Does the "any-qualified-provider" provision of the Medicaid Act, found in 42 U. S. C. § 1396a(a)(23)(A), confer individual rights that are enforceable by private parties? Specifically, can Medicaid beneficiaries sue state officials under 42 U. S. C. § 1983 for failing to comply with this provision? The case arises from South Carolina's exclusion of Planned Parenthood clinics from its Medicaid program.

• Spending-power statutes like the Medicaid Act typically provide federal funding termination as a remedy, not private causes of action under 42 U. S. C. § 1983.
• Section 1396a(a)(23)(A) does not use "rights-creating terms" or manifest an "unmistakable focus" on individuals required by *Gonzaga Univ. v. Doe*.
• The provision describes state duties to the federal government rather than individual rights, as evidenced by the "substantial compliance" standard in 42 U. S. C. § 1396c.
• State administrative processes and judicial review provide sufficient alternative remedies for provider exclusions.

• Section 1396a(a)(23)(A) creates an individual right to choose a healthcare provider, which is enforceable under 42 U. S. C. § 1983.
• The provision's mandatory language and "individual-centric" focus satisfy the tests for creating enforceable rights.
• Legislative history and the similar Medicare provision in 42 U. S. C. § 1395a demonstrate that Congress intended to guarantee a right of free choice.
• Federal funding cutoffs are too drastic and unrealistic to serve as an effective enforcement mechanism, making § 1983 litigation necessary.

• The Court held that 42 U. S. C. § 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under 42 U. S. C. § 1983.
• Applying the "stringent" and "demanding" test from *Gonzaga Univ. v. Doe* and *Health and Hospital Corporation of Marion Cty. v. Talevski*, a plaintiff must show a statute uses "rights-creating terms" with an "unmistakable focus" on individuals.
• The Court reasoned that spending-power statutes are especially unlikely to confer rights because they resemble contracts or treaties between sovereigns (*Pennhurst State School and Hospital v. Halderman*; *Neil, Moore & Co. v. Ohio*), where the typical remedy is funding termination.
• Section 1396a(a)(23)(A) lacks the explicit "rights-creating language" found in the Federal Nursing Home Reform Act (FNHRA) analyzed in *Talevski*.
• The Court noted that while the provision may benefit patients, it describes state duties to the federal government rather than individual rights.
• Statutory context supports this: 42 U. S. C. § 1396c requires only "substantial" compliance, suggesting a focus on aggregate obligations rather than the rights of any particular person (*Gonzaga*).
• The Court rejected the use of legislative history to create rights, noting that in spending-power statutes, the key is what States are "clearly told," not speculated intentions (*Arlington Central School Dist. Bd. of Ed. v. Murphy*).
• Policy arguments regarding the inadequacy of funding cutoffs were rejected based on *Armstrong v. Exceptional Child Center, Inc.*, which held that such cutoffs are a realistic source of relief.