WASHINGTON — Republicans celebrated last year when they barred Medicaid payments from going to Planned Parenthood for one year, predicting the financial impact would hollow out the organization. 

A year later, with that section of the “big, beautiful” law set to expire July 4, GOP lawmakers are trying to find a way to keep the nationwide prohibition in place, though they won’t be able to accomplish that before the deadline. 

That means states will now determine whether people enrolled in the program for lower-income individuals can, once again, get routine healthcare services from the Planned Parenthood clinics that remain open.  

Nora Walsh-DeVries, vice president of political and legislative affairs at Planned Parenthood Action Fund, said the law forced the organization to close nearly 30 of its healthcare centers.

“The impact is really horrible for us and some of it is unfortunately irreversible,” she said. “And it’s tough to try to deal with what’s happened in this past year, kind of also knowing that there is an intention from Republicans to permanently defund us.”

Some Planned Parenthood clinics, she said, tried to find ways to keep treating Medicaid enrollees, but ultimately that was “unsustainable” and not something every affiliate could manage. 

The result meant “tens of thousands of patients have been denied access to basic care services like cancer screenings, which I think we can all agree is something we should want people to get when they need it, where they need it, how they need it,” Walsh-DeVries said. 

The impact was ultimately less widespread than Planned Parenthood originally predicted, when its president said in a statement just days before the law took effect that “nearly 200 Planned Parenthood health centers in 24 states across the country are at risk of closure.”

The expiration won’t have an impact on abortion access for Medicaid enrollees, since a decades-old rider on government spending bills, which blocks taxpayer dollars from going to abortion with limited exceptions, remains in place. 

Republicans view the closures as a victory and are trying to renew the provision in an attempt to shutter more Planned Parenthood clinics. They believe any healthcare organization that provides abortions, even if those largely aren’t covered by taxpayer dollars, shouldn’t be included in any federal health programs. 

Pressure from conservatives

The House Freedom Caucus, a collection of far-right Republicans, wrote to Speaker Mike Johnson in late June, pressing him to include a similar prohibition in another party-line bill. 

“The American people rightfully expect a Republican-led Congress to deliver real results, not excuses or half-measures,” they wrote. “After years of broken promises, voters have entrusted us with majorities in both the House and Senate. This is our last and best chance to prove they were right to send us here to fight for them.”

They added that another reconciliation bill must prohibit “federal funding for abortion providers to ensure that taxpayer dollars are not being used to subsidize the radical abortion industry.”

Susan B. Anthony Pro-Life America President Marjorie Dannenfelser and other anti-abortion organizations are lobbying Republicans to again block Medicaid funding from going to Planned Parenthood.

“Defunding Big Abortion is now the default expectation of the pro-life movement,” Dannenfelser wrote in a statement. “When they return to D.C., Republicans must do all they can through reconciliation to once again block taxpayer dollars from Planned Parenthood and abortion businesses.”

Republicans used the complex budget reconciliation process to enact their “big, beautiful” law and the $70 billion package to fund immigration enforcement. The special process allowed GOP leaders to get around procedural votes in the Senate that would otherwise require bipartisanship as long as each provision has an impact on federal revenues or spending that is not deemed “merely incidental” by that chamber’s parliamentarian.

Strained system

Subasri Narasimhan, research director at the Center on Reproductive Health, Law, and Policy at UCLA Law School, said there often aren’t other health centers to cover the gaps left when a Planned Parenthood closes or is no longer reimbursed for treating a Medicaid enrollee. 

“We have a pretty strained healthcare system in so many different respects, but we’re looking at an extremely strained system when it comes to reproductive healthcare,” Narasimhan said. 

Some state governments, she said, tried to cover the budget holes created during the last year, though ultimately weren’t able to fully replace the loss of federal funding. 

Republicans reinstituting the same prohibition on Medicaid payments for non-abortion healthcare services, she said, would likely lead more people on the program to delay or skip preventative care altogether. 

“We’re looking at folks who are quite vulnerable and often use Planned Parenthood as their primary source of care,” she said. “And so there’s no option to look for another health center.”

Kathleen Adams, professor in the Rollins School of Public Health at Emory University, said that if a program can vary state to state, it will, and this was no exception. 

“What I’m seeing is the states are finding emergency funds, other ways to channel funds to Planned Parenthood to sort of keep that part of their system active,” she said. 

There are also other programs and clinics, like federally qualified health centers and safety-net providers, that Adams said could play a part in filling some of the gaps.

“I don’t lose heart so much as we might otherwise about these provisions to Planned Parenthood because states are aware of these issues,” she said. “And if they don’t provide access to contraceptives, they’re more likely to get unintended pregnancies, or pregnancies amongst uninsured women.”

State action

Laurie Sobel, associate director for Women’s Health Policy at KFF, wrote in a post that after the nationwide moratorium expires, a Supreme Court ruling from late June 2025 will allow state governments to block certain healthcare providers, like Planned Parenthood, from participating in their Medicaid programs. 

“This ruling marked a significant departure from longstanding interpretations of the Medicaid ‘free choice of provider’ provision, which guarantees enrollees the right to obtain care from any qualified and willing Medicaid provider,” Sobel wrote.

Alabama, Arizona, Arkansas, Florida, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina and Texas have either blocked or tried to block Medicaid reimbursements to Planned Parenthood, according to Sobel’s analysis.

Other states, she wrote, “may follow suit” once the nationwide Medicaid prohibition expires July 4.

A spokesperson for U.S. Health and Human Services confirmed to Stateline on Friday that the agency is canceling 53 out of 67 grants, worth about $68 million, under the Teen Pregnancy Prevention Program, affecting grantees in more than two dozen states.

A list obtained by Stateline of canceled grants includes those awarded to universities, community organizations, city and state health departments and Planned Parenthood affiliates in states such as Arizona, Montana, Michigan, Texas and West Virginia. The grants were canceled two years before their expiration dates because the programs did not align with agency priorities, according to one of the grantees who received a termination notice.

The program is part of the agency’s Office of Population Affairs and is a “national, evidence-based grant program that funds diverse organizations working to prevent teen pregnancy across the United States,” according to the HHS website. The agency provides funding to programs that develop and evaluate innovative approaches to prevent teen pregnancy as well as to prevent sexually transmitted infections among adolescents, and to promote positive behaviors.

Ayana Bradshaw, president and CEO of AccessMatters in Philadelphia, told Stateline her organization received the termination notice of its $1.2 million grant on Friday, and it was effective the same day. Bradshaw said the letter cited a misalignment with agency priorities, specifically that the program “normalizes or promotes sexual activity for minors.”

AccessMatters’ Adolescent Health Initiative is entirely funded by the federal grant and provides free sexual and reproductive health programs to more than 1,100 teens between the ages of 13 and 19. The program provides information, education and referrals for healthcare as needed.

“This is devastating for the youth that we serve,” Bradshaw said. “It also impacts us as an organization, our staff, and it impacts the partners that we had who supported us in implementing this program.”

During the first administration of President Donald Trump in 2017, HHS took the same action, ending grants for more than 80 recipients two years before they were set to expire. Legal advocacy organization Democracy Forward sued the administration on behalf of several grantees and won a permanent injunction after courts ruled the action violated agency regulations.

The Trump administration identified the teen pregnancy program as one to cut in its 2025 budget request, and it was included in the final 2026 appropriations bill. The language accompanying that bill said grants for sexual risk avoidance must use medically accurate information and teach youth about risky behaviors “without normalizing teen sexual activity.”  

Teen birth rates have fallen dramatically in the past 20 years, according to federal Centers for Disease Control and Prevention data — about 72% since 2007. Experts attribute that decline to fewer teens deciding to have sex earlier, sex education and better access to contraception, especially for girls. 

The agency also released two new grant programs this week, one of which is titled “Replicating Effective Teen Pregnancy Prevention Programs,” with $63.4 million available to be awarded. The other is “Rigorous Impact Evaluation of Programs to Prevent Teen Pregnancy and Achieve Optimal Health,” with $8.3 million available.

Both opportunities tell applicants that they must pass an alignment review process to ensure they meet agency priorities. That language mimics Trump administration language in the 2027 Notice of Funding Opportunity for Title X grants, which a national family planning organization filed a lawsuit over last week, arguing that it violates Congress’ intentions and administrative procedure.

Tara Mancini, director of public policy at reproductive health advocacy organization Power to Decide, said she expects the administration’s decision to cancel the grants to be challenged again in court.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.