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Felicia Ray Owens at the Center of It All.

In a landmark decision released Thursday morning, the U.S. Supreme Court ruled 6-3 in favor of South Carolina in Medina v. Planned Parenthood South Atlantic, granting states the authority to exclude reproductive health clinics from their Medicaid programs—even when those clinics provide essential care such as cancer screenings, birth control and STI testing. This decision could embolden Republican-led states to “defund” Planned Parenthood across the country.

The ruling marks a significant setback for reproductive health advocates, who warn it will disproportionately impact low-income women, especially in rural areas where health services are already limited.

“This is not just about abortion. This is about blocking low-income women from basic reproductive care—just because their provider also happens to offer abortions,” said Ellie Smeal and Kathy Spillar of the Feminist Majority Foundation (publisher of Ms.) in a joint statement.

At the center of the case was whether states can defund Planned Parenthood and similar clinics under Medicaid, the federal-state program that provides healthcare for millions of low-income Americans. While federal law guarantees Medicaid patients the right to see “any qualified provider,” Justice Neil Gorsuch, writing for the majority, argued that patients do not have the right to sue states that violate this provision.

“Translation: States can now discriminate—and patients are left with no legal recourse,” according to Smeal and Spillar. “Planned Parenthood and hundreds of independent reproductive health clinics have been a lifeline for millions. And now, states have a green light to cut that lifeline off.”

In her dissent, Justice Ketanji Brown Jackson, joined by Justices Elena Kagan and Sonia Sotomayor, blasted “the majority’s effort to resist the natural and obvious rights-creating reading of the Medicaid Act’s free-choice-of-provider provision.”

“Today’s decision is likely to result in tangible harm to real people,” they continued. “At a minimum, it will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians—and countless other Medicaid recipients around the country—of a deeply personal freedom: the ‘ability to decide who treats us at our most vulnerable.’”

The ruling could open the door for other states to follow South Carolina’s lead, effectively shutting down access to trusted reproductive healthcare providers for Medicaid patients. Clinics that serve low-income women—particularly Black and brown women, young women, mothers and survivors—may now face state-level exclusion solely because they also offer abortion services, even if those services are funded separately.

Over 60 percent of reproductive health clinics in rural areas have already closed or reduced services in recent years, according to the American College of Obstetricians and Gynecologists. Advocates warn this ruling could accelerate that trend.

“This is a calculated attack—part of a sweeping plan to dismantle every last safeguard for reproductive freedom,” Smeal and Spillar said.

In response, reproductive rights organizations are urging the public to mobilize. Calls to action include contacting members of Congress to pass federal protections for Medicaid patients, signing petitions and spreading awareness through social media.

“We will never accept a country where a woman’s healthcare is decided by partisan judges,” said Spillar. “We are the majority. And we are not done.”

Senate Parliamentarian Decision Complicates GOP Push to Restrict Abortion Coverage

The Court’s ruling comes on the same day the Senate parliamentarian issued a consequential decision on Republicans’ sweeping One Big Beautiful Bill Act. In a critical procedural victory for reproductive rights advocates, the parliamentarian ruled that several provisions in the bill—most notably, a ban on federal cost-sharing reduction payments to health plans that cover abortion—would be subject to a 60-vote threshold in the Senate. That hurdle could make it significantly harder for antiabortion measures to advance.

“Republicans tried to effectively ban healthcare plans on the ACA marketplaces from covering abortion altogether, which would have put abortion care out of reach for millions of women in states where abortion is legal,” said Sen. Patty Murray (D-Wash.). “This effort was part of Republicans’ plan to institute a backdoor nationwide abortion ban by making abortion care inaccessible for everyone, everywhere. Democrats challenged this attack on women’s healthcare under Senate rules and won—and we will keep fighting every Republican attempt to rip away abortion access every way we can.”

Still, the bill contains far-reaching proposals that would strip healthcare from millions, cut food assistance to the most vulnerable and attack Medicaid and Medicare—all while delivering massive tax breaks to corporations and the wealthiest Americans.