WASHINGTON — Officials from 23 states have sued the Trump administration over new conditions attached to federal family-planning grants, arguing that the requirements could restrict access to contraception and undermine protections for LGBTQ+ patients.
The lawsuit was filed Thursday in the U.S. District Court for the District of Maryland against the Department of Health and Human Services and other federal officials. New York, Maryland and Massachusetts are leading the challenge.
The states are asking a federal judge to block the administration from enforcing the new conditions when awarding Title X funds, the country’s only federal program devoted specifically to family planning and related preventive health services.
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The dispute centers on a new funding notice issued by HHS for the next five-year cycle of Title X grants.
HHS says it expects to make up to $257 million available for fiscal 2027, with grants going to public and nonprofit organizations that provide family-planning services, particularly to people with low incomes or limited access to healthcare.
Title X clinics provide services including contraception, pregnancy testing and counseling, infertility services, breast and cervical cancer screenings, and testing and treatment related to sexually transmitted infections.
Federal law prohibits Title X funds from being used in programs where abortion is offered as a method of family planning.
States Challenge New Funding Conditions
The states argue that the latest grant requirements go beyond administering those services and instead require applicants to align their programs with broader priorities established by the Trump administration.
According to the lawsuit, those priorities include ending diversity, equity, and inclusion policies within HHS programs and changing approaches to what the administration describes as overmedicalization in healthcare.
The attorneys general contend that the requirements could also penalize providers that maintain nondiscrimination policies protecting transgender patients.
New York Attorney General Letitia James’ office said the conditions would push Title X providers away from inclusive services for LGBTQ+ patients and encourage natural family planning over some forms of contraception. The office also said clinics could be expected to emphasize marriage and parenthood rather than provide what the states describe as neutral, patient-centered counseling.
Those are allegations made by the states in their lawsuit, and the court has not ruled on whether the new requirements are unlawful.
HHS had not responded publicly to the lawsuit when Reuters reported on the filing.
Lawsuit Raises Reproductive and LGBTQ Rights Issues
The states argue that some of the requirements conflict with existing Title X law and regulations.
Those rules call for projects to provide a broad range of family-planning methods and related preventive services. The states also contend that current regulations require nondirective counseling and nondiscriminatory access to care, including for LGBTQ+ patients.
They are also challenging the procedure HHS used to impose the conditions.
The complaint alleges that the department made significant changes without following the notice-and-comment rulemaking process required by the Administrative Procedure Act.
The coalition additionally argues that some conditions are too vague or unrelated to the grants’ purpose, potentially violating constitutional limits on the federal government’s authority to impose conditions on money provided to states.
Title X Serves Millions Through Thousands of Clinics
The stakes extend beyond the individual states bringing the lawsuit.
HHS data show that the Title X network has included nearly 4,000 service sites, operated by state and local health departments as well as nonprofit family-planning and community health organizations. The program has received approximately $286.5 million in annual funding in recent years.
New York officials said the state alone has 165 Title X-supported health centers that serve more than 250,000 patients. More than two-thirds of those patients received services at no cost because their incomes fell below the federal poverty level, according to the attorney general’s office.
New York receives about $11.1 million annually to distribute through its health department and other providers.
Massachusetts Attorney General Andrea Joy Campbell and Maryland Attorney General Anthony Brown joined James in leading the case. Officials from California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin are also participating, along with the governors of Kentucky and Pennsylvania.
The lawsuit asks the court to declare the disputed conditions unlawful and prevent HHS from applying them to Title X grants.
The case adds reproductive healthcare and LGBTQ protections to a growing series of legal battles between states and the Trump administration over conditions attached to federal funding.
