No. 25-6000

Appeal from the United States District Court for the Western District of Oklahoma (D.C. No. 5:24-CV-00842-J)

Michael Craig Riffel (Katresa J. Riffel, Jonathan F. Benham, and Matthew C. Russell, Riffel, Riffel & Benham, P.L.L.C., Enid, Oklahoma, with him on the briefs) for Plaintiffs-Appellants.

Ryan Gillett (Michael Williams, Oklahoma City, Oklahoma, with him on the brief) for Defendant-Appellee Ellen Buettner.

Susan L. Eads, Assistant General Counsel (Josh Holloway, Assistant General Counsel, Oklahoma City, Oklahoma, with her on the brief) for Defendant-Appellee Jeffrey Cartmell.

Page 2Before TYMKOVICH , PHILLIPS , and McHUGH , Circuit Judges.

TYMKOVICH , Circuit Judge.

Max and Peggy Lancaster applied for Medicaid benefits. After their applications were denied, the Lancasters sued the directors of the Oklahoma Department of Human Services and Oklahoma Health Care Authority (the Agencies) under 42 U.S.C. § 1983, asserting that the Agencies violated the Medicaid Act— specifically 42 U.S.C. § 1396a(a)(8)—by unlawfully denying the Lancasters’ Medicaid applications. The Agencies jointly moved to dismiss the lawsuit. The district court granted the motion, finding that the Lancasters were not eligible for Medicaid benefits because their financial resources exceeded the asset limitation for Medicaid eligibility. The Lancasters appealed.

During the course of the appeal, the Supreme Court decided Medina v. Planned Parenthood South Atlantic , 606 U.S. 357 (2025). The Agencies argue that under Medina , § 1396a(a)(8) does not confer an individual right enforceable though § 1983.

We agree and thus AFFIRM . The Supreme Court in Medina explained that a statute confers a personally enforceable right only if the law “clearly and unambiguously uses rights-creating terms” with an “unmistakable focus on individuals like the plaintiff.” Medina , 606 U.S. at 368 (citations modified). It then found that § 1396a(a)(23)(A)—a provision materially similar to § 1396a(a)(8)—did Page 3not satisfy that standard and rejected plaintiffs’ private right of action. Medina applies with equal force to the Lancasters’ claims here.

The Lancasters 1 transferred approximately $3.8 million worth of their real and personal property to The Lancaster Family LLC, a limited liability company owned by their three adult children. In return, the Family LLC executed a loan agreement, real estate mortgages, personal guarantees, and a promissory note. The Lancasters then applied for Medicaid benefits but were found ineligible.

The Lancasters sued the Agencies in federal court under 42 U.S.C. § 1983, claiming a violation of 42 U.S.C. § 1396a(a)(8). According to the complaint, the Agencies erred in finding the Lancasters ineligible based on their asset determination; the Lancasters argue this determination violated § 1396a(a)(8), which requires the Agencies to promptly provide Medicaid benefits to eligible individuals.

The Agencies moved to dismiss and argued, in part, that the Family LLC’s promissory note to the Lancasters was not bona fide—that is, the loan was not “legally valid under the applicable State’s law and made in good faith.” See POMS SI § 1120.220(B)(3). The promissory note was therefore a countable resource for purposes of determining the Lancasters’ Medicaid eligibility. And because the Lancasters’ resources exceeded the applicable threshold, the Agencies determined Page 4that the Lancasters were not eligible for Medicaid benefits. The district court agreed and granted the Agencies’ motion.

While the appeal was pending oral argument, the Agencies jointly moved for summary disposition under Federal Rule of Appellate Procedure 27 and Tenth Circuit Rule 27.3(A)(1)(b).² The Agencies cited Medina v. Planned Parenthood South Atlantic , which held that the any-qualified-provider provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(23)(A), did not clearly and unambiguously confer an individually enforceable right under § 1983. 606 U.S. 357. They argued that Medina ’s reasoning also applies to § 1396a(a)(8), the provision at issue in this case. The Agencies asserted that summary disposition was appropriate because Medina introduced a supervening change in law: legislation enacted pursuant to Congress’s spending power, like Medicaid, does not create privately enforceable rights under § 1983 unless Congress uses clear, unambiguous, and unmistakable individual-focused and rights-creating language.

The Lancasters opposed summary disposition, arguing that Medina merely clarifies existing law as to when a statute creates individual rights. On the merits, they argued that 42 U.S.C. § 1396a(a)(8) is distinguishable from the provision addressed in Medina . And in contending that § 1396a(a)(8) confers a private right of action under § 1983, the Lancasters cited and heavily relied on a Third Circuit case, Page 5Sabree v. Richman , 367 F.3d 180 (3d Cir. 2004), which made that exact holding. We denied summary disposition.

As we explain, Medina requires us to conclude that § 1396a(a)(8) does not clearly and unambiguously confer a private right of action enforceable under § 1983.

In 1965, Congress enacted the Medicaid Act pursuant to its spending power “to subsidize state efforts to provide healthcare to families and individuals whose income and resources are insufficient to meet the costs of necessary medical services.” Medina , 606 U.S. at 363 (citation modified). To receive those federal funds, States must submit a State plan for providing medical assistance and substantially comply with a series of conditions imposed by the Medicaid Act. 42 U.S.C. §§ 1396a(a), 1396c. One such condition is that “[a] State plan for medical assistance must . . . provide that all individuals wishing to make application for medical assistance under the plan shall have opportunity to do so, and that such assistance shall be furnished with reasonable promptness to all eligible individuals.” § 1396a(a)(8).

This is the provision that the Lancasters argue the Agencies violated by denying them Medicaid benefits despite their alleged eligibility.

In Medina , the Supreme Court considered whether an adjacent provision of the Medicaid Act, § 1396a(a)(23)(A), also known as the any-qualified-provider Page 6provision, conferred an individually enforceable right under § 1983. It determined that it did not.

The Court began by explaining that while “§ 1983 allows private parties to sue state actors who violate their ‘rights’ under ‘the Constitution and laws’ of the United States,” not all federal statutes confer enforceable rights. Medina , 606 U.S. at 365– 66 (citing Health & Hosp. Corp. of Marion Cty. v. Talevski , 599 U.S. 166, 183 (2023)).

The Court proceeded to clarify “how to determine whether a statute confers an individually enforceable right under § 1983.” Id. at 367. “To prove that a statute secures an enforceable right, privilege, or immunity, and does not just provide a benefit or protect an interest, a plaintiff must show that the law in question ‘clearly and unambiguously’ uses ‘rights-creating terms.’” Id. at 368 (citation modified). In part, the statute must “display an unmistakable focus on individuals like the plaintiff.” Id. (citation modified). The Court described the test as 'stringent' and “demanding” because federal statutes do not automatically confer rights enforceable under § 1983. Id. Rather, rights-creating provisions are rare exceptions. Id. at 368, 380. It noted that even after satisfying such requirements, “a § 1983 action still may not be available if Congress has displaced § 1983’s general cause of action with a more specific remedy.” Id. at 368 (citing Rancho Palos Verdes v. Abrams , 544 U.S. 113, 120 (2005)).

Page 7With this background, the Court explained why it is especially unlikely that spending-power statutes like the Medicaid Act would confer an enforceable right under § 1983. Id. at 365, 369. The Court reasoned that Congress's spending power allows it to “offer funds to States that agree to certain conditions.” Id. at 365. Accordingly, the “typical remedy” for violation of the conditions is for the federal government to terminate funds to the State; it is not a private enforcement suit. Id. at 365–66. That is because the statutes “address a State’s obligations to the federal government, not the rights of any particular person.” Id. at 379 (citation modified) (quoting Gonzaga Univ. v. Doe , 536 U.S. 273, 288 (2002)); see also Talevski , 599 U.S. at 183 (“For Spending Clause legislation in particular . . . the typical remedy for state noncompliance with federally imposed conditions is not a private cause of action for noncompliance but rather action by the Federal Government to terminate funds to the State.” (citation modified)).

The Court thus held that “whether a private party may sue to enforce the terms of a federal grant depends on ‘whether the State voluntarily and knowingly’ consented to answer private claims as part of its bargain with the federal government.” Medina , 606 U.S. at 373 (citing Pennhurst State School & Hosp. v. Halderman , 451 U.S. 1, 17 (1981)). In other words, a plaintiff must demonstrate, at minimum, that Congress provided States with clear and unambiguous notice that the State may be subject to private enforcement suits should it fail to comply with federal funding conditions. Id. (citing Pennhurst , 451 U.S. at 17); see also id. at 376 (“Because spending-power legislation is ‘in the nature of a contract,’ a grantee mustPage 8 ‘voluntarily and knowingly’ consent to answer private § 1983 enforcement suits before they may proceed.” (citation omitted)).

“[T]he Court [previously] restated these principles and explored how they interact with § 1983” in Gonzaga University v. Doe , 536 U.S. 273 (2002). Id. at 374. The Court acknowledged, however, that it had briefly “experimented with a different approach” by taking “an expansive view of its power . . . . to confer new rights under spending-power statutes that did not expressly provide them,” which has since “given rise to some confusion in the lower courts.” Id. at 375. But the Court explicitly clarified that lower courts should no longer consult cases from the preGonzaga era— specifically it called out three cases: Wilder , Wright , and Blessing . Id. at 375-76; see Wright v. Roanoke Redevelopment & Hous. Auth. , 479 U.S. 418, 432 (1987) (granting a statutory right under § 1983 for Public Housing Act 3 ); Wilder v. Va. Hosp. Ass’n , 496 U.S. 498, 509–10 (1990) (granting a statutory right under § 1983 for a reimbursement provision of Title XIX of the Social Security Act because the legislation was “intended to benefit the putative plaintiff” and the plaintiff’s interest in the statute was not “too vague and amorphous”); Blessing , 520 U.S. 329, 343–45 (denying individuals a general statutory right under § 1983 to enforce substantial compliance with Title IV–D of the Social Security Act).

Applying those principles to the statute at issue, the Court concluded that § 1396a(a)(23)(A) did not confer an individually enforceable right because the statute’s “language speaks to what a State must do to participate in Medicaid.” Medina , 606 U.S. at 377. Although the statute surely “seeks to benefit both providers and patients,” the Court held that it does not clearly and unambiguously confer on individuals a federal right. Id. at 377-78 (emphasis added).

Under the any-qualified-provider provision, States participating in Medicaid must provide that

any individual eligible for medical assistance (including drugs) may obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service or services required (including an organization which provides such services, or arranges for their availability, on a prepayment basis), who undertakes to provide him such services . . . .

42 U.S.C. § 1396a(a)(23)(A).

The Court pointed to the surrounding statutory context, which requires that a State “comply substantially” with the requirements in § 1396a to receive federal funding. 42 U.S.C. § 1396c. It recognized that the statute’s “focus on aggregate compliance suggests that the statute addresses a State’s obligations to the federal government, not the rights of any particular person.” Medina , 606 U.S. at 379 (citation modified). Moreover, the Court noted that the any-qualified-provider provision was nested under a subsection titled “Contents,” which outlines conditions that “a state plan must include to qualify for federal funding.” Id. And notably, Page 10those conditions “are directed to the Secretary of Health and Human Services, who must ‘approve any plan’ that meets them.” Id. (quoting § 1396a(b)). Finally, the Court indicated the “mandatory terms” in the provisions—such as “must,” “provide,” or “shall”—do not necessarily create individual rights. Id. at 380.

In conclusion, the Court reemphasized that rights-creating provisions in spending-power statutes are “atypical” exceptions and not the rule. Id. at 380, 38586. So because the language in § 1396a(a)(23)(A) did not clearly and unambiguously confer individual rights, the Court held that the Medina plaintiffs lacked an individual right enforceable through § 1983.

We turn to the Lancasters’ claim that 42 U.S.C. § 1396a(a)(8) confers a private right enforceable via § 1983. We find that Medina squarely controls and reject that argument.⁴

To begin, much of Medina ’s analysis regarding § 1396a(a)(23)(A) applies to § 1396a(a)(8). Both are Medicaid Act provisions that are nested within the same subsection, titled “Contents,” that lists requirements States must substantially comply with to receive Medicaid funding. § 1396c(2). Both are requirements directed to the Secretary of Health and Human Services for plan approvals. And although § 1396a(a)(8) arguably has more “mandatory terms” and directives (such as that a Page 11State “must . . . provide” certain obligations) than § 1396a(a)(23)(A), Medina teaches that mandatory language alone does not create individually enforceable rights.

Like the adjacent provision at issue in Medina , § 1396a(a)(8) is a Medicaid provision enacted under Congress’s spending power. That fact requires an assessment of whether this provision is the atypical, rare exception that confers individual rights. Medina , 606 U.S. at 380. For the same reasons the Medina Court found that § 1396a(a)(23)(A) does not confer a private enforceable right, neither does § 1396a(a)(8).

Resisting this conclusion, the Lancasters urge us to follow Sabree v. Richman , a Third Circuit case from 20 years ago that held 42 U.S.C. § 1396a(a)(8) does in fact confer an individual right enforceable through § 1983.⁵ 367 F.3d 180. They argue that Sabree applied the Supreme Court’s instructions in Gonzaga University , which explained how to determine whether Congress provided such clear and unambiguous language that States may be subject to answer private suits under § 1983. And because Medina reaffirmed Gonzaga University , they argue Sabree ’s analysis stands. We disagree.

While Sabree does rely on Gonzaga University , it did so by heavily leaning on the three Supreme Court cases disclaimed in Medina : Wright , Wilder , and Blessing . Sabree , 367 F.3d at 184–87; see id. at 184 ('[T]he Court relied on [ Wright and Wilder ] in crafting Gonzaga University . Accordingly, we will assess the rights Page 12claimed by plaintiffs in light of Wright, Wilder, Suter , and Blessing, as construed by Gonzaga University. ”). In fact, the Third Circuit explicitly applied the Blessing test, which finds a plaintiff to be within a statute’s zone of interest and have unambiguously conferred rights if: (1) Congress intended plaintiff to be the intended beneficiaries of the law; (2) the rights to be enforced are specific and enumerated, and not “vague or amorphous”; and (3) the statute imposes an unambiguous “binding obligation on the States.” See id. at 186, 189. As acknowledged by the Third Circuit, the three-prong Blessing test was established by drawing upon Wright and Wilder , as well as Suter v. Artist M. , 503 U.S. 347 (1992). Id. at 186.

After concluding that the Sabree plaintiffs satisfied the Blessing test, the Third Circuit then addressed whether there were any rights-creating terms in § 1396a(a)(8) for that zone of interest under Gonzaga University . Id. at 189–90. It observed that the provision uses mandatory language such as “[a] State plan must provide.” Id. at 190 (emphases added). And it noted that the provision focuses on individuals by making the entitlement available to “all eligible individuals.” Id. The Third Circuit thus determined that the plain language of § 1396a(a)(8) clearly and unambiguously conferred a privately enforceable right.

But given the Court’s directives in Medina , the analysis in Sabree cannot withstand scrutiny. The Third Circuit determined that the provision had rights-creating language and was “confiden[t] in this conclusion [because it] rests securely on the fact that the Court has refrained from overruling Wright and Wilder , which upheld the exercise of individual rights under statutes that contain similar (or, Page 13in the case of Wilder , identical) provisions to 42 U.S.C. § 1396.” Id. at 192. The reason for its confidence no longer holds—the Medina Court explicitly stated that its “longstanding repudiation of Wright and Wilder ’s reasoning” meant that those cases were unreliable in determining “whether spending-power legislation confers a privately enforceable right.” Medina , 606 U.S. at 377. And although Medina did not expressly overturn the Blessing test, it stated that the Blessing test was rooted in the previously, and now rejected, “expansive view of [the Court’s] power to imply private causes of action to enforce federal laws” and “confer new rights under spending-power statutes that did not expressly provide them.” Id. at 375–76 (“Building on those same ideas in Blessing v. Freestone , the Court outlined a three-factor test for recognizing new privately enforceable rights. . . . To the extent lower courts feel obliged, or permitted, to consider the contrary reasoning of Wilder , Wright , or Blessing , they should resist the impulse.”).

Moreover, Sabree relied on mandatory language in § 1396a(a)(8) to conclude that the provision confers individual rights—but that reasoning alone is not enough. See id. at 380 (finding that mandatory terms like “must” or “shall” do not necessarily create individual rights). Finally, Sabree held that because the provision focused on individuals rather than entities, § 1396a(a)(8) confers a privately enforceable right. But Medina repeatedly emphasized that provisions may benefit or even protect individual interests without conferring an enforceable right. Id. at 376–78.

Page 14We affirm because § 1396a(a)(8) does not confer an individual right enforceable by the Lancasters through § 1983.