The Trump Administration’s move to withhold millions of dollars allocated for family planning services is affecting reproductive health care access in more than 20 states—including some that have made efforts to protect reproductive rights.
Enacted in 1970, Title X is the nation’s sole federally funded family planning program. The program doesn’t fund abortion services, but it does allocate more than $200 million annually for clinics that provide other forms of health care—including birth control, cancer screenings, and STI testing—for people from low-income households. Last week, the U.S. Department of Health and Human Services (HHS) said it is withholding funds from 16 organizations in the Title X program “pending an evaluation of possible violations” of federal civil rights laws and President Donald Trump’s Executive Order that said undocumented immigrants are barred “from obtaining most taxpayer-funded benefits.” Affected organizations received notices from HHS that their funds would be temporarily withheld while they respond to the federal government’s inquiry regarding compliance with their grant terms. Reproductive health providers have called the freeze “politically motivated.”
Read More: Trump Administration Freezes Critical Title X Funding for 16 Organizations
The government’s action is threatening roughly $65.8 million in Title X funds, according to estimates by the National Family Planning and Reproductive Health Association (NFPRHA), a membership organization for family planning providers. The association estimates that about 846,000 patients could be affected by the freeze.
According to NFPRHA, clinics in 23 states have had at least some of their Title X funding frozen: Alaska, California, Connecticut, Hawaii, Idaho, Indiana, Kentucky, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, and West Virginia. Seven of those states—California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah—aren’t receiving any Title X dollars at all right now.
Fourteen of the 16 affected organizations are NFPRHA members. Clare Coleman, president and chief executive officer of NFPRHA, says the association has heard concerns from some of them about whether they’ll be able to continue providing family planning services or even stay open if the freeze continues. “They’re going to do everything they can to stay open, to subsidize services, to keep a breadth of services, but there’s a limit to what people can bear,” Coleman says.
Some of the affected organizations are based in 11 states where lawmakers have already restricted reproductive health care—Mississippi, for instance, has a near-total ban on abortion, and Utah has prohibited abortion after 18 weeks of pregnancy.
“This Title X money … is life-saving for the folks who are living in these states, and now there may be no place for them to turn inside their own state lines,” Coleman says. “Then you start thinking about are people going to have to start crossing state lines to get birth control the way they do for abortion?”
States that have made efforts to protect reproductive rights are not immune to the Title X funding freeze. California, Hawaii, and Maine, for instance, are all Democratic-led states that have passed various laws to protect abortion rights.
“Even though California stands strongly in the protection of access to abortion and it’s in our constitution, there are other ways to undermine our ability to have reproductive health,” says Democratic Rep. Judy Chu of California, who, along with 161 other House Democrats, signed a letter sent to HHS Secretary Robert F. Kennedy Jr. on April 3, urging the department to reinstate all Title X funds. “Title X funding is essential for the many, many preventive elements of reproductive health.”
Losing access in remote communities
Democratic Rep. Jill Tokuda of Hawaii, who also signed the letter sent to Kennedy last week, says the freeze is “devastating” to many communities.
“We are an island state,” Tokuda says. “For many of our people, transportation is a barrier, income can be a barrier.” She adds that even before the freeze, Title X funding wasn’t enough to ensure access for all. She says one island doesn’t have any Title X-funded health center at all. Now, she’s hearing from clinics that they’re “scrambling to try to keep doors open.”
“Sometimes people assume that if we have broad protections for reproductive freedoms in our state, that we are fine,” Tokuda says. “[But] they’re taking away health care from our people.”
Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, Kentucky (PPGNHAIK), which serves those four states as well as Idaho and western Washington, was one of nine Planned Parenthood affiliates that received a notice from HHS that its Title X funding was being withheld. Its CEO, Rebecca Gibron, says that about $150,000 is no longer being allocated to its clinics in Hawaii, and a little over $1 million is being withheld from the affiliate’s clinics in Alaska. She says PPGNHAIK serves the majority of Title X patients in those states: in Alaska, Planned Parenthood clinics see nearly 3,000 Title X patients a year, and in Hawaii, they see just under 1,000.
“There is no discernible pattern here around whether the Trump Administration is choosing red states or blue states—they’re attacking Planned Parenthood, and more importantly, they’re attacking the patients who rely on this Title X program,” Gibron says.
In 2019, during Trump’s first term, his Administration prohibited organizations or providers that receive Title X funding from providing abortion referrals. The restriction—often referred to as the “domestic gag rule”—prompted many organizations, including Planned Parenthood, to withdraw from the Title X program. The Guttmacher Institute, which researches and supports sexual and reproductive health and rights, found that the domestic gag rule, along with the COVID-19 pandemic, led to about 2.4 million fewer people receiving care through Title X in 2020 compared with 2018. Even after former President Joe Biden rescinded the domestic gag rule in 2021, Gibron says states like Alaska were still “struggling to rebuild the safety net.”
Hopeful for state funds
Maine Family Planning is the sole Title X recipient in the state. With Title X dollars, the organization manages more than a dozen sites, including a mobile medical unit, and distributes funds to other health centers. Maine Family Planning serves between 28,000 and 30,000 patients through the Title X program across the organization’s network of providers, says president and CEO George Hill.
HHS is withholding $1.925 million from the organization at the moment, which is about 20% of its operating budget, according to Hill. Maine Family Planning is responding to the government’s inquiry, and in the interim, is relying on private funds to maintain operations, Hill says. He adds that the Maine state legislature is considering a bill that would allocate funding for family planning services, which he is hoping would help mitigate the loss of Title X dollars. But if that is unsuccessful, Hill says the organization will have to consider closing some of its clinics, including in rural communities that “quite literally are the sole source of health care for many people in those areas.”
“I think this is the tip of the iceberg,” Hill says. “I think the reaction is going to be exactly what happened after [Dobbs v. Jackson Women’s Health Organization]: You’re going to have some states that are in better positions to support their sexual and reproductive networks, and some states where you’re going to have sexual and reproductive health care deserts.”
Conflict between voters and lawmakers
In Missouri, voters made history in November when they passed a ballot measure to enshrine the right to abortion until fetal viability in the state constitution (with exceptions after that if the pregnant person’s life or health is at risk). It marked the first time that a citizen-initiated ballot measure repealed a near-total abortion ban since the U.S. Supreme Court overturned Roe v. Wade. Despite that, anti-abortion lawmakers have been trying to block access to abortion care in the state.
The state’s sole Title X recipient, Missouri Family Health Council, is one of the 16 organizations that had their funding frozen by HHS. The council’s executive director, Michelle Trupiano, says that a total of $8.5 million is being withheld from the organization, which Missouri Family Health Council would have distributed to clinics both in Missouri and Oklahoma. (Some organizations receiving Title X money distribute funds to clinics in multiple states.)
“Without this funding, if it goes much longer, we are at a critical point where we see health centers that are going to be closing their doors,” Trupiano says. She says her team has been communicating with health centers about contingency plans, but that “business as usual” will likely last only a few weeks. Even if centers remain open, some of them won’t be able to offer a sliding fee scale anymore, which will make services unaffordable for many patients who now visit clinics through the Title X program, Trupiano says.
“The health centers are already and they have for years been working on what we would call a shoestring budget,” Trupiano says. “Any freeze in funding, any cuts to funding, is detrimental to their ability to stay open because they were already working at a deficit.” She says that, on top of the Title X freeze, many health centers are experiencing other public health funding cuts.
Unlike providers in other states, Trupiano doesn’t anticipate that Missouri lawmakers will help make up for the Title X funding freeze; she says the state legislature generally hasn’t been supportive of reproductive health care. “There’s a disconnect from what voters want, what people want, what they’re consistently saying they want, and yet what policymakers are actually prioritizing,” Trupiano says.
‘On our doorstep very shortly’
The day after the Title X funding freeze went into effect, Planned Parenthood of Michigan (PPMI) announced that it was permanently closing three of its health centers in the state, effective April 30, and that it would be consolidating two health centers in Ann Arbor by May 5.
Paula Thornton Greear, president and CEO of PPMI, says the affiliate hasn’t received a notice from HHS that its Title X funding would be withheld, but that the organization expects that it will arrive “on our doorstep very shortly.” She says the prospect of the Title X freeze, in addition to other threats to health care, such as the possibility of states barring Planned Parenthood from the Medicaid program, forced PPMI to “make these heart-wrenching decisions in order to ensure the long-term sustainability” of the organization.
“We’ve been contingency planning for months in anticipation of the Trump Administration coming and really taking what they did in 2019 to a whole new level,” Thornton Greear says. “The complexity and the layered approach of this is devastating, and that’s why we were forced to make the decision.”
PPMI said it plans to expand its virtual health services over the next few months, including by offering telehealth seven days a week to provide services like birth control, medication abortion, and gender-affirming care. In 2022, voters in Michigan passed a ballot measure to enshrine the right to abortion in the state constitution.
“In Michigan, the constitutional protections that we have for reproductive freedom—that’s absolutely crucial. It ensures that we can keep providing the full spectrum of reproductive health care without state level interference,” Thornton Greear says. “That’s a lifeline that many of our colleagues in other states simply did not have.”
“However, here’s the reality: these constitutional protections don’t shield us from federal funding cuts,” she says. “While we can legally provide abortion care in Michigan, the ability to maintain affordable access across our services still depends heavily on programs like Title X, like Medicaid. The ballot measure protects the right, but not necessarily the accessibility or the affordability.”
Many reproductive rights experts believe this Title X funding freeze is just the beginning of further federal cuts to family planning and reproductive health services. “Everybody needs to be doing contingency planning,” Coleman says. “Everybody now needs to be concerned that they may lose their Title X, whether it’s for a time or whether it’s for all time.”
And experts fear that additional cuts will result in people who need health care services the most being left out of the system.
“Health care disparities in this country are not new, but right now, we’re facing an Administration that wants to take a widening gap of health care disparities and turn it into a chasm that can never close,” Thornton Greear says. “For every dollar that is stripped away, we’re going to lose people.”
