The Trump Administration yanked more than $65 million in Title X funding from clinics nationwide in April, and some of that funding is still frozen, leaving clinics struggling to offer free or low-cost contraception and other family planning services. Some states are suing to get the funding back, but Idaho officials chose to forego it due to a conflict with state law. (Getty Images)

The Idaho Department of Health and Welfare quietly declined the entirety of its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services from a key family planning program. 

Though thousands of Idahoans relied on the health care provided through Title X for over 50 years, the state made no public announcements as the decision took effect in April, leading to the closure of 28 out of 43 — about 65% — Title X-funded family planning clinics in public health districts throughout the state, according to the Idaho Department of Health and Welfare. 

After turning down the Title X money entirely, Health and Welfare said there are no plans for the state to make up the difference by increasing the family planning budget. 

In one district, Eastern Idaho Public Health, spokesperson Brenna Christofferson said contraception services are no longer available at all, which has only been communicated to existing Title X patients. Sexually transmitted infection testing and treatment, and breast and cervical cancer screenings are still provided using different funding sources.

Many of the clinics closed in eastern Idaho, including more populated cities such as Twin Falls and Idaho Falls, and more rural areas such as Salmon, Rexburg and Rigby. Title X services also ended at clinics like Terry Reilly Health Services in one of southwestern Idaho’s most populous areas of Nampa and Caldwell. 

The decision to forego the funds came at the same time the Trump administration yanked more than $65 million in Title X funding from Planned Parenthood clinics and some independent reproductive health clinics across the country, much of which is still frozen, including for Idaho’s last remaining Planned Parenthood in Meridian. Spokesperson Nicole Erwin said Planned Parenthood continues to fundraise to help offset costs and keep family planning services affordable on a sliding scale.

Although Idaho’s move came at the same time national attention was focused on the frozen funds, it was a separate decision, according to Health and Welfare.

“The discontinuation of Title X funding … was not related to the federal administration’s Title X policy changes earlier this year,” said AJ McWhorter, spokesperson for the Health and Welfare Department. “The department made the decision to decline the funding to remain compliant with current Idaho laws concerning parental rights and counseling on pregnancy options.”

Nationally, seven out of 16 grantees have had their funding restored, while others have been waiting nearly seven months for resolution, said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association.

“For Idaho to walk away from the money doesn’t just disadvantage and imperil young people, it imperils all the people in the state,” she said. “It hurts women, it hurts men, and it hurts young people.”

Coleman’s organization sued the U.S. Department of Health and Human Services over the frozen funds, and the case is still pending. A coalition of 20 Democratic-led states sued federal government agencies in July to halt its actions related to several social safety net programs, including Title X. That case is paused while the government is shut down.

In 2023, U.S. Health and Human Services reported Title X provided care to nearly 3 million people nationwide, a 7% increase from the prior year. Under the program guidelines, people with family income levels at or below 100% of the federal poverty level can receive services free of charge, while those making up to 250% of the federal poverty level pay a discounted rate on a sliding scale.  

The program, established by Congress and signed by former Republican President Richard Nixon in 1970, is intended to prioritize low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. Abortion services cannot be covered by Title X dollars.

Pregnancy options and parental consent 

The federal statute guiding the administration of Title X funds includes a section on adolescent services that says grantees cannot require the consent of parents or guardians before or after the minor has requested or received family planning services. Another section directs grantees to allow pregnant patients the opportunity to receive information and counseling regarding prenatal care and delivery, infant care, foster care, adoption and pregnancy termination. Idaho has a near-total abortion ban with few exceptions.

Idaho’s Legislature passed Senate Bill 1329 in 2024, requiring parental consent for “the furnishing of health care services” to a child, with the exception of lifesaving care. Idaho Capital Sun reported the law has also created difficulties for the state’s suicide hotline, because some minors need permission from a parent to receive certain services.

Coleman said the adolescent and pregnancy options requirements have long been part of Title X guidance, and it has not conflicted with state law because federal law should take precedence under the U.S. Constitution.

Idaho is one of at least two states that currently has no Title X funding, Coleman said, after Utah lost all of its Title X money when the Trump administration withheld funding from Planned Parenthood clinics, which were the only places offering those low-cost or free services. Planned Parenthood of Utah closed two of its centers — in Logan and St. George — in the wake of the decision to freeze funding. Logan is less than an hour away from eastern Idaho’s border.

Some states were temporarily left without Title X providers after the Trump administration’s actions in April, but the funding was restored at later dates for certain states, including Missouri and Mississippi. The federal health agency also restored funds in May for two states with abortion bans, Tennessee and Oklahoma, whose grants were revoked under Democratic President Joe Biden’s administration because of their refusal to include abortion among the options during pregnancy counseling. 

In a letter from HHS to Tennessee state officials providing notice of the award, the acting chief grants management officer wrote, “Tennessee is one of only two states to have lost funding for failure to comply with the Title X 2021 regulations requiring counseling and referral for abortion. The department is declining to enforce this provision against the state, and you may rely on this letter to that effect.” 

A total of 7,528 Title X clients were served across Idaho in 2024, McWhorter said. The 15 remaining family planning clinics are supported by other funds, and additional service sites may be added as funding becomes available. Those clinics are in two out of the state’s seven public health districts, which served about 1,400 people combined in 2024. 

The closures add another challenge in an already difficult landscape for sexual and reproductive health care in Idaho. A recent study found that 94 of 268 practicing OB-GYNs left Idaho between August 2022 and December 2024, and care is becoming harder to obtain, according to residents, who say wait times are longer and certain treatment is unavailable locally. 

Coleman said under Biden’s administration, when an entity lost Title X dollars for noncompliance or other reasons, there was an effort to reallocate the funding to another willing participant. Without that action, it would revert back to the U.S. Treasury, and the next opportunity for another Idaho entity to apply for Title X funding will be late 2026. 

Preventing unplanned pregnancies 

Amy Klingler, a clinician in rural eastern Idaho, told States Newsroom she was devastated by the closure of Eastern Idaho Public Health’s family planning clinic. She worked there in addition to another clinical job since 2006 and said there aren’t many other options for family planning care in that area of the state.

“Idahoans don’t trust doctors, but they trust their doctor,” Klingler said. “So when we see rural health care being eroded and doctors leaving Idaho or not coming to Idaho, I think that is really going to impact the health of people in our communities.”

The additional cuts to Planned Parenthood through Medicaid, along with overall Medicaid cuts that may force the closure of more rural hospitals and clinics, will force people to delay care until they are sicker and require more expensive medical care, Klingler said.

The minor consent for treatment bill had good intentions, she said, and in an ideal world, every child would feel comfortable talking to their family members about birth control. But she said she is confident there are young women who don’t get birth control because they don’t want to have that conversation with their parents. 

And with Idaho’s abortion ban, unplanned pregnancies either have to be carried to term or the person must go to another state where abortion is legal. It’s also a felony in Idaho for someone to take a minor to another state for an abortion without parental permission.

“Providing free birth control is really powerful if you’re trying to prevent unplanned pregnancies,” Klingler said.

On her last day at the family planning clinic in June, Klingler said the staffers cried together.

“We often ended the day by saying, ‘We did some really good work today,’” she said. “And to not be able to do that good work kind of hurts the heart.”

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Planned Parenthood of Wisconsin resumed scheduling abortions on Monday after a nearly monthlong pause due to federal Medicaid funding cuts in President Donald Trump’s tax and spending bill that took effect at the beginning of October.

Planned Parenthood of Wisconsin said it was able to resume scheduling abortions as of noon on Monday because it no longer fits the definition of a “prohibited entity” under the new federal law that took effect this month and can receive Medicaid funds.

The organization said it dropped its designation as an “essential community provider” as defined under the Affordable Care Act. Dropping the designation will not result in changes to the cost for abortions or other services or affect the organization’s funding, Planned Parenthood of Wisconsin President and CEO Tanya Atkinson said.

“At this point, in all of our research and analysis, we really shouldn’t see much of an impact on patient access,” she said. “If relinquishing this does ultimately impact our bottom line, then we will have to understand what that path forward is.”

A national fight over abortion funding

Abortion funding has been under attack across the U.S., particularly for affiliates of Planned Parenthood, the biggest provider. The abortion landscape has shifted frequently since the U.S. Supreme Court ruling in 2022 that allowed states to ban abortion. Currently, 12 states do not allow it at any stage of pregnancy, with limited exceptions, and four more ban it after about six weeks’ gestation.

Planned Parenthood has warned that about half its clinics that provide abortion could be closed nationwide due to the ban in the new federal law on Medicaid funding for Planned Parenthood for services other than abortion.

Wisconsin, where abortion is legal but the Republican-controlled Legislature has passed numerous laws limiting access, was the only state where Planned Parenthood paused all abortions because of the new federal law, Atkinson said.

Because of the complexities and varieties of state abortion laws, Planned Parenthood affiliates are responding to the new federal law in a variety of ways, Atkinson said. In Arizona, for example, Planned Parenthood stopped accepting Medicaid but continued to provide abortions.

The move in Wisconsin is “clearly aimed at sidestepping” the federal law, Wisconsin Right to Life said.

“Planned Parenthood’s abortion-first business model underscores why taxpayer funding should never support organizations that make abortion a priority,” said Heather Weininger, executive director of Wisconsin Right to Life. “Women in difficult circumstances deserve compassionate, life-affirming care — the kind of support the pro-life movement is committed to offering.”

Impact on Wisconsin abortion clinics

In Wisconsin, pausing abortions for the past 26 days meant that women who would normally go to clinics in the southeastern corner of the state instead had to look for other options, including traveling to Chicago, which is within a three-hour drive of the Planned Parenthood facilities.

Affiliated Medical Services and Care for All also provide abortions at clinics in Milwaukee.

Atkinson said it was “really, really difficult to say” how many women were affected by the pause in services. She did not have numbers on how many women who wanted to have an abortion since the pause went into effect had to seek services elsewhere.

Planned Parenthood of Wisconsin serves about 50,000 people, and about 60% of them are covered by Medicaid, the organization said.

Given those numbers, the priority was on finding a way to continue receiving Medicaid funding and dropping the “essential community provider” status, Atkinson said.

Wisconsin is part of a multistate federal lawsuit challenging the provision in the law. A federal appeals court in September said the government could halt the payments while a court challenge to the provision moves ahead.

Ramifications for Medicaid

Planned Parenthood of Wisconsin cited a Sept. 29 court filing on behalf of U.S. Health and Human Services that said family planning organizations could continue billing Medicaid if they gave up either their tax-exempt status or the “essential community provider” designation.

By giving up that designation, it no longer fits the definition of “prohibited entity” under the federal law and can continue to receive federal Medicaid funds, the organization said. Planned Parenthood of Wisconsin is not giving up its tax-exempt status.

The “essential community provider” designation was originally given to organizations to help make it easier for them to be considered in-network for billing with private health insurers, Planned Parenthood said.

Atkinson called it a “nuanced provision” of the law and she does not anticipate that giving it up will affect Planned Parenthood’s ability to continue providing abortions and other services.

Planned Parenthood provides a wide range of services including cancer screenings and sexually transmitted infection testing and treatment. Federal Medicaid money was already not paying for abortion, but affiliates relied on Medicaid to stay afloat. Services other than abortion are expected to expand in light of the new law.

Planned Parenthood performed 3,727 abortions in Wisconsin between Oct. 1, 2023, and Sept. 30, 2024, the group said.

Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletters to get our investigative stories and Friday news roundup. This story is published in partnership with The Associated Press.

Planned Parenthood of Wisconsin resumes offering abortions after a nearly monthlong pause is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Advocates gather outside the Hippodrome Theater in Richmond, Virginia, this summer to protest Medicaid cuts. Medicaid covers nearly two-thirds of Black babies’ births in the U.S., federal data shows, and congressional cuts to the program are already limiting reproductive health care in Black and low-income communities. (Photo by Bert Shepherd/Courtesy of Protect Our Care PAC)

At least 90% of Black people surveyed for a new poll said Medicaid is important to them or their families, and more than half either have public insurance or a family member who relies on the program. 

“Medicaid is critical for so many things with regards to making sure that we’re healthy and addressing health disparities. By losing it or weakening it, it is just going to disproportionately harm our communities,” said Regina Davis Moss, the president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda. 

Davis Moss’ organization commissioned the 10-state poll, which includes views from California, Florida, Georgia, Michigan, North Carolina, New Jersey, Nevada, Ohio, Pennsylvania and Virginia. Nonpartisan research firm PerryUndem conducted the survey between May and June and interviewed 500 Black adults in each state. 

The findings, shared exclusively with States Newsroom, show a significant number of Black people who want children are not yet planning to have them due to cost and health care concerns. 

Results were released just as several Planned Parenthood clinics that served Black patients with low incomes closed after a law took effect blocking certain reproductive health clinics affiliated with abortion providers from receiving Medicaid reimbursements until July 2026.

Louisiana’s Planned Parenthood clinics, which never offered abortions in their decades of service, closed on Sept. 30. Sixty percent of the Baton Rouge and New Orleans patients were Black and most have Medicaid insurance, States Newsroom reported. One of two Planned Parenthood locations in Memphis, where more than 60% of the population is Black, temporarily closed its doors during the first week of October due to Medicaid cuts, Tennessee Lookout reported. 

“Proximity is important, and the fact that these clinics have to close means that individuals needing their services will go without,” said Danielle Atkinson, executive director of Mothering Justice, a national advocacy group based in Michigan. 

Four Planned Parenthood clinics closed in her state this spring after the Trump administration cut millions of Title X family-planning funding, Michigan Advance reported.  

“They’ll go without STI testing. They’ll go without cancer screening. They’ll go without counseling,” Atkinson said. 

The ban on Medicaid for some reproductive health providers was part of a larger reconciliation package that is also set to slash nearly $1 trillion from Medicaid more broadly over the next decade. 

“Medicaid is a lifeline for Black women, girls and gender-expansive people,” Davis Moss said. The state and federal program covers nearly two-thirds of Black births, according to the U.S. Centers for Disease Control and Prevention, and almost half of all births nationwide. 

Maternal health advocates are bracing for the impact of Medicaid cuts on labor and delivery units, which have already been closing at a rapid pace over the last 10 years, especially in rural communities. A maternity ward in northeast Georgia, one of the states included in the poll, will close at the end of the month partially due to Medicaid cuts, Georgia Recorder reported in September. 

Findings from the In Our Own Voice poll also show that Black people of reproductive age — 18 to 44 in this case — want children but are not planning to have them, citing high costs of living. 

California had the biggest disparity of 28 percentage points: 56% want children but only 28% plan to have them. 

“I believe some of the reasons they said are not new issues that we are grappling with, but it’s deeply concerning because they are being exacerbated in this current administration,” Davis Moss said. 

At least 69% of Black people polled in each of the 10 states said they worry about being able to take care of children or more children than they already have, while at least 67% cited housing costs and 57% pointed to child care expenses. 

“In a lot of these states, the cost of child care is more expensive than a year of tuition, which is such a barrier for people to be able to: one, go into the workforce, two, have that early intervention and early education that really sets their children up for success, and three, give individuals and families the opportunity to go and explore careers and learning opportunities,” Atkinson said. 

Abortion restrictions played a factor in family planning, too, though in smaller numbers. At least 45% said they don’t want children because they or their loved one could die from pregnancy, while 43% worry about miscarriage care and 30% said abortion bans are stopping them from growing their families. 

Three of the states included in the poll — Florida, Georgia and North Carolina — have abortion bans stricter than 20 weeks. Voters in California, Michigan and Ohio approved reproductive rights amendments in recent years that secured the right to an abortion up to fetal viability, while Nevada and Virginia may have similar safeguards in place after the midterms. 

A majority of voters in each of the 10 states say abortion should be legal in all or most cases and at least 78% say Black women should make the decisions about pregnancy that’s best for them. 

Overall, at least half of Black adults polled are struggling with economic security. Black women of reproductive age were more likely to expect less safety and security throughout the rest of Republican President Donald Trump’s second term than Black men. 

“We’re getting ready to celebrate our 250 years, and all the things that we have fought for and all these things that we have gained in terms of civil rights and human rights, they are under threat like never before,” Davis Moss said. 

Hope Broussard, 20, sought care at a Planned Parenthood in Washington in 2023 when her IUD became lodged in her cervix and the clinics in her hometown of Sandpoint, Idaho, weren’t able to help. She now lives in Pullman, Washington. (Photo by Geoff Crimmins for States Newsroom)

Fifth in a five-part series. 

Hope Broussard’s intrauterine device should have brought relief from her severe periods. But at 17, it started causing debilitating pain.

At the Sandpoint, Idaho, clinic where the device was implanted, providers suspected it was embedded in her uterine wall, but lacked the ultrasound equipment to make a diagnosis.

Homeless with no insurance after her mother kicked her out, Broussard couldn’t enroll in Medicaid as a minor without a parent’s involvement. The women’s clinics in Sandpoint couldn’t help. Hospital bills were out of the question.

“The only people that were able to help me were Planned Parenthood,” Broussard said.

She sought care across the border in Washington, at the Spokane Planned Parenthood, where an ultrasound showed the IUD was coiled around her cervix. A specialist carefully removed it in a follow-up appointment and she paid $20 for everything because it was all she could afford.

“It really was my saving grace at the time,” said Broussard, who moved from Idaho to Pullman, Washington, in part because of that experience of being unable to access health care locally. “I have no idea what I would’ve done if I didn’t have that option available to me.”

Broussard is one of more than 2 million people nationwide who used Planned Parenthood for health care between 2023 and 2024, according to the national organization’s annual report. But how many people will be able to afford and access care is changing after a new federal provision prohibits some organizations that provide abortions from receiving Medicaid payments for at least a year. Nationally, Planned Parenthood estimates it could lose $700 million from Title X and Medicaid cuts, forcing affiliates to close some clinics, curtail services and stop accepting Medicaid patients.

Many Republican lawmakers and anti-abortion groups celebrated the provision passed by Congress in July that essentially targeted Planned Parenthood clinics nationwide for “defunding” because abortion care is part of clinical services in many states where access is mostly legal. Federal Medicaid dollars cannot be used to pay for abortions except in limited circumstances, and abortion care makes up a small percentage of overall care provided by clinics. Still, conservatives argue the mere association with any such clinics is equivalent to funding all abortion. 

“Planned Parenthood’s desperate ploy for our tax dollars only underscores why the One Big Beautiful Bill is such a historic win,” said Susan B. Anthony Pro-Life America President Marjorie Dannenfelser in a July statement. “It halted, for the first time, over half a billion taxpayer dollars from propping up the corrupt abortion industry.”

Democratic-led states are in troubleshooting mode 

In response, elected officials in some Democratic-led states, including Washington, Hawaii, Colorado and Massachusetts have publicly pledged to backfill the funding needed to allow Planned Parenthood clinics to keep accepting Medicaid and other low-income patients. In July, Washington Gov. Bob Ferguson committed to filling the $11 million gap Planned Parenthood expected to see.

Many states don’t begin their legislative sessions until January, so some of the plans aren’t official yet and still need to make it through the legislative process or the details of allocation are still in progress. That means clinics either have to absorb the costs for now with the promise of reimbursement, or change their payment options and services for the time being. For example Hawaii is moving to sliding-scale fees for some Medicaid patients, and in Maine, a major independent clinic is making changes to its services. 

Idaho’s border with Washington and Oregon is a point of contention among lawmakers across state lines, where the political views could hardly be more polarized between the hard-line conservatives in Idaho and progressive politics in the other two states. But for the people who need abortion care, or even a basic ultrasound, like Broussard, clinics in places like Spokane and Ontario, Oregon, are some of the last options available. 

Oregon lawmakers are also brainstorming ways that the state can provide reimbursement to Planned Parenthood for lost funding. Clinics across the state billed Medicaid nearly $17 million for services in 2024, according to the Oregon Capital Chronicle. 

Courtney Normand, the Washington state director for Planned Parenthood Alliance Advocates, said this latest move from Congress is adding to challenges from the first Trump administration when there were other cuts, along with health care system pressures from the COVID-19 pandemic, and the impact of increasing patient volumes after the U.S. Supreme Court’s Dobbs decision that upended federal abortion rights protections.

“It feels like the hits have just kept on coming in Washington, and that’s why access, affordability and stable funding is our key concern,” Normand said. 

Brita Lund, the health center manager at a Planned Parenthood in Seattle, worries about having to turn away patients if the federal Medicaid cuts and other strains on the health care system become too much to bear. She already feels like she spends too much time grilling a patient about their personal details at an appointment so the staff can find a way to get the treatment paid for by a specific pocket of funding. 

“Who is going to help these people if we’re not going to help them? I want someone to give me that answer,” Lund said. “It literally keeps me up at night.” 

While Washington state is known for being one of the most openly accessible for sexual and reproductive health, a budget crisis led legislators to cut 55% of the funding to the Abortion Access Project, about $8.5 million. Normand said it’s hard to know exactly why legislators made the decision, but some regretted it and are trying to find a solution for the upcoming session. Ferguson pledged to restore the funding as well. 

‘I know the state is supportive, it’s just about what their capacity is’

In Hawaii, Title X cuts from the Trump administration earlier this year amounted to about $2.1 million, said Jen Wilbur, Hawaii state director for Planned Parenthood Alliance Advocates. The state legislature acted quickly in April to approve a new $6 million family planning fund to offset that loss over the next two years, with $3 million specifically allocated to Planned Parenthood clinics. What the funding program will look like exactly is still to be determined, Wilbur said. The needs vary by island, and an assessment of what those needs are is underway.  

Hawaii has trended slightly more conservative than other blue states in recent elections, Wilbur said, but support from lawmakers still feels strong. She and other advocates are trying to game plan in the event that the federal government restricts access to mifepristone through the mail, which would severely affect access for the islands. 

But Wilbur worries about the long-term sustainability of the funding in a small state that already has many challenges with high cost of living, difficulty retaining providers and navigating the unknown. 

“We don’t even know how many more cuts are coming, so is any state really going to be able to sustain this going forward? I don’t know,” Wilbur said. “I know the state is supportive, it’s just about what their capacity is.” 

Short-term state fixes in Maine, Massachusetts 

New England, considered a hub for abortion access and low-cost reproductive health services, has been especially impacted by the federal Medicaid rule. It affects not only Planned Parenthood affiliates, but also two nonprofit health networks that offer wide-ranging health services primarily to Medicaid patients: Health Imperatives in Massachusetts and Maine Family Planning, which, like Planned Parenthood, has sued over the new policy. 

Maine’s legislature this summer appropriated about $6 million for family planning funding, to go to organizations like Planned Parenthood of Northern New England and Maine Family Planning, the largest reproductive health provider in the state with 18 clinics compared to Planned Parenthood’s four. But as Maine Morning Star reports, the temporary relief does not fully meet both organizations’ deficits, and Maine Family Planning this week announced it will end primary care services in Ellsworth, Houlton and Presque Isle at the end of October.

Still, both Maine Family Planning and Planned Parenthood of Northern New England say they will continue to see Medicaid patients free of charge for reproductive health and family planning services. 

Massachusetts Democratic Gov. Maura Healey also announced the state would deliver $2 million to Planned Parenthood League of Massachusetts, which is one of the co-plaintiffs in Planned Parenthood’s lawsuit against the federal government.

“We want the people of Massachusetts to know that if you need reproductive health care services, you should continue to seek this care,” Healey said in a news release. 

Massachusetts has been a leader in policy promoting access to reproductive health including abortions, which is legal in the state up to 24 weeks of pregnancy with exceptions for significant fetal abnormalities and the pregnant person’s health.  

But access to broad reproductive health care even in a city like Boston remains limited, especially for people living in poverty, said Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts.

Lee told States Newsroom that making a primary care or OB-GYN appointment in the Boston area can mean having to wait 60 days, while Planned Parenthoods typically have same-day appointments. She noted that the communities with the least access to low-cost reproductive health services are concentrated in central and western Massachusetts, where Planned Parenthood has three clinics.

Lee said she is grateful for the $2 million in state funding, which she calls “short-term relief.” Because Medicaid funding represented about a quarter of her organization’s revenue, Lee said it is like a business losing its biggest customer. Her goal now is to figure out how the affiliate can sustain long term. She said they are brainstorming other revenue streams like offering vasectomies.

“We have gotten really good at contingency planning,” Lee said. “But it would be great to have a business model that is sustainable, that can withstand all of these attacks, and not have to worry about it. That would be a dream.”

The affiliate’s website notes that patients can no longer use their MassHealth or Medicaid Managed plans for care at Planned Parenthood clinics but says they are still seeing “all patients.”

Health Imperatives, which operates seven clinics in southern Massachusetts, is also looking at operations.

Health Imperatives CEO Julia Kehoe said the $19 million nonprofit serves about 23,000 people annually and offers social and psychiatric services to vulnerable populations. About 40% of what Health Imperatives does is offer low-cost sexual and reproductive health services for about 10,000 patients annually, Kehoe said. For now, they are continuing to see the same amount of patients and are working with the state government for funding help. 

But she said the organization is also looking at private funding because they are determined to continue seeing Massachusetts’ poorest residents, many of whom experience food insecurity in places like Nantucket, which is one of the nation’s wealthiest towns but where the main safety net for those who are not wealthy is a single Health Imperatives clinic. 

“I would never, ever make the decision to not see Medicaid patients,” Kehoe said. “We exist to provide services to people who fall through the cracks of mainstream systems of care. So we’re going to prioritize people who are on Medicaid or people who don’t have insurance. What I would do is, rather than further health disparities and wealth disparities in one of the most expensive states in the country, I would have fewer clinics.”

Correction: This article has been corrected to reflect that elected officials in Maine have not yet pledged to support family planning clinics with backfilled funding. The state passed a bill last session that provided family planning funding that was already needed before the congressional bill cut Medicaid funding.

Jess Deis, a nurse practitioner and nurse midwife in Kentucky and Indiana, learned she had cervical cancer after she qualified for Medicaid insurance in 2014. (Sarah Ladd/Kentucky Lantern)

Third in a five-part series.

It had been a decade since Jess Deis’ last women’s wellness exam when Kentucky expanded Medicaid and she finally qualified for the state insurance program.

Physicians recommend a cervical cancer screening — also referred to as a Pap smear, which is a swab of the cervix — as part of a wellness exam once every three to five years for women between the ages of 21 and 65. Deis, 43, was in her last semester of nursing school in 2014 when the test came back with abnormal results. Her doctor ordered additional testing.

“Then I got a call on a Sunday evening from a physician letting me know I had cervical cancer and I needed to see a specialist,” Deis said.

Cervical cancer is one of few cancers that has a known path of prevention after the approval of the first HPV vaccine in 2006. But that also means it falls at the intersection of three cultural issues that are facing strong political opposition — broad access to low-cost or free reproductive health care, access to vaccines for children, and sex education.

Kentucky had the highest cervical cancer incidence rate in the country between 2015 and 2019, according to medical research, and a mortality rate twice as high as the rest of the country. The state tied with West Virginia for the second-highest rate of 9.7 cases per 100,000 residents between 2017 and 2021. Oklahoma topped the list for that five-year period with 10.2 cases per 100,000, according to the National Cancer Institute.

Deis delayed the surgery to remove her uterus until after graduation, and later became a certified nurse practitioner. Now she provides Pap smears to patients multiple times a day at Planned Parenthood clinics in Kentucky and Indiana and other care via telehealth. She recently helped a patient who hadn’t been seen for a screening in 15 years discover she had advanced cervical cancer.

She is troubled by what could happen in the wake of the new Medicaid rule passed by Congress and signed by President Donald Trump in July that barred nearly all Planned Parenthood affiliates from receiving Medicaid reimbursements because some clinics in the nonprofit network provide abortions. Kentucky and Indiana both have abortion bans, but still have Planned Parenthood clinics to provide other reproductive health care.

“I don’t just worry; I know that there’s going to be more folks with stories like mine, but without the happy ending,” Deis said.

‘What we’re really talking about is our daughters getting cervical cancer’

The American Cancer Society recently reported the number of early cervical cancer cases has declined sharply among young people since the vaccine’s introduction nearly 20 years ago. But vaccine adoption rates for children are low in the states where rates are highest — about one-third of boys and girls between the ages of 13 and 17 were vaccinated in Mississippi as of 2020.

The vaccine is most effective when given before engaging in any kind of sexual activity for the first time, because it can prevent the sexually transmitted strains of HPV that present the highest risk of cervical cancer. More than 98% of cervical cancer cases are caused by HPV, and a 2024 study from the Journal of the National Cancer Institute found zero cases of cervical cancer in Scottish women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13.

“We could make (cervical cancer) an eradicated disease,” said Dr. Emily Boevers, an Iowa OB-GYN. “But everything is falling apart at the same time.”

Boevers said limitations on Medicaid coverage and the loss of Title X family planning funding will make screenings and vaccines less accessible for the populations that need them the most, even if clinics don’t close as a result. But it will take years to see the consequences of these changes, she said, because it takes about 15 years on average for HPV to become cancer. 

“So what we’re really talking about is our daughters getting cervical cancer,” she said. 

Kentucky’s legislature acknowledged the importance of HPV vaccines as recently as 2019, when representatives passed bipartisan House Resolution 80, which encouraged females and males between the ages of 9 and 26 to get the HPV vaccine and everyone to “become more knowledgeable of the benefits of the vaccine.” Only four legislators voted against it.

But today, the U.S. Department of Health and Human Services is led by Secretary Robert F. Kennedy Jr., who has made false statements about the HPV vaccine’s safety and effectiveness and played a leading role in organizing a mass lawsuit against one of the vaccine’s manufacturers, Merck. The Associated Press reported the judge dismissed more than 120 claims of injuries from Gardasil, the name of one HPV vaccine, because of a lack of evidence. 

“Secretary Kennedy supports renewing the focus on the doctor-patient relationship and encourages individuals to discuss any personal medical decisions, including vaccines, with their healthcare provider,” a Health and Human Services spokesperson wrote to States Newsroom in September. “The American people voted for transparency, accountability, and the restoration of their decision-making power, and that is exactly what HHS is delivering.”

The response did not clarify whether Kennedy still thinks the vaccine is unsafe and what basis there is for that claim. 

Dr. Linda Eckert, a University of Washington School of Medicine professor and practicing OB-GYN, has an extensive background in immunizations and cervical cancer prevention. She served as a liaison for the American College of Obstetricians and Gynecologists to the CDC’s Advisory Committee on Immunization Practices until 2024. Members of the committee were recently dismissed by Kennedy’s agency and replaced by new members, several of whom have reportedly expressed anti-vaccine views. Eckert said the group had plans in motion to present to the ACIP in June a case for administering the HPV vaccine at the earliest age of 9 before it was disbanded. 

Although Black and Hispanic women are affected by cervical cancer at disproportionate rates because of systemic inequities, Eckert said the fastest rising group experiencing late-stage cancer is white women in the Southeast. But she added that Alabama was the first state in the country that launched a targeted campaign to eliminate cervical cancer. 

Treatment for the cancer once it develops can also be difficult to obtain, Eckert said. It can be expensive and require many follow-up visits, and usually leads to infertility either through hysterectomy or invasive radiation treatments. 

“It is a really devastating disease to treat,” Eckert said. “Even if you live, you are permanently changed.”

Recent study showed zero cases of cervical cancer after HPV vaccine 

Dr. Aisha Mays, founder and CEO of a Dream Youth Clinic in Oakland, California, said the services her clinic offers to young people for free includes most of the same services that Planned Parenthood clinics provide, including the HPV vaccine.

“That’s the work of Planned Parenthood and clinics like mine that are encouraging and doing regular Pap smear screenings and vaccines, and having really clear conversations with young people around the importance of these procedures,” Mays said.

The recent turn against vaccines by some segments of the public and members of President Donald Trump’s cabinet who doubt their effectiveness and baselessly claim that they cause injury and developmental issues like autism has made the promotion of HPV vaccines more difficult for Mays. Overwhelming evidence, including from the Centers for Disease Control and Prevention, shows that they are safe and effective.  

The vaccine can also protect against genital warts, anal cancer and oropharyngeal cancer, Mays said. There are about 40 strains of HPV in total that are known to infect the genitals, and more that can attach to certain patches of skin. Most people who have sex will come in contact with one or more of the strains by the time they reach their mid-20s or early 30s.

Mays’ clinic is largely funded by state and local grants, but it received more than $100,000 in federal funding for a sexual health education program through the U.S. Department of Health and Human Services’ Office of Population Affairs. It was a nationally distributed podcast hosted by adolescents, Mays said, and they chose topics to talk about related to sexual health, including HPV.

The program’s grant was one of many that have been cancelled under the Trump administration. An objective laid out in Project 2025, the blueprint document for the next Republican presidency written by conservative advocacy group the Heritage Foundation, was to ensure no subgrantees of sex education programs were promoting abortion or “high-risk sexual behavior” among adolescents. It also stated that any programming should not be used to “promote sex.”

HHS also terminated funding for one of California’s sexual health programs in August over the state’s refusal to remove references in the programming related to gender, including the idea that biological sex and gender identity are distinct concepts. Another directive of Project 2025 was to make sure biological sex is never conflated with gender identity or sexual orientation.

States with high rates of cervical cancer have low density of physicians

States with the lowest incidences of cervical cancer, including Massachusetts, New Hampshire, Connecticut and Minnesota, also have the highest density of physicians per capita. According to the Association of American Medical Colleges’ state physician workforce data, Massachusetts has the highest number of physicians per 100,000 people, and Oklahoma ranks in the bottom three.

Kentucky is in the bottom 15, and so is Indiana, where Marissa Brown works as a Planned Parenthood health center manager in Bloomington. Brown described her clinic as “an oasis in a desert” because there are few options for gynecological care in the area, and even fewer for obstetrics. Brown said they routinely see patients from rural areas two or more hours away, and many of them are coming for wellness exams that include cancer screenings.

Indiana used to have 38 Planned Parenthood clinics, but through 15 years of funding cuts and targeted anti-abortion legislation, the organization closed 21 of them between 2002 and 2017. In the years since then, another seven shut down to consolidate services. Many of them did not provide abortions.

“We hear a lot about patients coming in who can’t get into their gynecologist for four to 12 weeks,” Brown said. “We can do that in a few days to two weeks, and we have walk-in appointments too.”

Health Imperatives, a nonprofit network of seven community health clinics in southern Massachusetts, can no longer bill for Medicaid because they provide medication abortions and received about $800,000 in reimbursements for other services in 2023, like Planned Parenthood. One of Health Imperatives’ clinics is in Martha’s Vineyard, whose working-class residents have to work three to four jobs just to afford to live on the affluent island, said Julia Kehoe, the organization’s president and CEO.

More than a decade ago, she said she noticed a pattern: Their patients would come in for an annual gynecological exam, receive an abnormal cervical cancer screening, but not follow up, because the closest available specialist would require expensive travel off the island. Kehoe said that once their Martha’s Vineyard clinic purchased a colposcopy machine, from privately raised funds, in 2012, they started diagnosing some of their regular patients with now-advanced cancer.

“In the first year that we did colposcopies, we found four individuals who had stage three or four cancer, who we luckily were then able to connect up to Boston for critical care,” she said. “But if we had had that capacity earlier … we would have caught it earlier.”

States Newsroom reproductive rights reporter Sofia Resnick contributed to this report.

Coming Thursday: Telemedicine could help narrow the care gap in rural communities.

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Planned Parenthood of Wisconsin will stop scheduling patients for abortions starting next week as it works to find a way to provide the service in the face of Medicaid funding cuts in President Donald Trump’s tax and spending bill, the nonprofit said Thursday.

Abortion funding across the U.S. has been under siege, particularly Planned Parenthood affiliates, which are the biggest provider. Wisconsin appears to be the first state where Planned Parenthood is pausing abortions because of the new law.

The organization warned earlier this year that about half its clinics that provide abortion could be closed as a result of a ban on Medicaid funding for Planned Parenthood for services other than abortion.

The measure was part of the tax and spending law President Donald Trump signed in July. Initially, a judge said reimbursements must continue, but a federal appeals court this month said the government could halt the payments while a court challenge to the provision moves ahead.

Planned Parenthood services include cancer screenings and sexually transmitted infection testing and treatment. Federal Medicaid money was already not paying for abortion, but affiliates relied on Medicaid to stay afloat.

The remaining Planned Parenthood clinics in Louisiana – where abortion is banned – are scheduled to shut down at the end of this month.

Planned Parenthood of Wisconsin said in a statement that it is trying to see as many patients as possible between now and Tuesday. The federal law takes effect Wednesday. It is not scheduling patients beyond that date, and the organization believes the move will allow it to continue seeing other Medicaid patients. The organization said it was working with providers across the state to make sure patients are referred quickly and receive timely care.

It is also considering taking legal action, the group said.

“Planned Parenthood of Wisconsin will continue to provide the full spectrum of reproductive health care, including abortion, as soon and as we are able to,” Planned Parenthood of Wisconsin President and CEO Tanya Atkinson said in the statement. “In the meantime, we are pursuing every available option through the courts, through operations, and civic engagement.”

The abortion landscape has been shifting frequently since the U.S. Supreme Court ruling in 2022 that allowed states to ban abortion. Currently, 12 states do not allow it at any stage of pregnancy, with limited exceptions, and four more ban it after about six weeks’ gestation.

The bans have resulted in more women traveling for abortion and an increased reliance on abortion pills. Prescribers in states where they’re allowed have been shipping the pills to places where abortion is banned, a practice that is facing some legal challenges and is expected to attract more.

The Wisconsin Supreme Court in July struck down the state’s 1849 near-total ban on abortion, saying it was superseded by newer state laws regulating the procedure. The same day it ruled in that case, the court dismissed a lawsuit filed by Planned Parenthood of Wisconsin asking it to find the law unconstitutional.

Wisconsin’s abortion ban was in effect until 1973, when the U.S. Supreme Court’s landmark Roe v. Wade decision legalizing abortion nationwide nullified it. Legislators never officially repealed it, however, and conservatives argued that the U.S. Supreme Court’s ruling that overturned Roe reactivated it.

Planned Parenthood of Wisconsin stopped providing abortions after that ruling for 15 months before resuming them as the lawsuit over the state law played out. It has been providing abortions at three clinics in Wisconsin for the past two years.

Planned Parenthood of Wisconsin serves about 50,000 people across the state. About 60% of them are covered by Medicaid, the organization said.

The federal Hyde Amendment already restricts government funding for most abortions, and less than 5% of the services Planned Parenthood provides are abortions, according to the organization’s 2023 annual report.

Planned Parenthood provides a wide range of services besides abortion. Its most recent annual report shows that contraceptive services and testing and treatment for sexually transmitted infections make up the vast majority of its medical care. It performs more cancer screening and prevention procedures than abortions, according to the report.

Mulvihill reported from Cherry Hill, New Jersey. Associated Press reporter Christine Fernando in Chicago contributed.

Wisconsin Watch is a nonprofit and nonpartisan newsroom. Subscribe to our newsletters to get our investigative stories and Friday news roundup. This story is published in partnership with The Associated Press.

Planned Parenthood of Wisconsin to pause abortions amid federal Medicaid funding cut is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.