Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 1 FILED United States Court of Appeals PUBLISH Tenth Circuit
UNITED STATES COURT OF APPEALS December 23, 2025 Christopher M. Wolpert FOR THE TENTH CIRCUIT Clerk of Court _________________________________
MAX LANCASTER, by and through Jan Green, next of friend and attorney-in-fact; PEGGY LANCASTER, by and through Jan Green, next of friend and attorney-in- fact,
Plaintiffs - Appellants,
v. No. 25-6000
JEFFREY CARTMELL, Director of Oklahoma Department of Human Services, in his official capacity; ELLEN BUETTNER, CEO/Director of Oklahoma Health Care Authority, in her official capacity,
Defendants - Appellees. _________________________________
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. _________________________________ Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 2
Before 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
2 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 3
not satisfy that standard and rejected plaintiffs’ private right of action. Medina
applies with equal force to the Lancasters’ claims here.
I. Background
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
1 Mrs. Lancaster passed away during this litigation, and thus the Agencies request that her claims be dismissed. But because we dispose of the case on independent grounds, we need not address whether Mrs. Lancaster must be individually dismissed from this appeal. 3 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 4
that 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,
Tenth Circuit Rule 27.3(A)(1)(b) allows parties to file “a motion for 2
summary disposition because of a supervening change of law or mootness.” 4 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 5
Sabree v. Richman, 367 F.3d 180 (3d Cir. 2004), which made that exact holding. We
denied summary disposition.
II. Discussion
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.
A. 42 U.S.C. § 1396a(a)(8)
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.
B. Medina v. Planned Parenthood South Atlantic, 606 U.S. 357 (2025)
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 5 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 6
provision, conferred an individually enforceable right under § 1983. It determined
that it did not.
1. Private Enforceable Rights under § 1983
The Court began by explaining that while Ҥ 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)).
6 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 7
With 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 must
7 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 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 pre-Gonzaga 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).
3 The Supreme Court in Blessing acknowledged that in Wright, it “did not ask whether the federal housing legislation generally gave rise to rights; rather, [it] focused [its] analysis on a specific statutory provision limiting ‘rent’ to 30 percent of a tenant’s income.” Blessing v. Freestone, 520 U.S. 329, 342 (1997) (quoting Wright, 479 U.S. at 430). 8 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 9
2. 42 U.S.C. § 1396a(a)(23)(A): No Private Enforceable Right
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,
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those 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, 385–
86. 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.
C. 42 U.S.C. § 1396a(a)(8)
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
4 The Lancasters’ argument that Medina clarified existing law and was not a supervening change in law was relevant only in relation to the Agencies’ motion for summary disposition and is not relevant to considering the appeal on the merits. 10 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 11
State “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
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
5 The Supreme Court did not cite Sabree in Medina. 11 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 12
claimed 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,
12 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 13
in 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.
13 Appellate Case: 25-6000 Document: 49 Date Filed: 12/23/2025 Page: 14
III. Conclusion
We affirm because § 1396a(a)(8) does not confer an individual right
enforceable by the Lancasters through § 1983.