FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

DELORES POLK; SCOTT UNGAR;

HEATHER HERRICK; LIEN LOI;

JOLENE MONTOYA; PETER LOI;

SUSAN MCKAY, as individuals and 

representatives of the requested 

class,

Plaintiffs-Appellants,

v.

BETTY YEE, in her official capacity 

as State Controller of California; 

SERVICE EMPLOYEES 

INTERNATIONAL UNION LOCAL 2015,

Defendants-Appellees.

No. 20-17095

D.C. No.

2:18-cv-02900-

KJM-KJN

Appeal from the United States District Court

for the Eastern District of California

Kimberly J. Mueller, Chief District Judge, Presiding
2 POLK V. YEE

ALICIA QUIRARTE,

Plaintiff,

and

NORA MAYA, an individual; ANH LE, 

an individual; VIET LE, an 

individual; JOSE DIAZ, an individual,

Plaintiffs-Appellants,

v.

UNITED DOMESTIC WORKERS OF 

AMERICA, AFSCME LOCAL 3930, a 

labor organization; BETTY T. YEE, in 

her official capacity as State 

Controller of the State of California,

Defendants-Appellees,

ROB BONTA,

* in his official capacity 

as Attorney General of California,

Intervenor-DefendantAppellee.

No. 20-55266

D.C. No.

3:19-cv-01287-

CAB-KSC

OPINION

Appeal from the United States District Court

for the Southern District of California

Cathy Ann Bencivengo, District Judge, Presiding

Argued and Submitted February 8, 2022

Portland, Oregon

* Rob Bonta has been substituted for his predecessor, Xavier 

Becerra, as California Attorney General under Fed. R. App. P. 43(c)(2).
POLK V. YEE 3

Filed June 8, 2022

Before: Richard A. Paez and Jacqueline H. Nguyen, 

Circuit Judges, and John R. Tunheim,** District Judge.

Opinion by Judge Nguyen

SUMMARY***

Civil Rights

The panel affirmed the district court’s dismissal of two 

cases brought pursuant to 42 U.S.C. § 1983 by Medicaid 

providers and former members of public-sector unions 

alleging that the California State Controller, in deducting 

union dues from appellants’ Medicaid reimbursements, 

violated the anti-reassignment provision of the Medicaid 

Act, which prohibits state Medicaid programs from paying 

anyone other than the providers or recipients of covered 

services. 

California uses some of its Medicaid funding to provide 

assistance with daily activities to elderly and disabled 

beneficiaries under a program called In-Home Support 

Services (IHSS). The recipients of these services are 

responsible for employing and overseeing the work of their 

IHSS providers, who are often family members. IHSS 

** The Honorable John R. Tunheim, Chief United States District 

Judge for the District of Minnesota, sitting by designation.

*** This summary constitutes no part of the opinion of the court. It 

has been prepared by court staff for the convenience of the reader.
4 POLK V. YEE

providers are paid by the State Controller because California 

law treats them as public employees. The Controller makes 

a variety of standard payroll deductions, including for 

federal and state income tax, unemployment compensation, 

and retirement savings. California law also authorizes the 

Controller to deduct union dues from the paychecks of IHSS 

providers. 

The panel held that the Medicaid Act’s antireassignment provision, 42 U.S.C. § 1396a(a)(32), does not 

confer a right on Medicaid providers enforceable under 

§ 1983. The text and legislative history of the antireassignment provision make clear that Congress was 

focused on preventing fraud and abuse in state Medicaid 

programs rather than on serving the needs of Medicaid 

providers. Because Congress did not intend to benefit 

Medicaid providers, the anti-reassignment provision did not 

confer a right an enforceable under § 1983.

COUNSEL

William L. Messenger (argued), Heidi E. Schneider, and 

Amanda K. Freeman, National Right to Work Legal Defense 

Foundation Inc., Springfield, Virginia; Rebekah C. Millard,

Mariah Gondeiro, Karin Sweigart, and Robert Alan 

Bouvatte, Jr., Freedom Foundation, Olympia, Washington; 

for Plaintiffs-Appellants.

Anthony O’Brien (argued), Jeffrey A. Rich, and Lara 

Haddad, Deputy Attorneys General; Anthony R. Hakl and 

Mark R. Beckington, Supervising Deputy Attorneys

General; Thomas S. Patterson, Senior Assistant Attorney 

General; Rob Bonta, Attorney General; Office of the 
POLK V. YEE 5

Attorney General, Sacramento, California; for DefendantsAppellees Betty Yee and Rob Bonta.

Stacey M. Leyton (argued) and Scott A. Kronland, Altshuler 

Berzon LLP, San Francisco, California, for DefendantsAppellees Service Employees International Union Local 

2015, and United Domestic Workers of America, AFSCME 

Local 3930.

OPINION

NGUYEN, Circuit Judge:

Appellants, Medicaid providers and former members of 

public-sector unions, challenge the district courts’ dismissals 

of these two cases, which we consolidated on appeal. When 

appellants joined the unions, they authorized the California 

State Controller to deduct union dues from their Medicaid 

reimbursements. Appellants now contend that, when the 

Controller made these deductions, she violated the “antireassignment” provision of the Medicaid Act, which 

prohibits state Medicaid programs from paying anyone other 

than the providers or recipients of covered services. See 

42 U.S.C. § 1396a(a)(32).

Appellants brought these putative class actions under 

42 U.S.C. § 1983, which makes state actors liable for 

violating federal rights. But not every federal law gives rise 

to a federal right that private parties can enforce under 

§ 1983. We must therefore decide a threshold question —

not whether the anti-reassignment provision has been 

violated, but whether that provision confers a federal right 

on Medicaid providers.
6 POLK V. YEE

For a federal statute to confer a right, “Congress must 

have intended that the provision in question benefit the 

plaintiff.” Blessing v. Freestone, 520 U.S. 329, 340 (1997).

Here, the text and legislative history of the anti-reassignment 

provision make clear that Congress was focused on 

preventing fraud and abuse in state Medicaid programs 

rather than on serving the needs of Medicaid providers. 

Because Congress did not intend to benefit Medicaid 

providers, we hold that the anti-reassignment provision does 

not confer a right that they can enforce under § 1983. We 

therefore affirm.

I

A

Under Medicaid, the federal government provides 

funding to state programs that offer health care for people of 

limited means. The Medicaid Act imposes numerous 

conditions on states concerning the operation of their 

Medicaid programs, which the Secretary of Health and 

Human Services may enforce by withholding funds from 

non-compliant states. See 42 U.S.C. §§ 1396a, 1396c; see 

also Planned Parenthood Ariz. Inc. v. Betlach, 727 F.3d 960, 

963 (9th Cir. 2003). As one such condition on state 

Medicaid programs, the anti-reassignment provision 

prohibits states from making payments for services to 

anyone other than the provider or recipient. See 42 U.S.C. 

§ 1396a(a)(32).

California uses some of its Medicaid funding to provide 

assistance with daily activities to elderly and disabled 

beneficiaries under a program called In-Home Support 

Services (IHSS). See Cal. Welf. & Inst. Code § 12300 et 

seq. The recipients of these services are responsible for 
POLK V. YEE 7

employing and overseeing the work of their IHSS providers, 

who are often family members.

IHSS providers are paid by the State Controller because 

California law treats them as public employees. See id.

§ 12301.6(c)(1). The Controller makes a variety of standard 

payroll deductions, including for federal and state income 

tax, unemployment compensation, and retirement savings. 

See id. § 12302.2(a)(1). California law also authorizes the 

Controller to deduct union dues from the paychecks of IHSS 

providers. See id. § 12301.6(i)(2).

B

Appellants provide services through California’s IHSS 

program. They all became members of the public-sector 

union with exclusive bargaining rights in their counties —

either the Service Employees International Union Local 

2015 (SEIU) or the United Domestic Workers of America 

AFSCME Local 3930 (UDW). When they signed up, 

appellants authorized the State Controller to deduct union 

dues from their paychecks. That authorization included an 

agreement that they could only revoke their consent during 

brief annual windows.

Appellants resigned from their unions outside the annual 

revocation windows. But they wanted their dues deductions 

to stop immediately. When the dues deductions continued, 

they brought these two putative class actions under 

42 U.S.C. § 1983 against their former unions and State 

Controller Betty Yee.

Appellants alleged that the continuing dues deductions 

violated their rights under the First Amendment and the 

Medicaid Act’s anti-reassignment provision. In Polk v. Yee, 

the district court granted a motion to dismiss under Federal 
8 POLK V. YEE

Rule of Civil Procedure 12(b)(6), and the Polk appellants 

elected not to amend their complaint. In Quirarte v. UDW, 

the district court granted a motion for judgment on the 

pleadings under Rule 12(c).

Both district courts dismissed these cases for the same 

reasons. As to the First Amendment claim, the district courts 

concluded that the unions were not state actors and that 

appellants’ consent to pay union dues precluded any First 

Amendment liability. This court subsequently decided 

Belgau v. Inslee, which rejected a virtually identical First 

Amendment claim on the same rationale. 975 F.3d 940 (9th 

Cir. 2020), cert. denied, 141 S. Ct. 2795 (2021). Appellants 

now concede that Belgau forecloses their First Amendment 

claim. As to the Medicaid Act claim, both district courts 

held that the anti-reassignment provision does not confer a 

right on providers that is enforceable under § 1983.

Appellants in both cases timely appealed. Shortly before 

oral argument, we consolidated these appeals for all 

purposes under Federal Rule of Appellate Procedure 3(b)(2).

II

We have jurisdiction under 28 U.S.C. § 1291. 

Reviewing de novo, see Daewoo Elecs. Am. Inc. v. Opta 

Corp., 875 F.3d 1241, 1246 (9th Cir. 2017) (judgment on the 

pleadings); Dougherty v. City of Covina, 654 F.3d 892, 897 

(9th Cir. 2011) (dismissal under Rule 12(b)(6)), we affirm.

A

In Blessing v. Freestone, the Supreme Court established 

a three-part test to determine whether a federal statute 

confers a right enforceable under § 1983: “(1) ‘Congress 

must have intended that the provision in question benefit the 
POLK V. YEE 9

plaintiff,’ (2) ‘the plaintiff must demonstrate that the right 

assertedly protected by the statute is not so “vague and 

amorphous” that its enforcement would strain judicial 

competence,’ and (3) ‘the statute must unambiguously 

impose a binding obligation on the States.’” Anderson v. 

Ghaly, 930 F.3d 1066, 1073 (9th Cir. 2019) (quoting 

Blessing, 520 U.S. at 340–41). “If all three prongs are 

satisfied, ‘the right is presumptively enforceable’ through 

§ 1983.” Planned Parenthood, 727 F.3d at 966 (quoting 

Gonzaga Univ. v. Doe, 536 U.S. 273, 284 (2002)).

To demonstrate that the anti-reassignment provision 

confers a federal right, appellants must satisfy the first prong 

by showing that Congress intended to benefit Medicaid 

providers. See Sanchez v. Johnson, 416 F.3d 1051, 1062 

(9th Cir. 2005) (holding that no enforceable right existed 

because the first prong was not met). Under this prong, we 

must “determine whether Congress ‘unambiguously 

conferred’ a federal right,” which above all “requires ‘rightscreating language.’” Henry A. v. Willden, 678 F.3d 991, 

1005 (9th Cir. 2012) (quoting Gonzaga, 536 U.S. at 283–84 

& n.3). “[I]t is Congress’s use of explicit, individually 

focused, rights-creating language that reveals congressional 

intent to create an individually enforceable right in a 

spending statute.” Sanchez, 416 F.3d at 1057. Because the 

Medicaid Act “does not describe every requirement in the 

same language,” we carefully examine the language of the 

particular Medicaid provision at issue. Id. at 1062. And to 

confirm what that language reveals, we may look to other 

indicia of congressional intent, including structure, 

legislative history, and agency interpretations. See Ball v. 

Rodgers, 492 F.3d 1094, 1112–15 (9th Cir. 2007).

Crucially, whether Congress intended to confer a right is 

a distinct question from whether the correct interpretation of 
10 POLK V. YEE

the statute would benefit the plaintiff. “‘[F]alling within the 

general zone of interest that the statute is intended to protect’ 

is not enough.” All. of Nonprofits for Ins., Risk Retention 

Grp. v. Kipper, 712 F.3d 1316, 1326 (9th Cir. 2013) (quoting 

Gonzaga, 536 U.S. at 283). “[I]t is rights, not the broader or 

vaguer ‘benefits’ or ‘interests’ that may be enforced under 

the authority of [§ 1983].” Gonzaga, 536 U.S. at 283. Even 

if a statute “incidental[ly] benefit[s]” the plaintiff, All. of 

Nonprofits, 712 F.3d at 1327, that does not by itself show 

that Congress “intended that the provision in question 

benefit the plaintiff,” Blessing, 520 U.S. at 340 (emphasis 

added); see also Sanchez, 416 F.3d at 1059 (explaining that, 

while Medicaid providers “may certainly benefit from their 

relationship with the State, . . . they are, at best, indirect 

beneficiaries” under 42 U.S.C. § 1396a(a)(30)(A), which 

thus confers no right).

Appellants devote a substantial portion of their briefs to 

arguing that the anti-reassignment provision prohibits all 

payments to third parties, including union dues deductions. 

But that is not the issue before us. Whether the antireassignment provision prohibits union dues deductions is a 

separate question about the scope of the statute. We need 

not decide that question and we instead ask whom Congress 

intended to benefit.

B

With those principles in mind, we begin with the 

language of the anti-reassignment provision: “A State plan 

for medical assistance must . . . provide that no payment 

under the plan for any care or service provided to an 

individual shall be made to anyone other than such 

individual or the person or institution providing such care or 
POLK V. YEE 11

service, under an assignment or power of attorney or 

otherwise . . . .”1 42 U.S.C. § 1396a(a)(32).

Because “cooperative federalism programs like 

Medicaid . . . are necessarily phrased as a set of directives to 

states that wish to receive federal funding,” Anderson, 

930 F.3d at 1074, we cannot infer a lack of congressional 

intent to create an enforceable right from the bare fact that a 

Medicaid provision is a state program requirement, see 

42 U.S.C. § 1320a-2; Ball, 492 F.3d at 1111–12. We 

therefore give no weight to the initial portion of the antireassignment provision — “[a] State plan for medical 

assistance must . . . provide” — which only captures 

Medicaid’s status as a federal spending program.

We instead examine whether the statute makes 

“recognizing and enforcing individual beneficiaries’ rights 

. . . a condition for federal funding of the state program.” 

Anderson, 930 F.3d at 1074. The key question is whether 

the text of the statute is “phrased in terms of the persons 

benefited . . . with an unmistakable focus on the benefited 

class.” Gonzaga, 536 U.S. at 284 (citation and internal 

quotation marks omitted). The dividing line is between 

statutes that are “concerned with whether the needs of any 

particular person have been satisfied” and those that are 

“concerned . . . solely with an aggregate institutional policy 

and practice.” Ball, 492 F.3d at 1107 (citation and internal 

quotation marks omitted). We ask on which side of the line 

the main portion of the text falls: “no payment . . . for any 

care or service provided to an individual shall be made to 

1 This provision is subject to narrow exceptions not relevant to this 

case. See 42 U.S.C. § 1396a(a)(32)(A)–(D).
12 POLK V. YEE

anyone other than such individual or the person or institution 

providing such care or service.” 42 U.S.C. § 1396a(a)(32).

The focus of this statutory language is on state payment 

practices. “Payment” is the subject of the statute’s main 

clause. And the statute is phrased in terms of what the state

may not do — make “payment . . . to anyone other than” 

service providers or recipients — rather than in terms of 

what providers are to receive. Id. The statute only 

references providers following “other than,” which 

underscores this focus on state payments. Even when 

describing the payees, the statute emphasizes those who are 

not to be paid. The provision’s language “is directly 

concerned with the State as administrator and only indirectly 

with recipients and providers as beneficiaries of the 

administered services.” Sanchez, 416 F.3d at 1062. But see 

Anderson, 930 F.3d at 1074 (noting that “[g]iven the 

conditional nature of [federal spending] programs, the 

statutes enacting them will nearly always be phrased with a 

partial focus on the state”).

Nothing in the statutory language reflects that Congress 

was “concerned with ‘whether the needs of [Medicaid 

providers] have been satisfied.’” Ball, 492 F.3d at 1107 

(quoting Gonzaga, 526 U.S. at 288). The statute does not 

say that “payment must only be made to providers or 

recipients,” much less that “only providers or recipients are 

to receive payment,” as other rights-conferring Medicaid 

provisions are phrased. Cf. Planned Parenthood, 727 F.3d 

at 966 (“Any individual eligible for medical assistance . . .

may obtain such assistance from any [provider] qualified to 

perform the service or services required.” (quoting 42 U.S.C. 

§ 1396a(a)(23)) (emphasis omitted)); Watson v. Weeks, 

436 F.3d 1152, 1159–60 (9th Cir. 2006) (“[A] state plan for 

medical assistance must provide ‘for making medical 
POLK V. YEE 13

assistance available, including at least [designated care and 

services],’ to ‘all individuals’ meeting specified financial 

eligibility standards.” (quoting 42 U.S.C. § 1396a(a)(10))). 

Unlike these other formulations, which are phrased in terms 

of Medicaid providers, the anti-reassignment provision 

“refers to [Medicaid providers] only in the context of 

describing the necessity of developing state-wide policies 

and procedures,” and as “a means to an administrative end 

rather than as individual beneficiaries of the statute.”2 

Sanchez, 416 F.3d at 1059.

Given this administrative focus, we cannot say that the 

anti-reassignment provision’s language shows that Congress 

“unambiguously conferred” an enforceable right on 

Medicaid providers. Gonzaga, 536 U.S. at 283.

C

We need not, however, rely on the statutory language 

alone. Another signal of congressional intent — legislative 

history — confirms that the anti-reassignment provision 

does not confer a right on Medicaid providers. When 

legislative history suggests whom Congress intends to 

benefit, it can be highly probative under the first prong of the 

Blessing test. See All. of Nonprofits, 712 F.3d at 1326–27.

In Alliance of Nonprofits, we recognized that the 

Liability Risk Retention Act (LRRA), which preempts 

2 The anti-reassignment provision refers to Medicaid providers as 

“person[s],” 42 U.S.C. § 1396a(a)(32), and “usually such use is 

sufficient . . . to finding a right for § 1983 purposes,” Planned 

Parenthood, 727 F.3d at 966 (quoting Ball, 492 F.3d at 1108). But, as 

we explain, the statute’s administrative focus and its clear legislative 

history show that this language does not signal Congress’s intent to 

confer an enforceable right in this case.
14 POLK V. YEE

certain state laws applicable to insurers, contained some 

rights-creating language. Id. at 1326. But we explained that 

“even if such language is necessary to the conclusion that 

Congress intended to create an enforceable right, that does 

not mean it is sufficient to do so.” Id. (citation omitted). We 

then looked to the legislative history, which indicated that 

“Congress primarily enacted the LRRA to benefit buyers of 

insurance, rather than the insurance companies themselves.” 

Id. at 1326–27. Accordingly, we held that the legislative 

history demonstrated that the statute conferred at most an 

“incidental benefit” on insurers, which “does not rise to the 

level of the ‘unambiguously conferred’ right that Gonzaga 

University requires us to find.” Id. at 1327 (quoting 

Gonzaga, 536 U.S. at 283).

Here, as in Alliance of Nonprofits, the legislative history 

leaves no doubt that Congress did not intend to benefit 

Medicaid providers. The anti-reassignment provision was 

enacted in response to a practice by providers of assigning 

their receivables to third parties, also known as “factoring.”3 

3 Many courts have so characterized the anti-reassignment 

provision. See Matter of Missionary Baptist Found. of Am., Inc., 

796 F.2d 752, 757 n.6 (5th Cir. 1986) (“An examination of the legislative 

history of this provision reveals that its purpose was to prevent 

‘factoring’ agencies from purchasing medicare and medicaid accounts 

receivable at a discount and then serving as the collection agency for the 

accounts.”); Danvers Pathology Assocs., Inc. v. Atkins, 757 F.2d 427, 

430 (1st Cir. 1985) (Breyer, J.) (“The purpose of the statute was to stop 

this ‘factoring’ of Medicaid receivables—the selling of Medicaid 

obligations to collection agencies at a discount and the presentation of 

those obligations by the collection agencies to the state for payment.”); 

Michael Reese Physicians & Surgeons, S.C. v. Quern, 606 F.2d 732, 734 

(7th Cir. 1979) (“Congress wished to eliminate factors, thereby making 

each provider responsible for billing for services rendered and personally 

liable for payments received for those services.”), aff’d on reh’g en banc, 

625 F.2d 764 (7th Cir. 1980).
POLK V. YEE 15

Providers would collect a percentage of the value of their 

claims, and the assignees would “undertake the effort and 

expense of submitting those claims to the states and would 

keep the reimbursement payments for themselves.” 

California v. Azar, 501 F. Supp. 3d 830, 834 (N.D. Cal. 

2020).

The House and Senate reports show that Congress 

adopted the anti-reassignment provision out of concern that 

factoring had led to fraud and abuse in the Medicaid 

program. The anti-reassignment provision was added to the 

Medicaid Act as part of the Social Security Amendments of 

1972. Pub. L. No. 92-603, § 236(b)(3), 86 Stat. 1329, 1415 

(1972). The reports from both chambers explained why 

Congress viewed factoring as a problem and how the antireassignment provision would help.

Experience with this practice under these 

programs shows that some physicians and 

other persons providing services reassign 

their rights to other organizations or groups 

under conditions whereby the organization or 

group submits claims and receives payment 

in its own name. Such reassignments have 

been a source of incorrect and inflated claims 

for services and have created administrative 

problems with respect to determinations of 

reasonable charges and recovery of 

overpayments. Fraudulent operations of 

collection agencies have been identified in 

medicaid. Substantial overpayments to many 

organizations have been identified in the 

medicare program, one involving over a 

million dollars.
16 POLK V. YEE

Your committee’s bill seeks to overcome 

these difficulties by prohibiting payment 

under these programs to anyone other 

than the patient, his physician, or other 

person who provided the service . . . .

H.R. Rep. No. 92-231, at 104 (1971), 

reprinted in 1972 U.S.C.C.A.N. 4989, 

5090; see also S. Rep. No. 92-1230, 

at 205 (1972).

The anti-reassignment provision was amended as part of 

the Medicare-Medicaid Anti-Fraud and Abuse Amendments 

of 1977 to eliminate a loophole that involved power of 

attorney agreements. Pub. L. No. 95-142, § 2(a)(3), 91 Stat. 

1175, 1176 (1977). The reports from both chambers again 

underscored that the goal of the anti-reassignment provision 

was to prevent fraud and abuse in the Medicaid program and 

argued that the “power of attorney” loophole should be 

closed to better accomplish that purpose.

By 1972, it had become apparent that such 

reassignments were a significant source of 

incorrect and inflated claims for services paid 

by medicare and medicaid. In addition, cases 

of fraudulent billings by collection agencies 

and substantial overpayments to these socalled “factoring” agencies were also found. 

Congress concluded that such arrangements 

were not in the best interest of the 

government or the beneficiaries served by the 

medicare and medicaid programs . . . .

Despite these efforts to stop factoring of 

medicare and medicaid bills, some 
POLK V. YEE 17

practitioners and other persons have 

circumvented the intent of the law by use of 

a power of attorney. The use of a power of 

attorney allows the factoring company to 

receive the medicare or medicaid payment in 

the name of the physician, thus allowing the 

continuation of program abuses which 

factoring activities were shown to produce in 

the past.

The bill would modify existing law to 

preclude the use of a power of attorney as a 

device for reassignments of benefits under 

medicare and medicaid . . . .

H.R. Rep. No. 95-393, at 44 (1977), reprinted 

in 1977 U.S.C.C.A.N. 3039, 3051; see also 

S. Rep. No. 95-453, at 6–7 (1977).

These reports clearly show that Congress was concerned 

not with “whether the needs of [Medicaid providers] have

been satisfied,” but instead with “aggregate institutional 

policy and practice.” Ball, 492 F.3d at 1107 (citations and 

internal quotation marks omitted). The anti-reassignment 

provision was Congress’s effort to end a practice among 

Medicaid providers because it interfered with the sound 

fiscal administration of the Medicaid program. In the face 

of this legislative history, we cannot say that “Congress . . .

intended that the provision in question benefit [Medicaid 

providers],” as the first prong of the Blessing test requires. 

520 U.S. at 340; see also All. of Nonprofits, 712 F.3d 

at 1326–27.

This legislative history harmonizes with our reading of 

the text. The textual focus on payment practices reflects 
18 POLK V. YEE

Congress’s goal of ensuring that state Medicaid payments 

are not lost to fraud and abuse. Given that goal, the antireassignment provision’s reference to Medicaid providers is 

only “as a means to an administrative end rather than as 

individual beneficiaries of the statute.” Sanchez, 416 F.3d 

at 1059. Considering text and legislative history together 

eliminates any doubt that Congress did not intend to confer 

a right on Medicaid providers enforceable under § 1983.

D

Appellants emphasize that, even though Congress was 

motivated by concerns about factoring, it enacted a broader 

prohibition encompassing all forms of diversion of Medicaid 

funds to third parties. However, as discussed above, 

appellants’ argument would at most show that Medicaid 

providers are indirectly benefited by Congress’s decision to 

enact a broad prohibition — not that Congress’s purpose was 

to benefit Medicaid providers. That does not suffice. See 

All. of Nonprofits, 712 F.3d at 1327 (explaining that an 

“incidental benefit does not rise to the level of [an] 

‘unambiguously conferred’ right” (quoting Gonzaga, 

536 U.S. at 283)); see also Sanchez, 416 F.3d at 1059.

Appellants also point out that the Centers for Medicare 

and Medicaid Services (CMS) adopted their broad 

interpretation of the anti-reassignment provision in a 2019 

regulation. See Reassignment of Medicaid Provider Claims,

84 Fed. Reg. 19718 (May 6, 2019), vacated by Azar, 501 F. 

Supp. 3d at 843. More recently, however, CMS issued a rule 

clarifying that employment-type payroll deductions do not 

violate the anti-reassignment provision. See Reassignment 

of Medicaid Provider Claims, 87 Fed. Reg. 29675 (May 16, 

2022) (codified at 42 C.F.R. § 447.10(i)). But even if CMS 

maintained its old interpretation, appellants still cannot show 

that Congress intended to confer an enforceable right. As 
POLK V. YEE 19

we have pointed out in response to similar arguments before, 

“an agency cannot create a right enforceable through § 1983 

where Congress has not done so.” Dev. Servs. Network v. 

Douglas, 666 F.3d 540, 548 (9th Cir. 2011); see also 

AlohaCare v. Haw. Dep’t of Human Servs., 572 F.3d 740, 

747 (9th Cir. 2009) (“Although ‘a regulation may be relevant 

in determining the scope of the right conferred by Congress,’ 

ultimately ‘the inquiry must focus squarely on Congress’s 

intent.’” (citation omitted)).

We therefore hold that the Medicaid Act’s antireassignment provision, 42 U.S.C. § 1396a(a)(32), does not 

confer a right on Medicaid providers enforceable under 

§ 1983. We affirm the district courts’ dismissals of these 

cases.

AFFIRMED.