Congress created Medicaid in 1965 to subsidize state healthcare for families and individuals “whose income and resources are insufficient to meet the costs of necessary medical services.” §1396–1. Medicaid offers States “a bargain”: federal funds in exchange for compliance 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 substantially” with any condition, the Secretary of Health and Human Services may withhold federal funding. §1396c. This case involves the any-qualified-provider provision in §1396a(a)(23)(A), which requires States to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. The provision does not define “qualified,” leaving that to States’ traditional authority over health and safety matters. The question is whether individual Medicaid beneficiaries may sue state officials under 42 U. S. C. §1983 for failing to comply with the any-qualified-provider provision.

Planned Parenthood South Atlantic operates two clinics in South Carolina, 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 Parenthood violated the any-qualified-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 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 enjoined the exclusion. The Fourth Circuit affirmed. This Court then granted certiorari, vacated, and remanded in light of Health and Hospital 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 reaffirmed.

Held: Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under §1983. Pp. 5–24.

(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 individual rights only in “atypical case[s].” Talevski, 599 U. S., at 183. Section 1983 provides causes of action for deprivation of “‘rights,’” not mere “‘benefits’ 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 unmistakable focus” on individuals. Id., at 284, 290. This is a “stringent” and “demanding” test. Talevski, 599 U. S., at 180, 186. Even qualifying statutes may be unenforceable if Congress provided alternative 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 enforcement poses delicate policy questions involving competing costs and benefits—decisions for elected representatives, not judges. Pp. 6–7.

(b) Spending-power statutes are especially unlikely to confer enforceable rights. Unlike Commerce Clause or other regulatory powers, Congress’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 sovereignties.” Neil, Moore & Co. v. Ohio, 3 How. 720, 742. Treaties may benefit citizens but generally do not confer individually enforceable rights 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. 8–10.

(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 enforcement requires showing States “voluntarily and knowingly” consented to private suits, meaning Congress must “clearly” and “unambiguously” 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 unambiguous intent to confer individual rights.” 536 U. S., at 280. Only “unmistakable” notice suffices. Id., at 286–287, and n. 5

Talevski reaffirmed that Gonzaga “sets forth [the] established method.” 599 U. S., at 183. Statutory provisions must “unambiguously confer individual federal rights”—a “demanding bar” cleared only in “atypical” cases. Id., at 180, 183–184. The statutes there qualified because they “expressly” used clear “rights-creating language.” Id., at 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. 10–15.

(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 reasoning, Talevski provides the only reliable measure.

Talevski addressed Federal Nursing Home Reform Act provisions requiring 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-qualified-provider provision looks nothing like these. Section 1396a(a)(23)(A) states that Medicaid plans must “provide that . . . any individual eligible for medical assistance . . . may obtain such assistance from any . . . qualified” provider. This language addresses state duties and may benefit providers and patients, but lacks FNHRA’s clear “rights-creating language,” Talevski, 599 U. S., at 186 (internal quotation marks omitted).

Congress knows how to create clear rights, as FNHRA shows by giving 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 confirm 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 provision 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 provisions would too, making rights-creating provisions the rule rather than “atypical” exceptions. Pp. 15–19.

(e) Four counterarguments are offered. First, the claim that Congress 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 Congress 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 established test by arguing that “individual-centric, mandatory language” is necessarily “rights-creating” without requiring the “ex plicit rights-creating terms” this Court has long required. This standard lacks foundation in precedent and obliterates the distinction between mere benefits 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 government 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 remedies prove insufficient, Congress can create new ones. But balancing enforcement costs and benefits is a policy question for Congress, not courts. Pp. 19–24.

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., filed a concurring opinion. Jackson, J., filed a dissenting opinion, in which Sotomayor and Kagan, JJ., joined.