirements relating to residents' rights¶

“ (1) General rights¶

“ (A) Specified rights¶

“A nursing facility must protect and promote the rights of each resident , including each of the 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 federal 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 confirm our conclusion. After announcing that state Medicaid plans must allow individuals to obtain care from any qualified provider, the provision proceeds to carve out various 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]” which felony convictions qualify for that exclusion. § 1396a(a)(23)(B). All that makes perfect sense if § 1396a(a)(23)(A) speaks only to a State's duties to the 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 surrounding statutory context yields similar clues. To continue receiving federal funding, the Medicaid Act says, a State need only “comply substantially” with the any-qualified-provider mandate. § 1396c. And, as this Court recognized in Gonzaga , that focus on “ `aggregate' ” compliance suggests that a statute addresses a State's obligations to the federal government, not the rights “ `of any particular person.' ” 536 U. S., at 288. Sometimes, we appreciate, a provision may overcome this weighty statutory evidence. In Talevski , after all, the Court found two FNHRA provisions to confer individual rights even though that statute also speaks of “substantial compliance.” See Brief for Respondents 35–36. But, at risk of repetition, the provisions at issue there employed explicit and unmistakable “ `rights-creating language,' ” 599 U. S., at 186, and § 1396a(a)(23)(A) does not.¶

Notable, too, is where Congress placed the any-qualifedprovider provision. It appears in a subsection titled “Contents.” § 1396a(a). That subsection outlines scores of things a state plan must include to qualify for federal funding. Ibid . Those requirements do not appear in any discernible order, and the any-qualified-provider provision does not crop up until paragraph 23 of 87. All of § 1396a(a)'s requirements are directed to the Secretary of Health and Human Services, who must “approve any plan” that meets them. § 1396a(b); see Armstrong , 575 U. S., at 331–332 (plurality opinion). None of this may suffice to prove that the any-qualified-provider provision is unenforceable under¶

§ 1983. See § 1320a–2. But it does show, once more, that the statute before us stands in stark contrast to the ones we faced in Talevski , where Congress set its rights-creating provisions apart from others and, in doing so, helped alert grantees that accepting federal funds comes with a duty to answer private suits.¶

Observe, as well, what it would mean if § 1396a(a)(23)(A) did create an individually enforceable right. Many other Medicaid plan requirements would likely do the same. And instead of remaining “atypical” exceptions, as our cases have said they are, rights-creating provisions might more nearly become the rule. Talevski , 599 U. S., at 183.¶

Take one example. See Brief for United States as Amicus Curiae 27–29 (offering others). Section 1396a(a)(32) follows several paragraphs down from the any-qualifedprovider 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 Respondents 38–39. Both speak in mandatory terms (“must . . . provide”; “shall”). Both discuss “individual[s].” Neither mentions “rights.” Yet, while the plaintiffs insist that paragraph (23)(A) clearly and unambiguously creates an individual right, they suggest that a court could reasonably “determine” 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 dissent offer four principal counterarguments.¶

First, the plaintiffs and dissent appeal to legislative history. The hearings and committee reports leading to § 1396a(a)(23)(A)'s adoption, they say, reveal that Congress meant for the statute to secure an individual right. See Brief for Respondents 30–32; see also post , at 399, 408–409 ( Jackson , J ., dissenting). But that does not move the needle. 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 history is not the law”). And that goes double for spendingpower 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 modeled § 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 benefits under this subchapter may obtain health services from any . . . person qualified 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-qualified-provider provision illustrates the pitfalls of trying to equate an unenacted legislative record with the law. On the plaintiffs' telling, Congress first enacted the any-qualified-provider provision “to prevent [the] second-class treatment” of Medicaid patients, as exemplified 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 beneficiaries from its protections. See § 1396a(a)(23)(B) (“[T]his paragraph shall not apply in the case of Puerto Rico, the Virgin Islands, and Guam”).¶

Medicaid offshoot must as well. Brief for Respondents 34; see post , at 409 ( Jackson, J. , dissenting).¶

This argument stumbles out of the gate. Its premisethat § 1395a(a) confers an enforceable right—is questionable. As the plaintiffs admit, “[n]o court has addressed whether a Medicare beneficiary can enforce this provision under Section 1983.” Brief for Respondents 34, n. 7. Even overlooking that deficiency, another quickly emerges. While the title of § 1395a(a) “guarantee[s]” a patient's “free choice” of provider—and while the plaintiffs and dissent insist this language can create a right—the any-qualified-provider provision never uses “guarantee” or its equivalent. So if the comparison between the Medicaid and Medicare provisions reveals anything, it is that Congress did not 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 Amendment 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¶

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 (capitalization omitted)).¶

Even beyond that, the dissent's test would risk obliterating the longstanding line between mere benefits and enforceable 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 benefits would suddenly create rights instead. Supra, at 380. All despite Talevski 's insight just two Terms ago that, while many statutes supply benefits, 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 414415 (opinion of Jackson , J.). How? Not based on their text (which the dissent never addresses) but, it seems, based on an unspoken judicial intuition that the provision before us is just more important than others. So, on top of all its other flaws, the dissent's approach would leave States guessing about the terms of their deals with the federal government and invite courts to revive their long-abandoned approach of usurping Congress's role in creating rights and remedies. Supra , at 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 409410, n. 5. But since the dissent relies heavily on that decision, post , at 409410, 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 extent O'Bannon addressed any right, then, it was an asserted property right under the Due Process Clause, not a clear and unambiguous statu-¶

Fourth and finally, the plaintiffs and dissent advance a policy argument. Only § 1983 litigation, they submit, can give the any-qualified-provider provision the teeth it needs. Yes, they acknowledge, the federal government can audit States' compliance with § 1396a(a)(23)(A) and withhold some or all Medicaid funds from noncompliant States. Brief for Respondents 44. But, the plaintiffs and dissent insist, the federal government has neither the capacity nor the 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 specifically rejected the notion that “the cut-off of funding” is “too massive” a remedy “to be a realistic 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 benefits for care [from a provider] that has been decertified.” 447 U. S., at 785. And that is precisely the right the plaintiffs assert here.¶

Separately, the dissent suggests that amicus briefs the government filed in other cases might suffice to supply States with notice of a 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 administration to administration. And our decisions have never suggested that anything less than clear statutory language can supply States with the unambiguous notice required. Instead, given the separation of powers and federalism concerns we have outlined, our decisions have always “insist[ed] that Congress speak with a clear voice.” Pennhurst State School and Hospital v. Halderman , 451 U. S. 1, 17 (1981) (emphasis added).¶

F. 3d, at 1038. That process can culminate with state judicial 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 insufficient, 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 observed, a decision like that comes with tradeoffs. At their best, individual suits under § 1983 can vindicate plaintiffs' rights while pushing States to fulfill their obligations. But private enforcement does not always benefit the public, not least because it requires States to divert money and attention away from social services and toward litigation. And balancing those costs and benefits 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” situations, Talevski , 599 U. S., at 183, where the provision in question “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 decision 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 today's dissenters). And in doing so, we reach the unsurprising conclusion that it generally belongs to the federal government to supervise compliance 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 recognizes that this case is not an atypical one.¶

otherwise, its judgment is reversed and the case is remanded for further proceedings consistent with this opinion.¶

It is so ordered.¶