By LINDSAY WHITEHURST

WASHINGTON (AP) — The Supreme Court appeared divided Wednesday over whether states should be able cut off Medicaid funding to Planned Parenthood, a case that comes amid a wider push from abortion opponents to defund the nation’s leading abortion provider.

Low-income patients who go there for things like contraception, cancer screenings and pregnancy testing could see their care upended if the court sides with South Carolina leaders who say no public money should go the organization.

The court is considering a legal question that could have wider effects: Whether Medicaid patients can continue to sue over the right to choose their own qualified provider.

South Carolina says those lawsuits aren’t allowed and barring them would save public money in legal fees. Some conservatives appeared open to that argument, with Justice Brett Kavanaugh saying there has been confusion among lower courts. “One of my goals coming out of this will be to revive that clarity,” Kavanaugh said.

The state says people could go through an administrative appeal process if denied coverage, though Justice Amy Coney Barrett raised questions about whether that would work for low-income patients who’d have to risk paying out of pocket before they could appeal for reimbursement.

Planned Parenthood argues Congress clearly wanted people to be able to make their own “intensely personal” decisions about which doctor to visit, and lawsuits are the only real way that right has been enforced.

Justice Elena Kagan agreed that patients do have the right to choose their doctor under the law, and suggested that blocking them from suing would be a sea change. “This is kind of changing the rules midstream, isn’t it?” Kagan said.

People on both sides of the issue gathered outside the court for demonstrations that included a brass band before arguments unfolded.

The case started in 2018, before the court’s decision that overturned the nationwide right to abortion. South Carolina has since banned it after around six weeks’ gestation.

Federal law prohibits Medicaid money from being used for abortions, with very limited exceptions, but patients often go there for other services because it can be tough to find doctors who accept the publicly funded insurance program and can schedule appointments quickly.

Other conservative states have also moved to cut Planned Parenthood out of the Medicaid program, and more would likely follow if South Carolina prevails.

About one-quarter of everyone in the U.S. is enrolled in the program, and the American Cancer Society has said that losing the ability to sue would hurt their access to care, especially in rural areas.

In South Carolina, $90,000 in Medicaid funding goes to Planned Parenthood every year — a tiny fraction of a percentage point of the state’s total Medicaid spending.