The Supreme Court is scheduled to hear arguments in a case that opponents of abortion say could lead to one of Planned Parenthood’s major sources of funding drying up. 

On Wednesday, the Supreme Court will hear arguments in Medina v. Planned Parenthood South Atlantic, which will determine whether states can block certain providers, such as those that perform abortions, from receiving Medicaid funds.

While the case rests on a relatively narrow question, abortion activists on both sides of the issue say the decision could have significant consequences for Planned Parenthood.

The case stems from a 2018 executive order issued by the governor of South Carolina, Henry McMaster, blocking facilities that perform abortions from receiving federal funds to provide services to Medicaid patients. 

Federal law currently prohibits federal funds from being used to pay for abortions in most cases. However, conservative states say that federal funds should not go to Planned Parenthood for any of the other services it provides so long as it continues to offer abortion services. South Carolina argues that money from the federal government paying for other services “frees up [Planned Parenthood’s] funds to provide more abortions.”

Although the case touches on the hot button topic of abortion and other health care services, the main question before the court is whether Medicaid’s statute “unambiguously” gives patients the ability to sue to enforce their right to choose who their provider is.  The Medicaid Act states that patients can receive health care from “any institution, agency, community pharmacy, or person, qualified to perform the service or services required.”

South Carolina is appealing a ruling from the U.S. Court of Appeals for the Fourth Circuit that blocked Mr. McMaster’s order from taking effect. The appeals court found that patients have a right to choose their provider as long as they are “qualified,” which it said means that the provider is “professionally competent” to provide the services the patient is seeking, and that they can sue to enforce their right.

Lawyers for South Carolina are not arguing that Planned Parenthood providers are not “competent.” However, they say the organization is not qualified to receive federal funding because it performs abortions, which is a “denial of the right to life.” It adds that it would consider Planned Parenthood “qualified” if it stopped performing abortions, but “it has chosen not to do so.”

The American Public Health Association and other health groups have raised concerns about states being able to block Medicaid funds from going to Planned Parenthood as they note the organization offers other services such as cancer screenings, physical exams, and, more recently, so-called gender-affirming care for those who want to medically transition to a sex other than the one they were born with.

A group of health care policy analysts said in a filing that Planned Parenthood “fills the gaps where South Carolina’s providers are scarcest — women’s health and preventative care — lessening the burden on other parts of the state’s health care system.” Already, health care professionals say there are too few federally qualified providers in the state. The Associated Press reports that there are fourteen counties with no practicing OB-GYN physicians and five that only have one.

An organization focused on expanding access to abortion, the Guttmacher Institute, says it would be a “grave injustice” to block Medicaid patients from going to Planned Parenthood. 

While health care professionals warn that letting South Carolina block Planned Parenthood from Medicaid’s program could lead to “deserts” of health services, the state argues it should be able to determine which providers are “qualified” and not be forced to let taxpayer dollars go to an organization that performs abortions. 

A conservative law firm, the Alliance Defending Freedom, which is representing South Carolina’s Department of Health and Human Services in the case, argues that the decision about which providers are qualified to receive Medicaid funds should be left up to the states. 

A senior counsel for the ADF, John Bursch, said in a statement, “Taxpayer dollars should never be used to fund facilities that profit off abortion and distribute dangerous gender-transition drugs to minors.”

“State officials should be free to determine that Planned Parenthood — a multi-billion-dollar activist organization — is not a real health care provider and is not qualified to receive taxpayer funding through Medicaid,” he added. “Congress didn’t intend to allow Medicaid recipients to drag states into federal court to challenge those decisions — nor did Congress intend for federal courts to second-guess states’ decisions about which providers are qualified to receive Medicaid funding.”

In response to concerns about blocking Planned Parenthood from Medicaid programs, South Carolina insists there are plenty of other options for patients, such as more than 140 federally qualified health clinics throughout the state. 

Even though the question at the heart of the case is not specifically about abortion, activists on both sides see the case as one that could potentially lead to severe financial hardships for Planned Parenthood if the court rules in favor of South Carolina. Texas, Arkansas, and Missouri also have laws that prevent Medicaid funds from going to Planned Parenthood. It is expected that additional conservative states would implement such prohibitions if the Supreme Court frees them up to do so. 

According to Planned Parenthood, about half its patients nationwide get their health care through Medicaid. During an anti-abortion rally at Capitol Hill last week, the head of Susan B. Anthony Pro-Life America, Marjorie Dannenfelser, said letting states block Planned Parenthood from Medicaid funds would be “the blow that brings them down.”

“They will not be able to survive this,” she added. 

Executives at Planned Parenthood seem to agree with that warning. They said in a filing that it might not be able to deliver services “in the same manner we have been” if the Supreme Court does not rule in its favor and that it could be forced to reduce its hours.

Meanwhile, other critics of South Carolina’s effort to restrict Medicaid funds say a ruling in the state’s favor could open the door for states to further clamp down on the organization for its expansion into the gender-affirming care business.