Trump restores Title X funding for two anti-abortion states — while wiping it out elsewhere

The Trump administration quietly restored federal family planning money to Tennessee and Oklahoma, despite court rulings that the states weren’t entitled to funds because they refused to provide women information about terminating pregnancies or abortion referrals on request.

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

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

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

Yet "there has been no agreement with Tennessee to settle this litigation," Department of Justice lawyers wrote in an April 23 court filing.

Zach West, an official with the Office of the Oklahoma Attorney General, separately wrote on April 17 that the state's grant notice "wrongly indicated that a settlement agreement had been reached. No agreement has yet been entertained or discussed in any substantial manner in this case."

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

"We are appreciative of all that has been involved in restoring Oklahoma’s long-standing and successful Title X grant," Rankin-Riley said, "and look forward to continuing these important services throughout the state as we have done for over 50 years."

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 preventive health care. As of 2023, more than 3,800 clinics across the country used federal grants to supply free or low-cost contraception, testing for sexually transmitted infections, screening for breast and cervical cancer, and pregnancy-related counseling.

Nationwide, more than 4 in 5 people who use Title X's services are women, according to HHS.

Federal law prohibits clinics from using Title X money to pay for abortions. However, HHS regulations issued in 2021 say participating clinics must offer pregnant women information about prenatal care and delivery, infant care, foster care, adoption, and pregnancy termination. That includes counseling patients about abortion and providing abortion referrals on request.

HHS under President Donald Trump has not yet revised the Biden-era regulations, which means participating clinics are still required to provide abortion counseling and abortion referrals for pregnant women who request them.

After the Supreme Court's June 2022 decision in Dobbs v. Jackson Women's Health Organization, which ended the constitutional right to an abortion, Tennessee and Oklahoma enacted strict abortion bans with few exceptions. The states told their Title X clinics they could discuss or make referrals only for services that were legal in their states, effectively cutting off any talk 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 even they weren't sure why they got some of their funding back before the lawsuits were resolved. "If Oklahoma's award is not being restored pursuant to a settlement agreement, then what is the reason for the partial restoration, and is it permanent?" West wrote.

“Tennessee has not yet ascertained the formal position of HHS with respect to whether HHS intends to fully restore Tennessee's Title X funding," Whitney Hermandorfer of the Office of the Tennessee Attorney General wrote in an April 7 letter.

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

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

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

On March 31, HHS withheld family planning funds from 16 entities, including nine Planned Parenthood affiliates.

At least seven states — California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah — now do not have any Title X-funded family planning services, according to a lawsuit filed in federal court by the ACLU and the National Family Planning and Reproductive Health Association, which lobbies for Title X clinics.

Overall, 865 family planning clinics are unable to provide services to roughly 842,000 people, the lawsuit states.

"We know what happens when health care providers cannot use Title X funding: People across the country suffer, cancers go undetected, access to birth control is severely reduced, and the nation's STI crisis worsens," Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, said in a statement.