WASHINGTON — Some Supreme Court justices appeared open Wednesday to allowing South Carolina to deny federal funding for Planned Parenthood, during oral arguments in a dispute over the state disqualifying the health care provider from Medicaid for providing abortions.

But key justices also aired concerns that such a decision would leave no way for recipients to challenge state decisions about what providers qualify.

The central question for the justices is whether Congress created a right for Planned Parenthood or other groups to file such a lawsuit, which involves how explicit Congress must be if it wants to allow such a right.

The attorney for Planned Parenthood, as well as justices on the liberal wing of the court, pointed out Wednesday that preventing the medical provider from suing over South Carolina’s actions could allow states to exclude providers from Medicaid for any reason at all.

Chief Justice John G. Roberts Jr. and Justice Amy Coney Barrett raised concerns that providers and beneficiaries may not have the ability to challenge South Carolina’s decision to exclude Planned Parenthood despite the law’s provision requiring care from “any qualified provider.”

“If a person thinks that’s not being provided, what remedies do they have?” Roberts said.

The attorney for South Carolina, John J. Bursch, responded that beneficiaries and providers both have the opportunity to challenge coverage denials.

Barrett pointed out that the way that challenge works is for a Medicaid recipient to seek services from their preferred provider and challenge a denial after the fact. “So then that’s the beneficiary taking the risk, going to the provider she wants to see, and then potentially having to pay out of pocket, right?” Barrett said.

Some conservatives on the court repeatedly brought up concerns about Planned Parenthood’s reliance on a federal law that allows individuals to sue when their rights are violated.

Justice Samuel A. Alito Jr. said that, particularly in spending legislation like the law that created Medicaid, Congress should have to be clear when it creates a right for an individual to step in and sue a state.

“We need something that’s out of the ordinary, that signals to the federal court, this is not just something that the state must do. This is something that allows the individual to go into court and get an enforcement,” Alito said.

Justice Brett M. Kavanaugh brought up the “huge waste of resources” that such lawsuits create for states and said that “collectively this court has failed to give guidance” to lower courts in finding the rights that trigger those lawsuits.

“One of my goals coming out of this will be to provide that clarity,” Kavanaugh said.

Kavanaugh repeatedly discussed with attorneys for South Carolina, the Trump administration and Planned Parenthood about how to draw a “bright line” in such cases, which could limit suits against the federal government outside Medicaid.

The justices are expected to issue a decision in the case, Medina v. Planned Parenthood South Atlantic, by the end of the court’s term in June.

A decision in the state’s favor could give states nationwide more say over which providers can be included in their Medicaid programs and limit lawsuits that accuse states of violating the rights of Medicaid recipients to receive care from the doctor of their choice.

The current fight started in 2018 when South Carolina’s governor sought to exclude Planned Parenthood from receiving Medicaid funding for family planning services it provides other than abortion services. The state argued that any funds provided to the organization helped subsidize abortions.

Last year, the U.S. Court of Appeals for the 4th Circuit upheld Planned Parenthood’s ability to sue for Medicaid funding, and the state asked the Supreme Court to reverse. The case turns on a provision of the law that allows individuals to receive care from “any qualified provider,” which lower courts said creates an individual right to sue for care.

A decision in Planned Parenthood’s favor would allow the case to continue, but a decision in South Carolina’s could end the dispute.

South Carolina argued that the Medicaid law was only meant to represent an agreement between the state and federal government on coverage requirements, not create a direct individual right to sue the government. Under that regime, a state can lose Medicaid funds if it doesn’t comply with rules like the “any qualified provider” provision, Bursch said.

Bursch said that just because the law references an individual’s ability to choose their doctor, it doesn’t mean they have a right to sue for it.

“It’s easy to cascade and find rights in any provision that mentions individuals and benefits,” Bursch said.

Justice Elena Kagan pushed back on South Carolina’s argument, saying that it was ignoring the obvious reading of what the provision meant for Medicaid beneficiaries.

“It is impossible to even say the thing without saying the word ‘right,’” Kagan said. “The state has to ensure that individuals have a right to choose their doctor. That is what the provision is.”

Kyle D. Hawkins, representing the Trump administration, said the provider provision was “buried deep” in a part of the statute that laid out the requirements a state plan had to meet.

Hawkins said the law was “concerned with compliance only in the aggregate,” not with every recipient’s ability to choose their doctor at all times.

Justice Sonia Sotomayor said it “does seem awfully odd to think that is a remedy at all.”

“You would be depriving thousands of Medicaid recipients coverage in a particular state over the fact that an individual has been denied something that the provision says they’re entitled to,” Sotomayor said.

Planned Parenthood, represented by Nicole A. Saharsky, said Congress added the provision two years after creating Medicaid, after several states sought to limit the pool of qualified providers.

“This is a very individual choice that Congress was trying to protect,” Saharsky said.

Saharsky said that a ruling in South Carolina’s favor would make the provision “not mean anything.” Saharsky said the provision satisfies the test the justices laid out in other cases, including referencing individual beneficiaries and the obligations that a state has to them.

“The only thing it doesn’t do is use the word ‘right’ and this court has repeatedly said Congress doesn’t need to use the word ‘right,’” Saharsky said.

Kagan said siding with South Carolina would allow states to withhold funds from providers because they provide contraception, abortion services or gender-affirming care, or because they don’t.

“Every state could split up the world by providers like that,” Kagan said.

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