WASHINGTON (AP) — States can block the country’s biggest abortion provider, Planned Parenthood, from receiving Medicaid money for health services such as contraception and cancer screenings without facing lawsuits from patients, the Supreme Court ruled on Thursday.

The 6-3 opinion by Justice Neil Gorsuch and joined by the rest of the court’s conservatives was not directly about abortion, but it comes as Republicans back a wider push across the country to defund the organization. It closes off Planned Parenthood's primary court path to keeping Medicaid funding in place: patient lawsuits.

The justices found that while Medicaid law allows people choose their own provider, that does not make it a right enforceable in court. The court split along ideological lines, with the three liberals dissenting in the case from South Carolina.

Public health care money generally cannot be used to pay for abortions, but Medicaid patients go to Planned Parenthood for other needs in part because it can be difficult to find a doctor who takes the publicly funded insurance, the organization has said.

Gov. Henry McMaster, R-S.C., said Planned Parenthood should not get any taxpayer money. The budget bill backed by President Donald Trump in Congress would also cut Medicaid money for the group. That could force the closure of about 200 centers, most of them in states where abortion is legal, Planned Parenthood has said.

McMaster first moved to cut off the Medicaid funding in 2018 but he was blocked in court after a lawsuit from a patient, Julie Edwards, who wanted to keep going to Planned Parenthood for birth control because her diabetes makes pregnancy potentially dangerous. She sued over a provision in Medicaid law that allows patients to choose their own qualified provider.

South Carolina argued that patients should not be able file such lawsuits. The state pointed to lower courts that have been swayed by similar arguments and allowed states such as Texas to act against Planned Parenthood.

The high court majority agreed.

“Deciding whether to permit private enforcement poses delicate policy questions involving competing costs and benefits — decisions for elected representatives, not judges,” Gorsuch wrote. He pointed out that patients can appeal through other administrative processes if coverage is denied.

McMaster, in a statement, said his state had taken “a stand to protect the sanctity of life and defend South Carolina’s authority and values — and today, we are finally victorious.”

In a dissent joined by her liberal colleagues, Justice Ketanji Brown Jackson said the ruling is “likely to result in tangible harm to real people.”

“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,'" she wrote.

Planned Parenthood officials said the decision will hamper access to care such as preventive screenings for 1 million Medicaid recipients in South Carolina and that other conservative states will likely take similar steps.

“Instead of patients now deciding where to get care, that now lies with the state,” said Katherine Farris, chief medical officer of Planned Parenthood South Atlantic. “If they fall on hard financial times, as many are right now, they are fundamentally less free."

She said South Carolina did not say Planned Parenthood provided inadequate care, describing it as political decision.

Other conservative states are expected to follow South Carolina's lead with funding cuts, potentially creating a “backdoor abortion ban,” said Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America.

Medicaid patients make up 3.5% of the organization’s South Carolina patients who come for services unrelated to abortion or gender-affirming care receive, officials said. Because South Carolina has not expanded its Medicaid program, reimbursements do not cover its preventive care costs, spokesperson Molly Rivera said.

Public health groups like the American Cancer Society have said in court papers that lawsuits are the only real way that Medicaid patients have been able to enforce their ability to choose their own doctor. Losing that ability is expected to reduce access to health care for people on the program, which is estimated to include one-quarter of everyone in the country. Rural areas could be especially affected, advocates said in court papers.

In South Carolina, $90,000 in Medicaid funding goes to Planned Parenthood every year, a tiny fraction of the state’s total Medicaid spending. The state banned abortion at about six weeks’ gestation after the Supreme Court overturned it as a nationwide right in 2022. The state says other providers can fill a health care void left by Planned Parenthood's removal from Medicaid.

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Associated Press writers Jeffrey Collins in Columbia, South Carolina, and Meg Kinnard contributed to this report.

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