Thousands of low-income people living with HIV could be losing drug coverage as states impose limitations on HIV assistance programs amid constrained budgets — raising alarms over consistent access to lifesaving medications.

Many factors are putting budget constraints on state programs, including federal funding — which has remained flat for years and hasn’t been adjusted for inflation — increased drug costs and rising insurance premiums.

The Ryan White HIV/AIDS Program is the national safety-net program supporting more than 600,000 low-income people living with HIV across the nation. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Congress has kept key drug assistance funding at $900.3 million annually since 2014. New enrollments for state programs jumped 30% from 2022 to 2024, in part because states cut off pandemic-era Medicaid assistance.

As of January, at least 18 states have pulled back their Ryan White AIDS Drug Assistance Programs, known as ADAPs, in some way, according to a March 2 analysis by health research group KFF and a report by the National Alliance of State and Territorial AIDS Directors, which offers consultation for states.

There are roughly 1.2 million people in the United States living with HIV, and about 1 in 4 people get support from a state drug assistance program.

A disproportionate number of HIV/AIDS patients are gay, bisexual and other men who have male-to-male sexual contact, according to the federal Centers for Disease Control and Prevention. LGBTQ+ communities have been targeted in recent years by some federal and state policies, including the rollback of civil rights, shutting down a youth mental health hotline, restricting health care access, and imposing discussion and book bans in public schools.

Florida has introduced the most dramatic restrictions on income eligibility for its HIV drug program — cutting individual eligibility for the program from 400% of the federal poverty level to 130%. That means uninsured and underinsured people up to that 400% poverty line no longer have coverage under the program.

That’s roughly slashing maximum annual income of $63,840 for an individual down to $20,748. The state says the change will prevent a $120 million shortfall.

“(That) creates an immense coverage cliff,” for example, for childless adults not eligible for Medicaid, said Amber Tynan, CEO of Big Bend Cares, a North Florida Ryan White provider. Florida is among the 10 states that haven’t expanded Medicaid eligibility under the Affordable Care Act.

Florida’s department of health didn’t respond to Stateline’s request for comment.

Delaware, Kansas, Pennsylvania and Rhode Island have also reduced income eligibility for their programs, but to a lesser extent, according to KFF. For example, Kansans with HIV/AIDS whose incomes are above 250% of the federal poverty level won’t be eligible for help with Obamacare insurance premiums. That change will affect about 230 people, the National Alliance of State and Territorial AIDS Directors estimates.

In Pennsylvania, about 1,600 people will lose HIV drug assistance coverage as the state imposes income eligibility caps at 350% of the federal poverty level.

“We cannot continue to provide services at a certain level when the funding to do so does not exist,” Neil Ruhland, Pennsylvania Department of Health press secretary, told Stateline in a statement. He pointed to drug costs and enrollment numbers that are “steadily rising while funding remains stagnant.”

Florida also is removing the brand-name drug Biktarvy, which is the only single-tablet HIV medication regimen recommended by national guidelines for those starting treatment and is the most widely prescribed antiretroviral medication nationally. There is no generic form.

The medication is highly effective at reducing a person’s viral load, meaning the virus is undetectable in blood tests and untransmittable to others.

Eighty percent of Floridians with HIV who are in the state’s program use Biktarvy, Tynan said.

“Not having the opportunity to stay on lifesaving treatment is creating quite the panic and crisis for our population,” Tynan said. “For decades we’ve worked to turn HIV from a fatal diagnosis into a manageable chronic condition, and that progress depends on one thing: consistent access to treatment. When that stability is disrupted like it has (been) in Florida, it creates real risk for patients and for public health.”

Other states (Arizona, Michigan, Pennsylvania, Rhode Island, Virginia and Washington, plus the District of Columbia) also are considering limiting which drugs they cover, according to the alliance’s report.

And several other states may impose other limits to their drug assistance program. Health agencies in Hawaii, Idaho, Montana, New Jersey, South Carolina, Virginia and Washington are considering cutting funding for core medication and support services. Others are considering implementing a six-month recertification period, restricting eligibility, putting caps on expenditures, changing covered medications and lowering assistance for insurance premiums.

While no state has implemented a waiting list for drug assistance, three states — Arkansas, Louisiana and New Jersey — are considering one as a future cost-containment measure, according to the national alliance’s report.

Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center, said many of her HIV patients are under-resourced and rely on her state’s Ryan White program. She added that she’s relieved Massachusetts’ program hasn’t announced any changes as of February, when the alliance’s report was released, but that she’s worried for patients in the other states.

“We’ve taken HIV from a very serious virus, a deadly virus when it was first discovered in the ’80s, to a very manageable chronic condition because of the medicines,” she said. “It is concerning to see … that we’re sort of moving backwards by not providing that kind of care that’s so much needed, and that’s lifesaving.”

Florida bypassed a rulemaking process when it announced its changes days before open enrollment ended. In late January, the AIDS Healthcare Foundation, a global nonprofit agency, sued the state department of health over the changes. The U.S. Centers for Medicare & Medicaid Services opened a new enrollment period for Floridians losing coverage to enroll in a different marketplace plan.

In late February, Florida issued an emergency rule putting the new eligibility requirements into effect. About 32,000 Floridians get help from the state program in some way — whether it’s through local health departments or the state helping to pay for insurance premiums.

Half of those, around 16,000, will lose coverage entirely — but many others will be affected in other ways, such as losing access to Biktarvy.

“So if you remain in the program, there’s a very high likelihood that you’re still going to be impacted by some of the other changes, like the dropping of the premium assistance, the elimination of Biktarvy from the formulary,” said Tim Horn, director of medication access for the National Alliance of State and Territorial AIDS Directors. “When you take a look at all of these changes in the net, the vast majority of Florida ADAP clients are going to be impacted by this, one way or another.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Editor’s note: This is the first report in an ongoing series.

The patient came in with a belly full of blood, Dr. Leilah Zahedi-Spung recalled. Her pregnancy was ectopic, no longer viable, and could have killed her if left untreated. But when she went to a mobile pregnancy help center offering free care in an RV in St. Louis, she was told the pregnancy could be saved.

By the time she saw Zahedi-Spung days later, her fallopian tube had ruptured.

In North Lauderdale, Florida, Ieshia Scott was pregnant and in the throes of postpartum depression. She thought she’d arrived at an abortion clinic. She told the staff she might hurt herself if she had another baby. They told her God would give her strength.

A woman and her partner in Sheboygan, Wisconsin, went to a pregnancy help center by mistake. When they made it to a Planned Parenthood clinic across the street, the pregnant patient handed Dr. Kristin Lyerly a copy of the sonogram. But the scan was not of her uterus. It was her bladder.

All three patients had gone to crisis pregnancy centers, organizations that advertise free pregnancy tests and ultrasounds but dissuade women from pursuing abortions and contraceptive options. Since the U.S. Supreme Court ended national abortion access in June 2022, the centers have seen an infusion of taxpayer dollars in many Republican-led states. But medical experts have urged lawmakers to reconsider the state support, as the centers can endanger public health by “causing delays in accessing legitimate health care,” according to the American College of Obstetricians and Gynecologists. 

States Newsroom conducted a 50-state investigation examining state and federal budgets, as well as the tax records of these organizations, finding that while the magnitude of public funding for them is growing, oversight is not. 

Twenty-one states funneled nearly a half-billion dollars, or $491 million, of taxpayer money to crisis pregnancy center organizations between fiscal years 2022 and 2025. That figure does not include millions some states diverted from federal programs like Temporary Assistance for Needy Families, and it does not include multimillion-dollar tax credit programs launched after federal protections for abortion rights were overturned. 

Nearly $1.3 billion in local, state or federal government grants were awarded to 1,259 crisis pregnancy centers in total between 2019 and 2024, according to States Newsroom’s analysis of tax records. The actual figure may be higher, as digital records are not comprehensive or entirely up to date.

Yet that largesse hasn’t been matched by corresponding regulation. Oversight of taxpayer funding remains weak, either blocked by legislators or ignored by state agencies. 

The centers are most often faith-based nonprofits that say they provide much-needed support for pregnant clients at no cost. An estimated 2,633 crisis pregnancy centers were operating in the United States as of March 31, 2024, according to research from the University of Georgia. 

John Mize, CEO of Americans United for Life, argues that pregnancy centers are important for people who really don’t want an abortion, and for anyone who regrets their abortion to find support. 

“I am strongly of the opinion that most women that have abortions do it because they don’t feel like they have any other option,” Mize said.

But critics and researchers say the pregnancy centers mislead potential clients about their services or pose as medical clinics despite lacking proper licensure. They sometimes promote treatments like abortion pill reversal, which is unproven and potentially dangerous. 

“Often, patients are lured in by this idea of getting free care,” said Dr. Rachel Jensen, Darney-Landy complex family planning fellow at the American College of Obstetricians and Gynecologists. “It’s free, because it’s often subsidized by taxpayer dollars. Free health care sounds amazing. It should be available to all people. But the problem is, then, that the CPCs are unregulated — and they operate outside of ethical principles and best care practices.”

Firsthand accounts: ‘What’s your plan for this pregnancy?’ Comfort, shame and a missed diagnosis

Indiana state Sen. Shelli Yoder, a Democrat, said access to maternal health care in her state continues to decrease while support for crisis pregnancy centers increases. Indiana boosted its budget for the centers from $250,000 in 2021 to $2 million, then doubled it to $4 million by 2024. The state’s maternal mortality rate is among the worst in the country. 

“It’s not that these centers don’t serve a purpose. But they certainly are not a replacement for maternal health care, and they are not health care centers, and yet our state is using taxpayer money to fund them as if they are,” Yoder said. “And we are sending a message to moms, or to women, that they are health care centers, and they are not.”  

Zahedi-Spung was working an emergency room shift in 2019 at a St. Louis hospital, not too far from the pregnancy center housed in an RV and frequently parked in front of a Planned Parenthood clinic. She said she was horrified to learn the patient with the ruptured ectopic pregnancy had been told at the mobile crisis pregnancy center a few days before that it could be saved. A tubal ectopic pregnancy is never viable.

Today, Zahedi-Spung works in Colorado as a high-risk OB-GYN. But that experience in the ER still haunts her.

“They’re a private organization providing medical care without a medical license, so they are not liable for anything they tell anyone,” she said.

Andrea Trudden, spokesperson for Heartbeat International, one of the largest pregnancy center networks in the U.S., said that as of 2025, more than 75% of Heartbeat affiliates offer medical services and are different from pregnancy resource centers, which offer parenting classes and material aid but not medical services.

“Medical affiliates that provide limited obstetrical ultrasound or other services follow applicable state laws, professional standards, and clinical protocols,” Trudden said in a written statement.

According to a report from the Charlotte Lozier Institute, 37% of 2,775 crisis pregnancy centers provided testing for sexually transmitted infections, and 29% provided STI treatment in 2024. The institute, which is the research arm of one of the largest anti-abortion policy groups, Susan B. Anthony Pro-Life America, found that 81% of surveyed centers provided ultrasound services in 2024. The report notes that 28% of paid center staff have medical licenses, along with 12% of volunteers.

The only option for miles

In North Florida’s largely rural Wakulla County, there are no full-time practicing OB-GYNs. Wakulla Pregnancy Center is in Crawfordville, the county seat of about 4,800 people. Many women in the area lack transportation, said the center’s director, Pam Pilkinton. They have to travel about 20 miles north to Tallahassee for prenatal care.

Run by a local ministry, the center has a blue-and-white sign that advertises “Free Pregnancy Tests.” Inside, a cozy living room furnished with sofas leads to a counseling room and donation space, where moms peruse a range of free baby clothes and supplies. Most of the center’s clients have low incomes, and are on Medicaid or uninsured.

When Florida passed a six-week abortion ban in 2023, legislators simultaneously increased state funding for crisis pregnancy centers by 455% — from $4.5 million to $25 million. The following legislative session, they added another $4.5 million. 

The funds go to the Florida Pregnancy Care Network, which manages contracts with more than 100 crisis pregnancy centers across the state. The organization is required to report the amount and types of services provided and the expenditures to the governor and state legislature once a year. But it is not required to make any noncompliance findings public. 

The public money for centers in Florida doesn’t end there. Wakulla Pregnancy Center received a separate allocation in the 2025 budget of $136,000. According to the funding request, $60,000 is allocated for a building asbestos issue, and $58,000 pays for the salary and benefits of the executive director and client coordinator. The rest is for pregnancy tests, educational materials, ultrasound referrals and other supplies. 

But Pilkinton is clear about one point: The center does not provide medical care in this maternal health care desert. 

“We’re not a medical facility, and that is something that we let everyone know up front,” Pilkinton said. “We provide material support, education, information and peer counseling.”

That doesn’t include practices like referring a patient to an OB-GYN for prenatal care after a positive test, for example, “because we’re not a medical facility,” she said.

Wakulla County’s severe maternal hospitalization rates ranked among the worst in the state in 2023 and 2024.

Like in other states, maternal health care has continued to flounder in Florida — and shortages are likely to worsen. Nearly half of 1,500 OB-GYNs who responded to a state survey say they plan to stop delivering babies within the next two years. 

The money Florida allocated for pregnancy centers might have covered more maternity care across the state, said Democratic state Rep. Anna V. Eskamani.

“We do need to strengthen our safety nets when it comes to supporting new moms,” Eskamani said. “Instead of addressing those gaps and investing in those areas, we continue to dole out millions of dollars to these unregulated and often religiously affiliated anti-abortion centers that are not addressing any of these disparities.”

In previous legislative sessions, Eskamani filed bills to repeal state funding and introduce regulation of existing centers. The bills have yet to receive a hearing, but she and her colleagues have filed them again.

“These not-for-profit organizations run with very little federal or state oversight, and sometimes they don’t even have licensed medical staff on site,” she said. “At this point, it’s a blank check.”

Big checks, little oversight

Much of the state funding for pregnancy centers did not exist before the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended federal protections for abortion rights in June 2022. 

Conservative-led states — such as Texas — that already allocated tens of millions to pregnancy centers have doubled or tripled their budgets for pregnancy resource groups since 2022. In Missouri, lawmakers have budgeted nearly $50 million since fiscal year 2022 from the general fund and federal block grant dollars. Texas’ allocation ballooned from $140 million in fiscal years 2024 and 2025 to $180 million in 2026 and 2027. 

In southwest Missouri, Republican state Rep. Christopher Warwick’s support of the centers is a focus of his reelection campaign.

“I think it’s important that we fund organizations that are willing to save life,” he said.

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Louisiana lawmakers directed $4 million from the state’s general fund to pregnancy centers for 2025, as part of its Pregnancy and Baby Care Initiative. But an audit found the state doled out the maximum amount per center allowed by state law — $100,800 — to most of the groups without requiring them to fully document how they spent it.

Auditors were concerned Louisiana paid the centers more than the cost of the actual services provided.

In Oklahoma, state auditors discovered in 2022 that an anti-abortion nonprofit called Oklahoma Pregnancy Care Network disbursed less than 7% of the $1.6 million it promised to nonprofits under the state’s Choosing Childbirth program. A month and a half before its contract was scheduled to end, the group had served 524 women, less than 6% of the 9,300 Oklahoma women it initially projected it would serve. An administrator with the nonprofit told The Oklahoman she was unaware there were problems.

Despite those findings, state lawmakers later directed nearly $18 million — a quarter of the state health department’s entire budget — toward Choosing Childbirth through November 2027. More than $4 million of it went to the Oklahoma Pregnancy Care Network. The network did not respond to States Newsroom’s requests for comment.

Inner workings

Lyerly, the OB-GYN in Sheboygan, Wisconsin, said the couple with the mislabeled sonogram came into her Planned Parenthood clinic in the early months of 2022. It wasn’t uncommon for patients with appointments at Planned Parenthood to accidentally go to the crisis pregnancy center across the street. This couple sought an abortion, she said, but came in with the ultrasound image of the woman’s bladder rather than her uterus. On top of the mislabeled ultrasound, they felt misled, because they were told the pregnancy was just a few weeks along when it was much more advanced.

“This was a challenging situation for them, was emotional and frustrating and upsetting to them, and it was so unnecessary,” said Lyerly. She stopped providing abortions in Wisconsin later that year when a state law banning the procedure went back into effect after the Dobbs decision.

Many centers are affiliated with umbrella organizations, including Care Net, Heartbeat International (formerly Alternatives to Abortion International) and National Institute of Family and Life Advocates, but often do not disclose that connection on their website. The parent companies provide guidance for operations, including yearly conferences, along with training for limited ultrasounds and other services. Training and funding for many of these centers’ ultrasound programs also come from national religious groups like Focus on the Family and the Knights of Columbus.

Heartbeat International is the largest of the three, with more than 4,000 affiliated service providers across the U.S. and in more than 100 countries, according to Trudden.

Trudden said Heartbeat International offers professional training and practical resources for affiliates, who determine their own governance, leadership and location and must agree to a set of standards also shared by Care Net and the National Institute of Family and Life Advocates. Those standards include practicing honesty and confidentiality with clients and complying with all legal and regulatory requirements. 

Some pregnancy centers are staffed with licensed professionals trained in sonography. The National Institute of Family and Life Advocates says it has trained more than 6,000 health care professionals “in the medical and legal ‘how to’s’ of limited obstetrical ultrasound.” But at its national conference last year, leaders discouraged centers from performing ultrasounds on women who they suspect have ectopic pregnancies to avoid liability. The guidance came in the wake of a lawsuit against a Massachusetts center, in which the plaintiffs alleged that center staff failed to diagnose an ectopic pregnancy that ruptured, prompting emergency surgery. The clinic reached a settlement with the patient. 

Some centers offer more medical services, like prenatal support and testing and treatment for STIs, such as Idaho’s Stanton Healthcare, which is accredited by the Accreditation Association for Ambulatory Health Care and does not receive any public funding. 

“We have caught ectopic pregnancies. … I can think of three in the last eight months off the top of my head,” said Angela Dwyer, Stanton’s director of client services. 

But advocacy groups such as Campaign for Accountability have raised alarms about how many clinics do not have to follow federal health privacy laws, including the Health Insurance Portability and Accountability Act, known as HIPAA.

Clinics that offer free services and do not bill insurance face no penalty for disclosing a client’s information. 

In contrast, Jessica Scharfenberg, CEO of Healthfirst Network in central Wisconsin, said if any of her 10 reproductive health clinics violated HIPAA, they would face steep federal fines and possible jail time for staffers. 

“If my entity broke HIPAA, we would have federal consequences, even though we also have an internal policy for it,” Scharfenberg said. “They have their internal policies. They break HIPAA, there’s no consequences for it.”

The websites of some centers give the appearance of being HIPAA compliant even though they aren’t, States Newsroom has reported. 

The other two main umbrella organizations did not respond to multiple requests for comment by email and phone. 

‘So much help’

In North Lauderdale, Ieshia Scott would stare at her 6-month-old, unable to hold the baby when she cried. Scott, who also had a 10-year-old, felt overwhelmed by a constant cloud of stress and sadness, all while trying to keep up with college classes.

When she found out she was pregnant again, Scott searched for an abortion clinic in the city, and a pregnancy resource center came up in the search results. That 2018 visit would last nearly three hours, during which she fielded dozens of questions about why she wanted an abortion. Scott had suicidal thoughts and was depressed but felt totally unheard. 

“I really was disregarded,” said Scott, now 36. “I was actually saying to her, like — ‘I don’t know, I might hurt myself, I might hurt the baby.’”

The center didn’t refer her to a psychiatrist, therapist or OB-GYN. The staff member instead reminded her of the Ten Commandments.

“I’m literally telling her, I can’t — I can’t do it. And she was like, ‘You can, you can. And there’s so much help.’”

Mental health is a contributing factor in about 23% of the nation’s maternal deaths, reports from the federal Centers for Disease Control and Prevention show.

Scott eventually went to a clinic to get the care she needed. But she worries for women who can’t. 

More than a dozen states passed abortion bans after Dobbs, and efforts continue nationwide to dismantle what access remains. Several states with abortion bans — including Missouri, South Carolina and Texas — have moved to cut Planned Parenthood out of state Medicaid programs as well, after the U.S. Supreme Court ruled last year that excluding the organization did not violate Medicaid’s provision requiring freedom of choice in providers. Florida legislators are also discussing cutting Planned Parenthood out of the state Medicaid program.

In 2025, at least 51 Planned Parenthood locations closed or limited medical services after losing state and federal support. Those communities lost access not only to abortion services but also to other reproductive and primary medical care. Independent clinics such as Maine Family Planning stopped offering primary care services for about 600 patients because of a funding loss of about $1.9 million, even though none of the Medicaid dollars were used for abortion.

‘Government handouts’

Lawmakers are not only opening public coffers to provide direct financial support to pregnancy centers, but they’re also creating tax breaks, drawing on federal sources and shifting funds meant to help low-income families to aid the anti-abortion organizations — with few regulations.

Some legislators have resisted stronger oversight. 

In Missouri, state Rep. Warwick opposed a colleague’s suggestion to require the centers to report how they spend their donations in a tax credit program, saying he wanted to limit bureaucracy. He said in a February 2025 legislative hearing that the tax credit keeps the state from having to “verify what programs work.” 

“I don’t think they’re funded enough to be able to mishandle their money,” he told States Newsroom in December. “At least not the ones I’m familiar with.”

Warwick proposed raising the tax credit for pregnancy center donations from 70% to 100% in 2025, meaning someone donating to a pregnancy center could reduce their state tax bill by the exact amount donated. 

The credits that Missourians redeemed shot up from about $2 million to an average of more than $7 million per year after lawmakers removed a cap on credits in 2021, according to a fiscal note attached to Warwick’s bill. State officials estimated a 100% tax credit just for pregnancy center donations would cost the state more than $10.7 million in the first year.

Missouri also funnels more than $2 million per year in state and federal dollars to pregnancy resource centers and similar organizations through its Alternatives to Abortion program. That’s in addition to what the centers receive from Missouri’s federal Temporary Assistance for Needy Families fund — $10.3 million in this fiscal year.

Although Warwick’s 100% pregnancy center tax credit failed, he plans to try again in this year’s session. “I don’t think it (a 100% tax credit) would significantly hurt the state, especially when we’re talking about protecting life, protecting the birth of children,” he said.

Nebraska Sen. Joni Albrecht, a Republican who also sponsored a six-week abortion ban, said the centers were a valuable investment when she sought to create a $10 million tax credit program that was revised down to $1 million in 2024. 

Of the 13 pregnancy centers approved for tax credits in Nebraska, four provided less than $150,000 in services, according to tax returns, and one had three consecutive state audit reports with findings of deficiencies in controlling and complying with federal grant funding requirements.

In Montana, a state without an abortion ban, Republican Gov. Greg Gianforte found another way to give taxpayer money to pregnancy centers by donating a portion of his annual salary. In 2020, he pledged to give his salary to nonprofit organizations and charities, and has for the past three years included pregnancy centers in that list for a total of more than $60,000.

Idaho state Sen. Ben Adams, a Republican who sponsored a bill to establish a grant fund of $1 million for crisis pregnancy centers in 2025, told States Newsroom he felt it was important to put resources into helping people choose to have a baby. 

“We have, for a very long time, primarily through the federal government, essentially funded abortion through funding for Planned Parenthood and all these different organizations,” Adams said. “We say we’re going to restrict a woman’s access to abortion and that we’re pro-life. Well then, we actually have to be investing in those folks who are choosing life and show them that we mean it when we say we want them to choose life.”

For decades, the Hyde Amendment, a provision Congress has renewed annually, has prohibited the use of federal funding for abortions, except in cases of rape, incest and to save the mother’s life.

Idaho is one of a few states with an abortion ban that isn’t providing government support for crisis pregnancy centers. Adams’ bill failed by one vote in committee and faced opposition from many constituents, including a former board chairman of a crisis pregnancy center in Idaho who said subsidizing nonprofit entities with taxpayer dollars is not the proper role of government.

“Providing taxpayer funds on either side of this moral question is inappropriate,” said John Crowder in his testimony to the legislative committee, prefacing his comments by saying he is a Christian who believes life begins at conception. “Such decisions to lend financial support should be left to churches and individuals, not the government.”

Based on his knowledge of the finances of that center, Crowder said, it was clear they could meet the goals of their mission with the donations they received and “without government handouts.” 

Stateline reporter Amanda Watford contributed to this report. 

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund.

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

METHODOLOGY: To identify government grant funding received by nonprofit crisis pregnancy centers (CPCs), a team of States Newsroom reporters used multiple data sources. Reporters reviewed state and federal budgets and legislation to identify public funding allocated to CPCs between 2019 and 2025, with a particular focus on the period following the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, as well as in prior years, as applicable. The team did not include federal funding from sources such as Temporary Assistance for Needy Families in the nationwide analysis, and state tax credit programs were also excluded.

Data reporter Amanda Watford cleaned and analyzed a publicly available dataset of CPCs originally collected by the nonprofit advocacy group Reproductive Health and Freedom Watch. Organizations that appeared to be permanently closed or did not report enough revenue to file a full IRS Form 990 were removed from the States Newsroom analysis. Watford extracted filings from ProPublica’s Nonprofit Explorer for about 2,000 organizations, covering 2019 to 2025. Government grant totals were only available for 217 organizations for 2023 and 2024 due to data infrastructure limitations. A separate analysis using the GivingTuesday 990 database captured basic financial and government grant data for 1,243 organizations between 2019 and 2023. Watford combined the 2019-2023 GivingTuesday data and 2023-2024 ProPublica data. The total amount of government funding provided to CPCs was calculated for each year, yielding a grand total of nearly $1.3 billion across 1,259 CPCs between 2019 and 2024.

This analysis is not comprehensive. Some IRS Form 990 filings were unavailable digitally, and some organizations did not report any government grant funding, so grant funding reported outside the available electronic filings was not fully captured. Financial information available through IRS Form 990 filings is self-reported by organizations to the IRS and is not independently audited. Additionally, there is a lag between when organizations are expected to file returns and when filings are publicly available. Due to these factors, the States Newsroom  findings likely undercount the total amount of public, government funding directed to CPCs. An estimated 2,633 CPCs were operating in the United States in 2024, according to research from the University of Georgia.

For nearly 60 years, crisis pregnancy centers have been a pillar of the anti-abortion movement.

Largely staffed by volunteers or part-time workers, these centers — sometimes referred to as pregnancy resource centers — offer limited services related to pregnancy and are guided by a religious mission to stop people from considering abortion.

States Newsroom conducted a 50-state investigation examining state and federal funding for these centers. Between 2022, when the U.S. Supreme Court overturned federal protections for abortion rights, and the end of fiscal year 2025, 21 states have funneled nearly a half-billion dollars to crisis pregnancy centers. Physicians and researchers told reporters they’re concerned about the magnitude of public money crisis pregnancy centers are receiving while Planned Parenthood clinics and other community clinics offering reproductive health care are defunded.

Read our investigation: Taxpayer dollars flood pregnancy centers. Oversight hasn’t followed.

As part of an ongoing series to shed light on the issue, States Newsroom spoke with dozens of doctors, patients and people who found themselves in crisis pregnancy centers. These are some of their stories.

Alabama

When Valkyrie Brodt, 30, became pregnant for the first time last year, she did an online search to find a clinic that would take someone without insurance. She and her husband were waiting to be approved for health insurance, and she was hoping to find a provider who would confirm her pregnancy and check that it looked healthy so far. In her search results, she found what she thought was a pregnancy-focused medical clinic a couple of blocks from the hospital in her hometown of Huntsville, Alabama. She booked an appointment. 

The couple arrived and began to fill out the clinic’s paperwork, but Brodt said something felt off.

“A lot of the questions were less about medical history and more so faith-based questions, and other questions like, ‘What’s your relationship with the baby’s father?’ ‘What’s your plan for this pregnancy?’ I think it did specifically ask what your religion was.

“At that point I realized, OK, this is clearly a Christian-run kind of place. I grew up Church of Christ, and I have a lot of religious trauma from the way that I grew up. I would not consider myself religious at this point. I’m very open-minded towards people who are religious, no bias other than just not wanting it shoved on me.

“I was also under the impression they were going to do the blood test analysis to confirm pregnancy, but it was just another urine sample. And I was like, well, I’ve already done four of these, and they were all positive.

“Then when they called us back, she (the clinic staffer) literally used the words ‘divide and conquer.’’’

Brodt was taken to one room, while a male counselor took her husband to another room. She said she understands why staff might want to separate them, in case of concerns about possible domestic violence or coercion. But Brodt said she was never asked about the couple’s relationship or whether she felt safe. The counselor confirmed that Brodt wanted to keep the baby, asked more faith-related questions, and told her that if she attended counseling sessions she could earn “baby bucks” to redeem on baby items from their store.

“At one point, towards the end, she (the counselor) said, ‘Well, if you know anybody who’s thinking about getting an abortion, send them our way.’ So it was very clear at that point that that was their goal. They gave us probably three or four different pamphlets, and only one of them was a piece of paper with the pregnancy confirmation on it. The rest was ministry stuff, like faith-based parenting classes.”

The clinic scheduled an ultrasound for her, but she and her husband decided not to go back.

“It felt very predatory to me as a 30-year-old woman that’s married. So I can’t imagine how it would feel to a teen mom or a single mom having to walk in there by herself.” 

Read more: Federal funding for people in poverty heading to anti-abortion centers instead

Idaho

Dr. Cate Heil knew people in her hometown who worked at crisis pregnancy centers, and she didn’t have much of an opinion about the centers, other than they seemed like good places for pregnancy counseling. 

That perspective changed.

During her training to become a family medicine physician in Idaho in 2020, she saw a 17-year-old patient who had gone to a pregnancy center, where she received a transabdominal ultrasound. The center told the patient there was “a lot of fluid.” 

“Based on her period, she would’ve been about eight weeks and three days. It didn’t seem like they told her much else. 

“We did a transvaginal ultrasound and saw some concerning things. This patient had a molar pregnancy, which shows up pretty characteristically on ultrasound and is considered a pre-malignancy. Her uterus at supposedly eight weeks was 1 centimeter above her pubic bone, which is much larger than would be expected. She underwent surgery the next week.

“It was concerning to me that this wasn’t recognized as something that’s abnormal. This is not quite an emergency, but it’s something that needs to be managed within a week or so, or needs immediate referral for a surgeon — and that made me nervous.

“Is there other stuff that we’re missing? This is a fairly rare thing, but it’s not unheard of, and it should be able to be recognized by people who are operating an ultrasound, in my opinion. … It made me want to double-check things when someone has gone to a crisis pregnancy center.”

Oregon

Emily Gartman wanted to keep her baby. Unexpectedly pregnant at 21, a friend recommended a pregnancy center, saying nice people would quickly confirm the pregnancy without an appointment. She took a test there, but before the results came back, Gartman said the staff asked her what she would do if she were pregnant. 

They showed her pictures of how an embryo develops into a fetus and told her that it would respond to painful stimuli at 13 weeks, an idea that is not supported by science. Multiple studies have shown that a fetus does not have the capacity to experience pain until at least 24 weeks’ gestation.

“They just kept driving home that if I got an abortion, my baby would be in pain. That it would feel itself being chopped up.

“I was 11 weeks pregnant, and they were clearly trying to make me feel like a piece of s— if I did get an abortion because I was hurting the baby. I wasn’t sure what I wanted to do, but they basically told me if I waited any longer, I wouldn’t have a choice.

“There’s a very high chance that I would’ve kept it. The person I was pregnant by had Marfan syndrome, and the thing I wanted to wait for was an amniocentesis.”

Severe forms of Marfan syndrome, a connective tissue disorder, can cause fatal heart problems. Gartman had wanted more information about her options. An amniocentesis is typically performed between 15 and 20 weeks of pregnancy.

“I ended up having that abortion three days later. I felt like if I didn’t do it right away, I was going to have no choice, and that they’d be right, that I would be a monster.”

Despite many years passing, Gartman, 45, of Portland, said the trauma she endured is one of the main reasons she never had any children. The shame stuck with her, she said, and she thought she had no right to try to have another baby after having an abortion.

“Seeing public money going to these places pisses me off a lot. That’s my money. I don’t want my money being used to do this to someone else.

“My experience with them has been to just tell everybody I know who’s going to go to them to just not do it. I would never set foot in one of those places again.”

North Carolina

After Carley Causey discovered she was pregnant last year, she wanted to know how far along she was. 

So she searched online for a place to “get an ultrasound to try and date how pregnant” she was. 

Causey, 36, said she had originally called an OB-GYN’s office, but she was told that she couldn’t get an appointment for at least seven weeks. 

“Well, most doctors’ offices won’t see you until you’re, like, 12 weeks pregnant. I did call, and they were like, like, not very helpful, because they were like, ‘You’re not far enough along,’” Causey said. 

So she ended up calling a crisis pregnancy center. 

“And this place is totally free. If you wanted to go to the ER and get an ultrasound, that’s like hundreds of dollars. And this is a community resource that charges you nothing, right?” 

Causey said center volunteers told her that it may be too early to do an ultrasound and that she could potentially have an ectopic pregnancy for which she would have to go to the emergency room. But she wanted a transvaginal ultrasound, and she found out that she was almost two months pregnant. 

Causey said her mom used to volunteer at “pregnancy support centers,” and she felt more comfortable going there. And as a Christian woman and family ministries director at a church in Durham, North Carolina, she said she felt awkward going to a place like Planned Parenthood, which she associated with abortion, although it offers a range of medical services. 

“I know that they (pregnancy centers) totally have this reputation of trying to scare women into not having abortions, but that’s just not been my experience with the people who work there,” Causey said. “And I want to give space for that, because I don’t know all these Christian pregnancy centers, but the truth is like, yeah, they do value life, but they also want to provide resources that make it seem possible.” 

Florida

Taylor Biro was sleeping under bridges all over Tallahassee when she found out she was pregnant in 2006. She called a local pregnancy center, telling them she was homeless and seeking an abortion. 

“I was 19 … I was pregnant, and I had no business having a child — I had a lot of difficult things going on around me at the time.

“I remember being very clear. I talked to them on the phone. I told them what I wanted to do. They said, ‘Great, come on in.’

“I went in, and they counseled me — and it ended up not being an actual place that helps, or had any means to help, with abortions. They were more like a faith-based group and wasted a lot of my time. I ended up passing the window when I was able to get an abortion.’’

It was “degrading” when she’d have to attend their classes to earn “mommy bucks” before she could have a few diapers — not even a full pack, she said. 

“Less than a week after I gave birth, I was working at a sandwich shop. I remember standing there taking someone’s lunch order, hoping the pad in my underwear was thick enough to last till my break. For the first five years of my son’s life, I worked four jobs and made less than $11,000 a year. I was exhausted and trying to hold on to some version of myself before all this.”

Being pregnant and giving birth as a homeless teen, Biro experienced violence.

“It forces you to play into relationships that you probably never would have had to endure. You don’t have all the safety nets. It opened me up to domestic violence; it opened me up to sexual violence.”

Biro went on to start her own drop-in center for runaway and homeless youth. She and her team raised money for teens who needed abortions and provided Plan B for those over age 18. 

After her experience with the crisis pregnancy center, she made diapers much more accessible for the new parents who came to the drop-in center, telling them: “You want to take five packs of diapers? Take six.”

She also worked with officers investigating sexual violence and human trafficking of youth, and helped write legislation requiring special training for law enforcement interviewing victims of sexual assault. Biro works with the National LGBTQ Task Force, and also founded Bread and Roses Collective, a team of grant writers for social justice organizations. Her child is now 18.

“It took me years to understand that the shame was never mine to carry. A Christian organization manipulated a homeless teenager into having a child when it was not safe, but (I) should be embarrassed? I know now that my struggle and trauma was not some penance for being young and irresponsible. But that experience, being tricked out of health care, was my origin story.

“It’s strange that even now, I feel compelled to preface it all by saying how much I love my son. As if naming my trauma or the loss of my autonomy could mean I love him less. That guilt buries stories like mine. We hear more about how a child ‘saved’ someone, when the truth is my life had meaning on its own.”

States Newsroom’s investigation is ongoing. If you have had an experience with a crisis pregnancy center, please get in touch at cpcproject@statesnewsroom.com.

In Johnson County, Iowa, the number of tuberculosis cases has increased in recent years — and so has the cost of containing it.

The cost of contact tracing and surveillance, traveling each day to patients’ homes to ensure they take their meds or booking hotel rooms to quarantine patients, has surged from $17,000 in 2020 to $65,000 last year.

That doesn’t include $13,000 spent last year for language translation, as many of the cases were among the local immigrant communities, said Danielle Pettit-Majewski, director of the Johnson County public health department. She said the rise in spending is directly tied to the increase in diagnoses since 2020, with latent infections tripling, from 27 that year to 90 last year.

Last week, the state informed the county that the greater number of cases had made it too costly to help pay for the home visits, forcing the county to pay for them on its own.

“I was kind of dumbfounded,” Pettit-Majewski said. “It was surprising.”

Tuberculosis cases have been rising nationwide since 2021, and in 2024 — the most recent year for which data is available — they reached the highest level since 2011. Thirty-four states and the District of Columbia reported increases in TB case counts and rates from 2023 to 2024, according to the federal Centers for Disease Control and Prevention.

In 2024, there were 10,347 reported cases nationwide, up 8% from the 9,622 cases reported the year before.

The case numbers for 2025 won’t be released until the end of March. But the Trump administration’s immigration crackdown last year might have dissuaded some people from seeking care, perhaps leading to fewer recorded diagnoses, some TB experts say.

Some states, however, are reporting preliminary data to the National Tuberculosis Coalition of America that shows that the number of cases grew from 2024 and 2025 by between 10% and 20%, said Donna Hope Wegener, the coalition’s executive director.

“There are a number of [tuberculosis] program managers that are reporting double-digit increases,” Wegener said, adding that the cost of antibiotics to treat TB is rising. “These back-to-back increases that states are contending with are certainly alarming.”

In San Antonio, Texas, case numbers have been steady, but the local public health department is still struggling to cover treatment costs.

Tommy Camden, health program manager at the City of San Antonio’s tuberculosis clinic, said the city has proposed eliminating a full-time specialist position that assists with TB contact tracing, blood draws and home visits.

Whatever the 2025 numbers show, many public health agencies are struggling to keep up, especially as they also contend with a growing measles outbreak that so far has affected 26 states.

Tuberculosis is a bacterial infection with both active and latent stages. A person with active tuberculosis disease, which can be deadly, can spread the disease. A person with a latent infection can’t, but they can develop the disease at any point.

Consistent, daily antibiotic treatment for four to nine months, with no skipped doses, is crucial to knocking it out. Skipping doses can allow the germs to mutate into drug-resistant TB, which is one reason health agencies spend so much to ensure patients take their medication.

In the U.S., the disease disproportionately affects people born in countries where it’s more common, as well as Hispanic, Black, Asian American, Pacific Islander and Indigenous communities, according to the CDC.

Immigrant communities tend to be disproportionately affected, in part because the disease can spread more easily in multigenerational households and other crowded home and work settings. Poverty, a lack of access to health care because of language, transportation and cultural barriers, and the stigma around the disease also can make those communities more vulnerable, Pettit-Majewski explained.

The California Department of Public Health says the cost of drugs to prevent a latent tuberculosis infection from turning into full-blown disease can be about $857 for what is usually three to four months of treatment. In contrast, diagnosing and treating one infected person who develops active tuberculosis disease can cost about $43,900.

While there is a vaccine for tuberculosis, it isn’t recommended for use in the U.S. because it can cause false positives in TB tests taken by skin sample. The vaccine also isn’t consistently effective against adult pulmonary tuberculosis.

Research has been underway for developing a new vaccine. But the Trump administration’s antipathy toward vaccines of all kinds is dampening investment in new products.

Immigration crackdown

Before the COVID-19 pandemic, tuberculosis was the world’s deadliest infectious disease, killing about 1.5 million people each year, according to the World Health Organization. It remains a leading infectious disease killer globally. Immigrants coming to the U.S. are screened for active TB and connected with treatment, and U.S. residents may be asked about travel abroad during routine checkups.

Many immigrants might be reluctant to seek care amid the Trump administration’s immigration crackdown, said Dr. Michael Lauzardo, a University of Florida associate professor at the division of infectious diseases and global medicine and director of the Florida TB Physicians Network.

“I think the numbers will be lower because people are afraid,” Lauzardo said of the soon-to-be-released 2025 data. “A lot of the people at risk for TB are not seeking care, I suspect.”

Munira Maalimisaq, a family nurse practitioner in Minneapolis, said such fear has been rampant across immigrant communities in her area. After President Donald Trump was elected, a health care center where she worked had to drop a routine question on patient intake forms that asked where a patient is from, because people were scared to answer it. The question was meant to assess exposure to TB in countries where it’s more common.

“That was a big barrier, because people would just not answer that question, or would not even want to engage and say ‘yes’ or ‘no,’” said Maalimisaq, CEO of a nonprofit health care center in Minneapolis, Inspire Change Clinic.

She said such fear could cause more active cases later on, as people with latent TB may not get diagnosed or get care — increasing the risk that they’ll develop the disease and become contagious.

“The whole thing delays seeking care,” she said. “If I don’t get screened for it, there’s no way that my provider is going to diagnose me.”

In Iowa, Pettit-Majewski said she hopes that Johnson County residents won’t be scared to seek care.

“If you are a Johnson County resident, you are our neighbor, and it is our responsibility to keep you safe and healthy — and we take that very seriously,” said Pettit-Majewski. “We want to make sure that folks are able to get the best care, regardless of immigration status, regardless of where you came from.”

People in detention or correctional facilities also are disproportionately at risk of infection. In recent weeks, two tuberculosis cases cropped up at a U.S. Immigration and Customs Enforcement facility in El Paso, Texas. Last year, California, Alaska and Arizona also saw cases at ICE detention facilities.

ICE didn’t respond to Stateline’s questions about the recent two cases at the El Paso facility. On a recent visit to the detention center, Democratic U.S. Rep. Veronica Escobar, who represents El Paso, said she saw agents go into a community pod, which can hold between 30 to 70 detainees, without protective attire.

“I was about to walk into a pod with the ICE agents, and the security guard said, ‘No, no, ma’am, you don’t want to walk in there. They’ve not been tested for TB yet,’” Escobar told Stateline.

“But I did see contractor staff coming in and out of the pod, and so I asked, ‘Why are they not wearing [personal protective equipment]? Why aren’t they wearing a mask?’ And my concerns were pretty much dismissed, and I was told it’s their choice and they don’t have to if they don’t want to.”

Cuts to public health funding 

Earlier this month, the Trump administration told Congress it intends to rescind $600 million in public health funds to four Democratic-led states: California, Colorado, Illinois and Minnesota. Many of the grants targeted HIV, and some also targeted tuberculosis.

The four states have sued to stop the cuts, arguing that the administration is targeting them with “devastating funding cuts to basic public health infrastructure based on political animus and disagreements about unrelated topics such as federal immigration enforcement.”

A federal judge has temporarily halted the cuts, saying the administration’s statements suggest “hostility to what the federal government calls ‘sanctuary jurisdictions’ or ‘sanctuary cities.’” An agency action, U.S. District Judge Manish S. Shah said, can’t be honored “if it is arbitrary or capricious.”

One of the California grants affected is a grant to the Tuberculosis Elimination Alliance, a partnership of community-based organizations that conduct outreach and education about tuberculosis.

The group received notice Feb. 11 that its grants were ending — putting in jeopardy $100,000 the alliance distributes to groups serving high-risk communities across California, Illinois, Washington state, the District of Columbia and U.S. island territories.

One of the largest tuberculosis outbreaks in recent weeks occurred at a San Francisco Bay Area high school, where latent TB was detected in more than 200 students and staff.

“It’s just such a scary and confusing time for our communities,” said Chibo Shinagawa, associate director of infectious diseases at the Association of Asian Pacific Community Health Organizations, which leads the Tuberculosis Elimination Alliance.

“The instability, the uncertainty right now — it’s such a disruption to public health, to the trust we’ve built in our communities.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Roger Williams Medical Center in Providence, R.I. A new study shows that women with breast cancer living in Rhode Island and other states that expanded Medicaid eligibility were less likely to die from the disease. (Photo by Michael Salerno/Rhode Island Current)

Women with breast cancer living in states that expanded Medicaid eligibility were less likely to die from the disease — but not everyone benefited equally, according to a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan, and others looked at data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates among women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with the rates in states that did not expand. About 58% of the women lived in expansion states, and roughly 42% lived in nonexpansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower overall mortality — no matter the disease stage, race or ethnicity, or neighborhood income of the women. Women in expansion states whose cancer had spread to other organs — the most advanced stage of disease — saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women — they were 19% less likely to die if they lived in an expansion state. There were smaller gains among non-Hispanic Black women and residents of low-income areas. The smallest difference was among white women.

Hispanic women’s large gains could be due to many previously lacking insurance, said Dr. Oluwasegun Akinyemi, senior research fellow at the Howard University College of Medicine’s Clive O. Callender Outcomes Research Center and a coauthor of the study.

Black women have higher breast cancer death rates compared to white women, even though there are fewer cases among them, partly because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefitted less from Medicaid expansion than other groups because they are disproportionately located in the South, where most states have not expanded, Akinyemi noted. The expansion holdout states include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three nonexpansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women living in the highest-income neighborhoods, as well as those who received immunotherapy treatment, had lower mortality rates. Akinyemi said that result suggests that coverage leads to greater access to treatment.

In July, President Donald Trump signed a broad tax and spending bill  that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people may lose Medicaid coverage, according to estimates by the Center on Budget and Policy Priorities.

Editor’s Note: Because of inaccurate information provided to Stateline, an earlier version of this story misstated the position of Dr. Oluwasegun Akinyemi. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Robert F. Kennedy Jr. promotes "real food" at a rally in Harrisburg, Penn., last month. Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study says. (Photo by Whitney Downard/Pennsylvania Capital-Star)

Over the next decade, obesity rates across the nation could surge to close to half of U.S. adults, a new study published in the medical journal JAMA estimates.

Researchers at the University of Washington conducted the analysis using body mass index data from the National Health and Nutrition Examination Survey and self-reported weight data from a national survey of adults ages 20 and older. They examined the 2022 rates and created estimates for 2035 based on current trends. The researchers also looked at race, ethnicity and state-level data, finding wide disparities across states and racial groups.

About a fifth of U.S. adults were living with obesity in 1990. By 2022, the percentage increased to nearly 43%. Obesity was more prevalent in states in the Midwest and South.

If current trends continue, about 47% of U.S. adults will be living with obesity by 2035, according to the researchers. Obesity rates are projected to increase among Americans of all ages and racial groups.

In 2022, non-Hispanic Black women had the highest age-standardized obesity rate, at about 57%, followed by Hispanic women at 49%. Hispanic males, non-Hispanic white males and females, and non-Hispanic Black males had similar rates, ranging from about 40% to nearly 43%.

The study comes amid exploding demand for weight-loss drugs, and as U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. continues to push his Make America Healthy Again campaign.

HHS and the U.S. Department of Agriculture last month made changes to the federal food pyramid, placing a greater emphasis on animal protein, dairy and fats. Like the previous guidelines, the new pyramid discourages the consumption of processed foods, which can cause weight gain.

Despite disparities between men and women and between racial groups, HHS says its nutrition strategy moves away from the “health equity” focus of the Biden administration, in favor of making “the health of all Americans the primary goal.”

For Hispanic people, obesity rates were generally higher in states in the Midwest and the South in 2022, a pattern that is expected to continue through 2035.

In 2022, the obesity rate for Hispanic women was highest in Oklahoma, at about 54%. For Hispanic men, the rate was highest in Indiana, at roughly 47%. In 2035, Indiana is projected to have the highest rate of obesity among Hispanic men at about 54%, while the highest rate for Hispanic women, nearly 60%, is expected to be in South Dakota.

The Midwest and South also had high rates of obesity for non-Hispanic white men and women. In 2022, West Virginia had the highest obesity rates for white men and women — about 47% and 49%, respectively. In 2022, obesity rates for white men and women were lowest in the District of Columbia, at roughly 24% for men and 26% for women.

Among Black women, obesity rates were over 50% for all states, except Hawaii, in 2022. That pattern is expected to continue through 2035. Black men have lower obesity rates than Black women across all states. In 2022, the highest obesity rate for Black men was in Oklahoma, at about 44%. That rate projected to rise to 49% in 2035.

“While no locations were predicted to have decreases in obesity prevalence between 2022 and 2035, there were many with small increases over this time,” the authors wrote. They pointed to Mississippi, where Black women had the highest obesity rates between 1990 and 2022, but are projected to see one of the smallest changes — an increase of about 1.8% — by 2035.

“Predictions in states with historically high levels of obesity, such as Mississippi, suggest that the prevalence of obesity may be plateauing in some locations,” the researchers wrote.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.