With a new law cutting Medicaid funding to certain clinics, Planned Parenthood estimates 200 of its clinics in 24 states are at risk of closure with the cuts, and nearly all of those clinics — 90% — are in states where abortion is legal. (Photo by Kayla Bartkowski/Getty Images)

A federal judge ruled Friday against the Trump administration’s efforts to strip Medicaid funds from primarily Planned Parenthood-affiliated abortion providers.

Massachusetts U.S. District Judge Indira Talwani denied the federal government’s motion to lift a block on a new law, rejecting the U.S. Department of Justice’s argument that allowing Planned Parenthood to continue to bill for Medicaid while their lawsuit plays out would cause the government “irreparable injury.” She said the plaintiffs were more likely to suffer injury if the provision went into effect, such as having to close clinics and reduce services.

“Here, Defendants suffer no irreparable harm where Plaintiffs are substantially likely to succeed in establishing that Section 71113 violates several constitutional provisions,” Talwani wrote in an order, denying the federal government’s request to stay two preliminary injunctions. “[I]t is precisely because Congress targeted only a ‘certain’ group of entities for exclusion from Medicaid programs — all but two of which are Planned Parenthood Federation Members — that Plaintiffs are likely to succeed in establishing that Section 71113 is unconstitutional.”

Late last month Talwani ordered a partial and then a full preliminary injunction after Planned Parenthood Federation of America and its Massachusetts and Utah affiliates sued in early July over the new federal reproductive health restriction. After unsuccessfully asking the district court to lift the block, the federal government appealed the preliminary injunctions to the U.S. Court of Appeals for the First Circuit. Shortly after, the DOJ filed a motion asking the district court to reconsider the preliminary injunctions. Last week, the appellate court declined the government’s request, pending the district court’s decision. Defendants are now expected to re-appeal the injunction to the First Circuit. 

The provision, set to expire July 4, 2026, would primarily affect health clinics affiliated with Planned Parenthood, which has estimated it could lose 200 of its 600 clinics, many of which are in rural areas and others that are critical abortion-access points. 

But two other affected organizations are Health Imperatives in Massachusetts, which according to WBUR, operates seven clinics and serves about 10,000 patients, and Maine Family Planning, which has also sued over the provision. On Monday, U.S. District Judge Lance Walker in Maine, an appointee of President Donald Trump, denied Maine Family Planning’s motion for a preliminary injunction, despite the organization facing losses up to nearly $2 million, potential layoffs, and disruption of care for about 8,000 patients.

“This ruling is a devastating setback for Mainers who depend on us for basic primary care,” said George Hill, president and CEO of Maine Family Planning, according to Maine Morning Star. “The loss of Medicaid funds — which nearly half our patients rely on — threatens our ability to provide life-saving services to communities across the state. Mainers’ health should never be jeopardized by political decisions, and we will continue to fight for them.”

Does the new federal Medicaid rule unlawfully target Planned Parenthood?

Federal funding of abortion is already prohibited in most cases under the Hyde Amendment. But the new funding rule would bar from the Medicaid program reproductive health clinics that provide abortions and received more than $800,000 in federal and state Medicaid funding in fiscal year 2023 for health services like birth control, cancer and gender-affirming care. 

The legislation has caused confusion throughout the Planned Parenthood network because its definition of “prohibited entity” includes a barred organization’s “affiliates, subsidiaries, successors, and clinics.”

The nonprofit health network comprises its national membership and advocacy organization, PPFA, and nearly 50 independently structured and operated affiliates, some of which do not offer abortion, such as co-plaintiff Planned Parenthood Association of Utah. These organizations are reimbursed after the fact for specific health services covered by Medicaid. 

Even though the provision is currently blocked, several Planned Parenthood clinics around the country have already closed, both because of the new rule and the Trump administration’s other restrictions stripping abortion providers of federal family planning grants. 

Many of the recently shuttered clinics did not provide abortion, like in Ohio, and some are in states where abortion is illegal, like in Louisiana. 

Planned Parenthood’s attorneys have argued that the new federal Medicaid rule violates their equal protection, speech and association rights, because it excludes their clinics from the Medicaid program on the basis of their association to other organizations — in this case organizations that provide abortions and advocate for abortion rights.

“[S]ince this Court issued its decision, the government has now admitted that Section 71113 (the “Defund Provision”) was intended to punish Planned Parenthood for its ‘political advocacy,’” the plaintiffs wrote in a recent brief opposing defendants’ motion to lift the injunction. 

Plaintiffs referred to a recent public statement made by Andrew G. Nixon, a spokesperson for co-defendant U.S. Department of Health and Human Services. 

“States should not be forced to fund organizations that have chosen political advocacy over patient care,” Nixon said, after the district court’s initial preliminary injunction on July 22. 

But in court, the federal government argued the tax and spending cuts law excludes large abortion providers only because they provide abortions. They say they are also excluding smaller or non-abortion-providing affiliates, not because of their speech or advocacy, but because of their “non-expressive activities of corporate control and financing.” Their basic argument is that money to any Planned Parenthood clinic — even for health services unrelated to abortion — is money for abortion. 

“[B]ecause money is fungible, extending the funding restriction to affiliates prevents an organization from undermining federal policy not to subsidize abortion providers by shifting funds between entities that do not perform abortions and entities that do,” defendants wrote.  

The DOJ has also rejected plaintiffs’ claim that the federal legislation is a bill of attainder, which refers to legislation that unconstitutionally imposes punishment on a specific person or group of people without a judicial trial. 

“Halting the flow of federal Medicaid funds to those entities bears no resemblance to the forms of punishment that implicate the Bill of Attainder Clause,” reads the DOJ’s motion. “Historically, bills of attainder involved punishments such as ‘death,’ ‘banishment,’ and ‘imprisonment.’”

But Talwani disagrees with the DOJ’s reasoning.

“[T]here is no indication in the record that Planned Parenthood Members share revenues from Medicaid reimbursements,” she wrote. “The result is a restriction on associational freedom that is in no way ‘essential to the furtherance of [Defendants’] interest’ in withholding funds from certain abortion providers … and instead imposes a wholly unwarranted burden.”

While the new federal tax and spending cuts law does not mention Planned Parenthood by name, a bill introduced this year with similar language is explicitly titled, “Defund Planned Parenthood Act of 2025.” Meanwhile, several state legislatures have successfully stripped funding from the organization. The U.S. Supreme Court allowed South Carolina to exclude Planned Parenthood from its Medicaid program in late June after a long legal fight, but the state’s affiliate just sued again over Medicaid eligibility.

“You have to be living in a cave to believe this isn’t about Planned Parenthood,” said abortion law expert Mary Ziegler. “The reason Planned Parenthood is a target is because it’s a twofer. It’s both the nation’s largest abortion provider and also the nation’s best advocate for abortion rights. … But I think the problem for Planned Parenthood is that disaggregating the two is hard, and proving congressional intent to target one rather than the other is challenging.”

Anti-abortion activists and conservative commentators have accused Talwani, an Obama appointee, of judicial activism.

“Now the abortion industry is suing to block the will of the voters, duly passed by Congress,” wrote Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, in a recent op-ed for National Review. “They argue they’re constitutionally entitled to our tax dollars in perpetuity, and they’ve found a single activist judge willing to take their side and impose that view on the entire nation — for now.”

Ziegler said the bill of attainder argument is rarely used, but is plausible in this case. 

“Generally, with a bill of attainder, you have to show that there’s no other kind of valid legislative purpose, and that it’s selectively targeting the person who’s suing,” she said. “In this case, it seems pretty clear that there’s some targeting of Planned Parenthood happening. … But I think there being no other purpose is more complicated.”

Ziegler said the case will likely be hard to win if it gets to the majority conservative Supreme Court. But if the injunction holds, Planned Parenthood could run out the clock on the one-year Medicaid restriction. She thinks it might seem too politically risky to renew this provision right before the 2026 midterm elections to more moderate Republicans in the House, like Rep. Mike Lawler of New York, who told NOTUS in May, “from the standpoint of providing health care to women, you know, I’m not for taking away people’s health care.”

“They’ll either have to say, ‘All our boasts about defunding Planned Parenthood were not real, because Planned Parenthood is going to get funded again,’ or they’re going to have to make the funding prohibition permanent, which could have the consequences that people like Lawler were afraid of.”

Planned Parenthood has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of a provision in the massive budget bill signed by President Donald Trump last week. (Photo by McKenzie Romero/Utah News Dispatch)

Days after President Donald Trump signed a massive budget bill, attorneys for Planned Parenthood Federation of America and its state members in Massachusetts and Utah filed a lawsuit Monday challenging a provision they say will affect more than 1 million patients who use their clinics across the U.S.

Planned Parenthood says if the defund provision stands, those targeted will be patients who use Medicaid as their insurance at its centers for services including birth control and cancer screenings. The organization says it only uses federal Medicaid funding for abortion in the very narrow cases allowed, including rape, incest, and to save a pregnant person’s life.

The complaint, filed in U.S. District Court of Massachusetts against U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Medicaid and Medicare administrator Dr. Mehmet Oz, challenges a provision on page 597 of the reconciliation bill. It prohibits Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $800,000 in federal and state Medicaid funding in fiscal year 2023. That prohibition will last one year from the date the bill was signed.

While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics. The entire organization has about 600 clinics in 48 states, and according to their calculations, more than 1.1 million patients could lose access to care because of the change in the law.

“This case is about making sure that patients who use Medicaid as their insurance to get birth control, cancer screenings, and STI testing and treatment can continue to do so at their local Planned Parenthood health center, and we will make that clear in court,” said Planned Parenthood Federation of America president and CEO Alexis McGill Johnson in a public statement.

The organization identified 200 of its clinics in 24 states that are at risk of closure with the cuts, and said nearly all of those clinics — 90% — are in states where abortion is legal. In 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. Because of that, some reproductive health advocates have called it a backdoor nationwide abortion ban.

The nonprofit also warned that eliminating Planned Parenthood centers from the Medicaid program would likely also impact patients who use other forms of insurance, if centers are forced to cut their services or close. 

Planned Parenthood argued this section of the bill is unconstitutional because it specifies and punishes them, saying it violates equal protection laws and qualifies as retaliation against free speech rights. 

“The Defund Provision is a naked attempt to leverage the government’s spending power to attack and penalize Planned Parenthood and impermissibly single it out for unfavorable treatment,” the complaint says. “It does so not only because of Planned Parenthood members’ long history of providing legal abortions to patients across the country, but also because of Planned Parenthood’s unique role in advocating for policies to protect and expand access to sexual and reproductive health care, including abortion.”

The complaint also details numerous instances when Trump said he was committed to defunding Planned Parenthood in 2016 and 2017, during his first presidential term, and it highlighted the provisions of Project 2025 that called for the defunding of Planned Parenthood. Project 2025 is the blueprint document drafted by the conservative Heritage Foundation, and the administration has followed many of its directives so far.

According to the lawsuit, Planned Parenthood members have “structural independence,” meaning no member “has control over the operations or decision-making processes of another.” It’s argued in the complaint that 10 members, including plaintiff Planned Parenthood Association of Utah, don’t meet the definition of prohibited entity under the new law, because they do not provide abortion services or did not receive over $800,000 in Medicaid funds during fiscal year 2023. They say these members are not “affiliates, subsidiaries, successors, or clinics” of any prohibited entity because they are separately incorporated and independently governed.

“But these Non-Qualifying Members can take no comfort in the plain text of the statute,” reads the lawsuit. “Defendants will willfully misinterpret the statute to disqualify them from receiving federal Medicaid funding, based solely on their association with PPFA and other Planned Parenthood Members.”

“As the Trump administration guts our public health care system, we know millions will suffer and struggle to get care. We will not tolerate these attacks,” said Shireen Ghorbani, interim president of Planned Parenthood Association of Utah, in a statement. “For over 55 years, we have proudly cared for generations of Utahns, and we will always find ways to meet the health care needs of our communities. Here in Utah, we are used to politicians trying to strip away our rights for political gain. We haven’t backed down before, and we won’t now.”

Defunding will harm general wellness, not abortion care, Arizona clinic owner says

Planned Parenthood also noted in its complaint that the harms could be especially devastating because “even where alternative providers are theoretically available, those providers, who are already stretched to capacity, often do not offer the same comprehensive sexual and reproductive health service options, have long wait times for patients, and cannot accommodate the huge influx of patients who would need to find a new provider of care.”

Some clinics that operate independently of Planned Parenthood will be affected by the law as well. George Hill, president and CEO of Maine Family Planning, said they receive nearly $2 million from Medicaid funds (MaineCare) on a yearly basis, and about half of their patients are enrolled in some form of Medicaid. Hill said they plan to sue as well, but the timing is uncertain at this point. Abortion care makes up about 15% of their overall services, while the rest is routine gynecological and preventative health care, he said.

In the meantime, Hill plans to solicit as much support as possible from individual donors to keep the doors to their 19 clinics open and serving Medicaid patients.

“Whether or how long we’ll be able to do that is another question,” Hill said.

In Arizona, Dr. DeShawn Taylor operates the independent clinic Desert Star Institute for Family Planning. About 75% of the services at Desert Star are abortion related, and while Medicaid (AHCCCS in Arizona) dollars can’t be used for the procedure, Taylor said they could often at least get the initial consultation appointment covered by Medicaid.

The cuts that are coming, Taylor said, will not stop people from obtaining an abortion somehow. But there will be other downstream effects.

“People are already economically depressed,” she said. “What we’re going to see is people are still going to do what’s necessary to get (abortion) care, but what’s going to fall off is their ability to get their preventative care, their contraception, their wellness exams, those types of things.”

Planned Parenthood has identified 200 of its clinics in 24 states that are at risk of closure through federal cuts under the budget reconciliation package before the U.S. Senate. (Photo by Michael B. Thomas/Getty Images)

If the budget reconciliation package before the U.S. Senate becomes law in the coming weeks, reproductive health advocates say the provision that would cut federal funding to Planned Parenthood clinics could serve as a backdoor nationwide abortion ban, eliminating access to 1 in 4 abortion providers.

The Republican-led bill, which already passed the House by a slim margin, is more than 1,000 pages and includes sweeping tax cuts that mostly benefit the wealthy coupled with steep spending cuts to social services, including Medicaid.

On page 339 of the bill, Republicans included a provision prohibiting Medicaid funding from going to any sexual and reproductive health clinics that provide abortions and received more than $1 million in federal and state Medicaid funding in fiscal year 2024. While there may be a few independent clinics with operating budgets that high, it effectively singles out Planned Parenthood clinics.

Planned Parenthood clinics rely heavily on Medicaid funding, not to provide abortions, which is not permitted by federal law (except in cases of rape, incest or life-threatening health emergencies), but to provide standard reproductive health care at little to no cost, including treatment for sexually transmitted infections and cancer screenings, as well as contraception. Planned Parenthood provides services for about 2 million patients every year, and 64% of its clinics are in rural areas or places with health care provider shortages.

A Planned Parenthood spokesperson said people who use Medicaid make up half of the total patient volume nationwide for essential health care services provided by their clinics. Even though those patients aren’t seeking abortion care, funding cuts would affect the financial sustainability of those clinics, the spokesperson said.

The organization already identified that 200 of its clinics in 24 states are at risk of closure with the cuts but told States Newsroom on Thursday that further analysis revealed nearly all of those clinics — 90% — are in states where abortion is legal, and in 12 states, approximately 75% of abortion-providing Planned Parenthood health centers could close. The entire organization has about 600 clinics in 48 states.

The “One Big Beautiful Bill” would result in nearly 11 million people losing access to health insurance by 2034, according to the nonpartisan Congressional Budget Office, and add $2.4 trillion to the federal deficit over the next 10 years.

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, told States Newsroom she and other advocates have been meeting with senators to lobby against the bill’s passage, emphasizing that it will have an outsized negative effect on rural clinics and hospitals.

“We are encouraging everyone to reach out to their representatives about this,” McGill Johnson said. “They know that they’re doing this under a watchful eye, and we want to make sure their constituents know about it.”

The defunding effort would be a win for several prominent anti-abortion organizations that have long lobbied for this change and nearly achieved it in 2017 with a similar budget bill. Americans United for Life sent a fundraising email to its supporters Thursday saying this is a “crossroads” for abortion in America. 

“So far in 2025 more than a dozen Planned Parenthood clinics have closed, their taxpayer funding is hanging by a thread, and the highest-ranking federal health officials are undertaking a ‘top-to-bottom review’ on the abortion pill,” the email attributed to CEO John Mize said. “It’s possible that very soon, mail-order abortion could be walked back, and more Planned Parenthood locations could be closing their doors for good.”

Susan B. Anthony Pro-Life America, another anti-abortion organization that helped draft the Heritage Foundation’s Project 2025 blueprint for the next Republican president, told States Newsroom in an emailed statement that the budget provision should be no surprise, and there are better uses for the funding, like community health centers.

“Republicans have identified budgetary concerns with funding Big Abortion since 2015, and the bill language to do so has remained substantially the same,” said SBA President Marjorie Dannenfelser.

Closures would affect already fragile health care system, Midwest doctor says

Planned Parenthood has already closed some clinics around the country, including eight clinics across Iowa and Minnesota at the end of May. Dr. Sarah Traxler, chief medical officer of Planned Parenthood North Central States, which includes Iowa and Minnesota, said the U.S. Health and Human Services’ decision to freeze Title X family planning funding to many reproductive health clinics at the beginning of May contributed to the decision to close those clinics. The North Central States affiliates serve more than 93,000 patients each year, about 20,000 of which use telehealth services.

About 30% of those patients use Medicaid to access care, she said.

“When Planned Parenthood isn’t able to provide services to patients as an essential safety net provider, it has ripple effects across the health care system at large,” Traxler said. “We are already sitting in a time in our country, and have for several decades, where we have patients who can’t access care.”

Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, told States Newsroom that 865 Title X clinics in 23 states are impacted by the federal freeze. She said there are no Title X services in eight states: California, Hawaii, Maine, Mississippi, Missouri, Montana, Tennessee and Utah. She said the funding freeze affects one-quarter of all Title X funding grantees, translating to about 842,000 patients who have lost access to care.

“In the two months since HHS withheld federal funding for nearly two dozen Title X family planning grants, affected grantees have been struggling with the unknown of whether they will ever receive the vital funds,” Coleman said in an email. “Some have had to close clinics, lay off staff, and reduce essential contraceptive and sexual health care services. … On top of the Title X funding freeze, proposed Medicaid cuts will be devastating for Title X grantees. Rates of unintended pregnancies and STIs will increase, cancer screenings and diagnoses will be delayed, and decades of public health progress will be reversed.”

After the Iowa Legislature axed Planned Parenthood from its family planning program, Traxler said, the rates of sexually transmitted infections increased considerably across the state — an outcome verified by a 2022 medical study. She expects similar effects from these cuts.

People already travel long distances for abortion care, she said, and that will only get worse if more cuts come to pass. But she also expects to see patients start traveling long distances for routine gynecological care.

‘Changes to Medicaid … only adds to the chaos’

Like many independent abortion clinics, the all-trimester Maryland abortion clinic Partners in Abortion Care does not receive Title X funding. But because Maryland is one of 17 states whose Medicaid program covers abortions, they do see a lot of patients who are on Medicaid, at a significant cost to the clinic. Certified nurse-midwife and Partners co-founder Morgan Nuzzo said the clinic did not receive more than $1 million in federal or state Medicaid dollars in fiscal year 2024, and in fact loses about $1 million annually for seeing Medicaid patients.

Nuzzo said Maryland’s Medicaid program reimburses first-trimester abortions at a “decent rate,” but at a very low rate for later abortion cases, which are more medically complex.

“After about 15 to 16 weeks [gestation], we’re losing money on these cases,” Nuzzo said. “We’ve been billing now for almost a year through the state. In second and third-trimester abortion care, we’re losing about 85% of what we would charge for a cash pay fee. So that comes out to about $250,000 a quarter that we are losing just by the under-reimbursement from Maryland Medicaid.”

For that reason, Nuzzo is hopeful about Maryland’s new $25 million Public Health Abortion Grant Program, recently approved by Gov. Wes Moore. The program will be open to clinics like Partners and abortion funds like the Baltimore Abortion Fund, but Nuzzo said it could be a while before that funding is available. Right now she is uncertain and concerned about how the federal reconciliation bill could potentially impact Maryland’s Medicaid program. 

Because Partners provides abortions for all trimesters, they see patients from all over the country, and even the world, and the vast majority need financial assistance, Nuzzo said.

“People are traveling further for their procedures, just like they were before,” she said. “The landscape is constantly changing, almost week to week, about where you can access abortion, which is confusing and chaotic to patients. Changes to Medicaid and insurance coverage of abortion only adds to the chaos.”