23 States Sue HHS Over New Political Strings on Title X Family Planning Money

Twenty-three states sued the Trump administration Thursday, August 27, 2026, over new political conditions attached to Title X, the only federal grant program dedicated to family planning for low-income Americans.

The lawsuit, filed in federal court in Maryland, targets a Department of Health and Human Services funding notice issued in July for the 2027 fiscal year Title X grant cycle. New York Attorney General Letitia James is leading the effort alongside Massachusetts, joined by attorneys general from California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin, according to CBS News. Democratic governors Andy Beshear of Kentucky and Josh Shapiro of Pennsylvania also joined, per The Hill.

Title X funds birth control, STI testing, cancer screenings and other non-abortion health services for roughly 3 million low-income patients a year. Abortion funding is already banned under the program and has been for decades. Nobody in this lawsuit disputes that.

What the New Rules Actually Require

HHS's funding notice says applicants will be judged on whether they align with a list of department priorities, according to Courthouse News Service. Those priorities include eliminating diversity, equity and inclusion practices, promoting abstinence and "natural family planning" over hormonal contraception, declining to recognize transgender identities or provide transgender-specific care, and counseling patients toward marriage and parenthood.

Recipients who stop complying could lose their grants entirely, the notice states.

Minnesota Attorney General Keith Ellison summed up the states' objection bluntly, telling CBS News that health care decisions belong to patients and doctors. "There's no room in that equation for Donald Trump," he said.

Illinois Attorney General Kwame Raoul called it a politicization of a program that's historically been bipartisan, saying in a press release that the administration "jeopardizes funding for a broad range of reproductive and sexual healthcare services." California Attorney General Rob Bonta went further, saying Trump is using "ideologically driven conditions to unravel this historically bipartisan safety net and fashion it into a political bludgeon."

The Money at Stake

The numbers matter here. Minnesota alone gets about $3.5 million a year in Title X funds for Planned Parenthood North Central States and Ramsey County, part of $17 million in combined state and federal spending on these services, according to CBS News. Ellison says Minnesota could lose about a fifth of that if the lawsuit fails.

Nationally, states stand to lose roughly $286 million in annual Title X grants, according to Ground News. The states argue in their complaint that most can't backfill that gap with state dollars alone, meaning "curtailing services and even shuttering clinics" for low-income patients, per Courthouse News.

This isn't hypothetical. Similar restrictions during the first Trump administration caused nearly a quarter of Title X grantees nationwide to drop out, and the number of patients served fell more than 60 percent in two years, according to The Hill.

The Legal Argument

The states are making two separate claims. First, that the new conditions violate the Constitution's Spending Clause and exceed what Congress authorized when it created Title X, since the statute requires broad contraceptive access and "nondirective" counseling, not counseling steered toward marriage and abstinence. Second, that HHS skipped the notice-and-comment process required under the Administrative Procedure Act before imposing the changes.

Fox News, however, reports a wrinkle largely absent from the center and left coverage. Shapiro's own framing of the suit, calling it about protecting "lifesaving reproductive care," drew direct pushback from Live Action, an anti-abortion group. Live Action's Noah Brandt accused Shapiro of using euphemisms to defend funding for Planned Parenthood specifically, saying "there is nothing lifesaving about abortion." Fox's coverage notes what the Democratic-led coverage downplays: the lawsuit isn't just about screenings and STI tests. It also directly challenges HHS language requiring grantees to "maintain strict separation from prohibited activities" and support "life-affirming" program delivery, phrasing that goes beyond the existing abortion-funding ban Title X has always had.

A Related Ruling Already Went Against the Administration

This isn't the administration's first legal setback on family-planning-adjacent funding. In a separate case, U.S. District Judge Christopher Cooper, appointed by Barack Obama, partially blocked a Trump administration effort to redirect Teen Pregnancy Prevention Program funds away from Planned Parenthood affiliates toward abstinence-based curricula, according to the Daily Signal. Cooper ruled HHS couldn't impose funding criteria Congress didn't authorize when it created that program in 2009, writing that an approach ignoring "the realities of unprotected intercourse" would "defy social reality, common sense, and scientific evidence alike."

That ruling isn't the Title X case, but it signals how at least one federal judge views the administration's legal footing on similar grant conditions.

Where This Stands

No ruling has been issued in the Title X case as of this writing. The states are seeking a court declaration striking the challenged conditions from the funding notice, plus an injunction letting states keep operating under the existing program rules while litigation proceeds. HHS has not filed a public response to the specific claims in the complaint. The court will have to decide whether the executive branch has the authority to attach these ideological strings to a program Congress designed around neutral, comprehensive family planning access, or whether that crosses into an APA violation and unconstitutional coercion of the states.