A coalition of 23 states filed a lawsuit Thursday in federal court in Maryland to block the Trump administration's sweeping changes to the Title X family planning program, arguing the new conditions would withhold federal funds from states and providers unless they adopt the administration's conservative political agenda.
The lawsuit, led by Democratic attorneys general from New York, Maryland, Massachusetts, California, Illinois, Michigan, New Jersey, and Virginia, also includes Democratic governors Andy Beshear of Kentucky and Josh Shapiro of Pennsylvania. The plaintiffs contend that the Department of Health and Human Services (HHS) has imposed unlawful requirements on the next five-year grant cycle, which would force states to either alter their programs to match the administration's ideology or risk losing federal support.
New Conditions on Title X Funding
Title X is the only federal program dedicated to providing free or subsidized birth control, STI testing, cancer screenings, and other non-abortion reproductive health services to low-income Americans. The current grantees are in the final year of a funding cycle awarded under Biden-era rules, but the Trump administration has moved to reshape the program with a more conservative focus on promoting pregnancy and marriage.
The HHS funding notice, published in April, introduces for the first time a requirement that applicants align their programs with a broad set of political priorities. These include eliminating diversity, equity, and inclusion initiatives, discouraging contraception in favor of abstinence and “natural family planning,” recognizing only two genders—male and female—and mandating that clinics counsel patients toward marriage and parenthood.
The states argue that these conditions are inconsistent with Title X's statutory and regulatory purpose, which has historically been to provide comprehensive, evidence-based family planning services without political strings attached. They warn that if federal funds are withheld, they will be forced to fill budget gaps from state coffers, and many may not be able to sustain services at current levels.
“With federal Title X funds in jeopardy … Plaintiff States will be forced to scramble to fill the funding gap from their own coffers to preserve these critical services; many will not be able to continue funding these programs at the same level using state-only dollars,” the lawsuit alleges.
Legal Challenges and Precedent
The lawsuit also charges that HHS violated the Administrative Procedure Act by imposing the new conditions without the required notice-and-comment period. Similar legal challenges have already been filed by nonprofit organizations in Pennsylvania and by Planned Parenthood in Washington, D.C., signaling a coordinated effort to stop the administration's overhaul.
This is not the first time the Trump administration has attempted to restrict Title X. During his first term, similar rules led nearly a quarter of grantees to drop out, and the number of patients served by the program plummeted by more than 60% in just two years. The current lawsuit seeks to prevent a repeat of that disruption, which advocates say would disproportionately harm low-income women and families.
The case comes amid broader political battles over reproductive health policy, with the administration's moves on contraception access drawing sharp criticism from Democrats. As the midterm elections approach, the fight over Title X is likely to become a key issue, with President Trump's approval ratings already under pressure.
The states are asking the court to block the new funding conditions and preserve the current program structure while the legal challenge proceeds. A ruling could have significant implications for millions of Americans who rely on Title X services.
