Trump restores Title X funding to two anti-abortion states - while eliminating himself elsewhere

Trump restores Title X funding to two anti-abortion states - while eliminating himself elsewhere

The Trump administration quietly restored federal family planning funds in Tennessee and Oklahoma, despite court rulings that the states were not entitled to funds because they refused to provide women with information about ending pregnancies or abortion referrals upon request.

The Department of Health and Human Services' decision to restore millions of dollars to the two states came as it simultaneously withheld nearly $66 million from clinics in the Title X program elsewhere. For more than 50 years, Title X has provided sexual and reproductive health services, particularly to low-income, hard-to-reach people, including minors.

The Biden administration in 2023 cut funding to Tennessee and Oklahoma, saying they violated federal rules by not offering abortion counseling to patients. The states sued federal health officials. And courts ruled against the states.

On March 31, HHS restored $3.1 million in family planning funding to the Tennessee Department of Health and nearly $2 million to the Oklahoma Department of Health. In the notices, HHS said family planning funds were sent to the two states “pursuant to a settlement agreement with the recipient.”

“However, there has been no agreement with Tennessee to resolve this litigation,” Justice Department lawyers wrote in an April 23 court filing.

Zach West, an official with the Oklahoma attorney general's office, wrote separately April 17 that the state's notice "incorrectly indicated that a settlement agreement had been reached. No agreement has been entertained or discussed in any way in this case."

“To our knowledge, no agreement has been reached between the state of Oklahoma and HHS in the pending litigation,” Erica Rankin-Riley, public information officer for the Oklahoma Department of Health, said in an email in response to questions. She said the state's Title X clinics do not provide referrals for abortion or counseling pregnant women about ending the pregnancies.

“We are grateful for everyone involved in restoring Oklahoma’s long-standing and successful Title

Spokespeople for HHS and the Tennessee Department of Health did not respond to requests for comment.

Title X was established to reduce unintended pregnancies and provide related preventative health care. As of 2023, more than 3,800 clinics across the country used federal grants to provide free or low-cost contraception, testing for sexually transmitted infections, screening for breast and cervical cancer, and pregnancy-related counseling.

More than 4 in 5 people who use Title X services are more than 4 in 5 people, according to HHS.

Federal law prohibits clinics from using Title X money to pay for abortions. However, HHS regulations in 2021 state that participating clinics must provide pregnant women with information about prenatal care and delivery, nursing, foster care, adoption, and termination of pregnancy. This includes counseling patients about abortion and providing abortion referrals upon request.

HHS under President Donald Trump has not yet overhauled the Biden-era regulations, meaning participating clinics still provide abortion counseling and abortion referrals to pregnant women who request them.

According to the Supreme Court's decision in June 2022 inDobbs v. Jackson Women's Health Organizationthat ended the constitutional right to abortion, Tennessee and Oklahoma had strict abortion bans with few exceptions. States told their Title X clinics that they could only discuss or make referrals for services that were legal in their states, effectively shutting down any conversations about abortion.

“Continued funding is not in the best interest of the government,” two HHS officials wrote to Tennessee officials on March 20, 2023.

Tennessee and Oklahoma subsequently sued in federal court. A three-judge panel for the U.S. Court of Appeals for the 6th Circuit ruled against Tennessee, while Oklahoma asked the Supreme Court to review the case after that state lost in the U.S. Court of Appeals for the 10th Circuit.

State officials suggested they were unsure why they got some of their funding back before the lawsuits were resolved. “If Oklahoma’s award is not restored pursuant to a settlement agreement, what is the reason for the partial restoration, and is it permanent?” West wrote.

“Tennessee has not yet determined HHS’s formal position on whether HHS intends to fully restore Tennessee’s Title X funding,” Whitney Hermandorfer of the Tennessee Attorney General’s Office wrote in an April 7 letter.

A report from the HHS Office of Population Affairs said 60% of the approximately 2.8 million patients who received Title X services in 2023 had family incomes at or below the poverty level. Twenty-seven percent were uninsured, more than three times the national uninsured rate.

In fiscal year 2024, the federal government awarded Title X grants to nearly 90 companies, a mix of state and local governments and private organizations. These grantees distribute funds to public or private clinics.

The decision to restore some of Tennessee and Oklahoma's funding differs sharply from HHS's approach under Trump with other Title X participants.

As of March 31, HHS withheld family planning funds from 16 companies, including nine parenting partners.

At least seven states—California, Hawaii, Maine, Mississippi, Missouri, Montana and Utah—now have no Title X-funded family planning services, according to a federal court lawsuit filed by the ACLU and the National Family Planning and Reproductive Health Association, which advocate for Title X clinics.

In total, 865 family planning clinics are unable to provide services to approximately 842,000 people, the lawsuit says.

“We know what happens when health care providers cannot use Title

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