A major reproductive health advocacy group and the American Civil Liberties Union (ACLU) filed a lawsuit against the Department of Health and Human Services for withholding millions of dollars in Title X federal family planning grants.
The National Family Planning and Reproductive Health Association (NFPRHA), the ACLU and the ACLU of the District of Columbia filed the lawsuit (PDF) in the U.S. District Court for the District of Columbia on behalf of the NFPRHA and its members. As a result of the Trump administration’s actions to freeze funding, at least seven states—California, Hawaii, Maine, Mississippi, Missouri, Montana and Utah—have been left without any Title X-funded family planning services, the groups said in a press release.
Title X provides federal funding to support clinics across the country to provide comprehensive family planning services to low-income and uninsured individuals. Federal support assists nearly 4,000 clinics across the country to provide services to 2.8 million clients in all 50 states, D.C. and U.S. territories, according to the KFF.
The family planning programs provide access to effective contraceptive methods, cancer screenings, testing and treatment for STIs, and other preventive services, with priority given to patients with low incomes.
In the lawsuit, the groups allege that the Trump administration "unlawfully" withheld $65.8 million in Title X grants for federally funded family planning services from 16 Title X grantees.
"On March 31—one day before the grants were set to be awarded—16 Title X grantees were informed of HHS’s decision to withhold funds pending investigation. This decision is seemingly based on the grantees’ public statements supporting diversity, equity, and inclusion (DEI) and opposing racism, which HHS claims amount to a 'possible violation' of federal civil rights law, and a desire to ensure the grantees’ compliance with an anti-immigration executive order," the groups wrote in a press release. "Grantees were given only 10 days to produce extensive documentation from their service sites and subgrantees, and funding has yet to be released."
“The unprecedented action by the Trump Administration to withhold 22 federal Title X grants—25% of the Title X network—leaves approximately 842,000 people across the United States without access to Title X-funded services,” said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association (NFPRHA). “The consequences of withholding funding are devastating. The loss of Title X means hundreds of thousands of patients are at risk of losing access to critical health care, including contraception, testing and treatment for sexually transmitted infections, and cancer screenings."
Coleman said affected grantees and their health centers "simply do not have the resources to operate for weeks or months without Title X funding."
"NFPRHA is taking legal action to defend its members, the essential health care they provide access to, and the patients they serve," Coleman said.
A spokesperson for the HHS told Time in an email earlier this month that the department was withholding Title X funds from 16 organizations “pending an evaluation of possible violations of their grant terms, including based on Federal civil rights laws and the President’s Executive Order 14218, ‘Ending Taxpayer Subsidization of Open Borders,’” which Trump signed Feb. 19. The executive order declares that undocumented immigrants are prohibited “from obtaining most taxpayer-funded benefits.”
Brigitte Amiri, deputy director of the Reproductive Freedom Project at the ACLU, said the harm caused by the funding freeze will fall "disproportionately on Black and Latina people, people in rural areas, young people, immigrants, and people with low incomes."
According to Planned Parenthood, more than three-quarters of its affiliates receive Title X funding, and, in 2023, there were more than 1.5 million visits to Planned Parenthood health centers that received Title X funding, the organization said in an online post March 31.
The lawsuit argues the HHS violated its own rules and a federal statute that together govern how the agency can ensure compliance with grant terms and federal civil rights laws.
The lawsuit also alleges the HHS acted "arbitrarily and capriciously" by, among other things: providing no reasonable explanation or justification for its decision to select these grantees for fund withholding and investigation; targeting the grantees based on statements that align with the requirements of the Title X program; and suddenly departing from its own prior understanding of Title X and federal civil rights law without any acknowledgment of or explanation for that departure.
“The Trump administration is stripping people of essential health care—and it’s causing real harm,” said Arthur Spitzer, senior counsel at the ACLU of DC, in a statement. “Withholding Title X funds blocks access to cancer screenings, STI tests, and birth control. Preventive care works, and communities suffer without it.”
In 2019, during the first Trump administration, the federal implemented a new restriction on Title X family planning program funds to block groups that provide abortion referrals. That provision, which opponents called a "gag rule," required providers that receive Title X funding to maintain "physical and financial separation" from an abortion provider.
Organizations that receive federal funding were already prohibited from using those funds to fund abortion services.
The Biden administration rescinded that rule in 2021.
On April 3, more than 150 House Democrats signed a letter (PDF) addressed to HHS Secretary Robert F. Kennedy Jr. urging the department to reinstate the Title X funds being withheld, referring to the program as a "cornerstone of safety-net care."
"Freezing these funds will unquestionably result in the loss of health care for many of the millions of people that Title X supports annually, making our country less healthy," the Democrats wrote. "Title X health centers served 2.8 million people in FY 2023, administering high-quality family planning and sexual health care, including cancer screenings, testing and treatment for sexually transmitted infections, contraceptive services and supplies, pregnancy testing, and other essential health care services.
"These centers offer care to populations that often face severe structural and systemic barriers to accessing quality health care, including individuals with no or insufficient insurance and rural and underserved communities. Freezing funds for this essential program will harm communities that otherwise may not have access to care," the lawmakers wrote.