Medina v. Planned Parenthood South Atlantic (606 U.S. 357, 2025)

PRELIMINARY PRINT Volume 606 U. S. Part 1 Pages 357–418 OFFICIAL REPORTS OF THE SUPREME COURT June 26, 2025 Page Proof Pending Publication REBECCA A. WOMELDORF reporter of decisions NOTICE: This preliminary print is subject to formal revision before the bound volume is published. Users are requested to notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, pio@supremecourt.gov, of any typographical or other formal errors. OCTOBER TERM, 2024 357 Syllabus MEDINA, DIRECTOR, SOUTH CAROLINA DE- PARTMENT 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 with congressionally imposed conditions. To participate in 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 Page Proof Pending Publication 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 358 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC 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 Page Proof Pending Publication 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 Cite as: 606 U. S. 357 (2025) 359 Syllabus 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 Page Proof Pending Publication 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 360 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Syllabus duties and may beneft providers and patients, but lacks FNHRA's clear “rights-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 Secretary, without discernible organizational principle. If § 1396a(a)(23)(A) created individual rights, many similar Medicaid pro- visions would too, making rights-creating provisions the rule rather Page Proof Pending Publication 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- Cite as: 606 U. S. 357 (2025) 361 Syllabus ernment lacks capacity or appetite for funding cutoffs. This Court has rejected 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 Page Proof Pending Publication 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 362 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC 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., Page Proof Pending Publication 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 Cite 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- forts to provide healthcare to families and individuals “ `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 Page Proof Pending Publication 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. 364 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court money, too. See § 1396d(b). Historically, the federal gov- ernment 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 any- qualified-provider provision, as it is sometimes called, 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- Page Proof Pending Publication 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- Cite as: 606 U. S. 357 (2025) 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. Page Proof Pending Publication 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- 366 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC 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 Page Proof Pending Publication 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 Cite 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). Page Proof Pending Publication 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 368 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC 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- Page Proof Pending Publication 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 Cite as: 606 U. S. 357 (2025) 369 Opinion of the Court private suits.” Hernández v. Mesa, 589 U. S. 93, 100 (2020). After 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 Page Proof Pending Publication 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. 370 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court 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 Page Proof Pending Publication 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- Cite as: 606 U. S. 357 (2025) 371 Opinion of the Court 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 Page Proof Pending Publication 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 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court same as contracts “between individuals. ” Sear ight 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 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 Page For muchProof Pending of the Nation's Publication 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). Cite as: 606 U. S. 357 (2025) 373 Opinion of the Court (1947). The same analogies guided the Court, too, after fed- eral 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 Page Proof Pending Publication 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 374 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court 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 Page Proof Dakota v. Dole, Pending 483 U. S. 203, Publication 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). Cite as: 606 U. S. 357 (2025) 375 Opinion of the Court Just two Terms ago, we reaffrmed these points. In Ta- levski, 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). Page Proof Pending Publication 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 recognizing new privately enforceable rights. 520 U. S. 329, 376 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court 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 Page Proof Pending Publication 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- Cite as: 606 U. S. 357 (2025) 377 Opinion of the Court 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 rights.” § 1396r(c)(2)(A) (emphasis added). And both provisions sat in a subsection called “[r]equirements relating to residents' r ights. ” Page Proof Pending Publication § 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. 378 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court 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). Page Proof Pending Publication 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]” Cite as: 606 U. S. 357 (2025) 379 Opinion of the Court 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 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- Page Proof Pending Publication 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- provider 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 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 380 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court § 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 Page Proof Pending Publication 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. Cite as: 606 U. S. 357 (2025) 381 Opinion of the Court First, the plaintiffs and dissent appeal to legislative his- tory. 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 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 Page Proof Pending Publication 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”). 382 MEDINA v. PLANNED PARENTHOOD SOUTH ATLANTIC Opinion of the Court 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 Page Proof Pending Publication 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., a