Family planning organizations sue Trump administration over Title X funding announcement

Title X, established by Congress and signed by former Republican President Richard Nixon, is a grant program prioritizing low-income or uninsured people, including those who make too much to qualify for Medicaid, who may not otherwise have access to family planning and reproductive health services. That includes services such as contraception, pregnancy tests, testing for sexually transmitted infections and wellness exams. Abortion services cannot be covered by Title X dollars.

The complaint takes issue with the 2027 Notice of Funding Opportunity for Title X, which was released in April. Potential awardees must submit applications by January for consideration in the next funding cycle.

The funding opportunity language states that all applicants must first meet an “alignment review” to determine their eligibility for a grant. That alignment is based on the priorities laid out by the U.S. Department of Health and Human Services, the Office of the Assistant Secretary for Health and the Office of Population Affairs. Those priorities include ending diversity, equity and inclusion efforts and gender-affirming care. The complaint notes that the decision regarding an applicant’s eligibility cannot be appealed.

Coleman said those priorities directly conflict with the ones that were laid out in the last funding round under former President Joe Biden, whose administration emphasized the importance of health equity efforts and the inclusion of gender-affirming care for transgender patients. Coleman said that means it could be impossible for some applicants to be awarded funds, and that it would favor new applicants.

“We believe that the funding announcement is designed to favor the kind of providers the administration would rather see in the program,” Coleman said, which could include clinics with a religious mission, such as crisis pregnancy centers or major Catholic healthcare organizations.

The complaint also says those requirements directly conflict with the Title X statute, which mandates that HHS consider factors such as how many patients will be served, how much the services are needed locally and whether the applicant can make rapid and effective use of grant funds. The family planning organizations say the new application process is meant to further the Trump administration’s political agenda instead of fulfilling Congress’ mandate to “offer a broad range of acceptable and effective family planning methods and services” to patients.

The guidance associated with the funding notice also shifts the focus of the Title X grants from expanding access to services like contraception to strengthening “family formation” and assisting clients in “achieving healthy pregnancies.” Clinics are instructed to prioritize and promote natural methods of family planning, such as menstrual cycle tracking, which is less effective at preventing pregnancy than contraception, according to the American College of Obstetricians and Gynecologists.

“The (funding notice) enables defendants to pick winners and losers based on political alignment, as opposed to merit and the ability to provide high-quality Title X services,” the complaint reads. “This is not how federal grants should be awarded, and, specifically, this is not how Congress instructed defendants to make Title X grants.”

A hearing for the case will likely be scheduled in the coming weeks.

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