Shapiro joins lawsuit over Trump administration restrictions on family planning funding

Gov. Josh Shapiro joined nearly two dozen states in a legal challenge to conditions on federal family planning funding he said is intended to advance the Trump administration’s political agenda.

The lawsuit, filed Thursday in U.S. District Court in Maryland, seeks a court order to vacate requirements for states applying for funding under Title X of the Public Health Service Act that include ending diversity, equity and inclusion and “ending support for gender ideology.”

Title X provides funding — mostly under Medicaid — for family planning clinics that ensure access to reproductive health care and preventative health services for low-income and uninsured people.

“The Trump Administration has repeatedly and consistently worked to restrict access to reproductive health care – and now the federal government is trying to politicize federal funds used to promote public health and safety,” Shapiro said in a statement. 

“I’ve made very clear that I will do everything in my power to ensure that every Pennsylvanian has access to the health care services they need,” he added. “So long as I’m Governor, I will continue using my authority to fight for this critical funding and protect access to these services.” 

The challenge comes about four months after a Pennsylvania court ruled the state’s ban on the use of Medicaid funding for abortion is unconstitutional.

In April, the Commonwealth Court issued a 4-3 decision that struck down the ban in the state’s 1982 Abortion Control Act as unconstitutional sex-based discrimination. It also declared the right to abortion in fundamental, meaning the state can restrict the right only when it can demonstrate compelling interest in doing so.

Republican state Attorney General Dave Sunday has appealed the decision to the state Supreme Court. 

For more than 50 years, Title X has been the only dedicated stream of funding to the states that helps pay for essential health care including cervical cancer screening, testing for sexually transmitted infections and fertility and contraceptive care that empowers people to choose when and how to have children, according to the lawsuit.

In July, the Office of Population Affairs in the U.S. Department of Health and Human Services (HHS) published a notice stating the terms and conditions for the 2027-2032 grant cycle and soliciting applications. It listed several sets of policy priorities articulated by HHS and its sub-agencies.

They included ending DEI policies and procedures; ending support for gender ideology, including “accurately reflect[ing] science, including the biological reality that a person’s sex, as either male or female, is unchangeable and determined by objective biology”; ending “overmedicalization,” including disfavoring hormonal contraceptives; and enforcing the Hyde Amendment, which blocks the use of federal tax dollars for abortion.

It requires states to adopt policies favoring counseling that pushes patients toward parenthood and marriage and miscellaneous priorities including “understanding autism,” caring for those with long COVID, ending crime and other policies unrelated to Title X, the suit says.

“It directs applicants to address the Agency Priorities in their project proposals; specifies that these submissions will be judged disproportionately based upon their ability to ‘advance’ the Priorities; and requires prospective recipients to ‘demonstrate ongoing compliance with these priorities’ throughout the duration of any award or face termination of funding,” the complaint says.

The states say the inclusion of the policy requirements harms them and other direct grantees within their borders by requiring them to either conform with the conditions, which are inconsistent with Title X, or risk losing funding.

The suit claims the conditions exceed the Office of Population Affairs authority because they are not authorized by Congress, conflict with the requirement that “all pregnancy counseling be non-directive” and undermine the program’s main goal of providing access to a broad range of family planning methods in an inclusive and equitable manner.

It also alleges the conditions are “arbitrary and capricious” and so vague that many are practically meaningless. 

“For instance, it is wholly unclear what ‘ending support for gender ideology,’ or ‘contributing to … efforts to safeguard life affirming’ program delivery mean in the context of Title X family planning services programs,” the suit says.

The inclusion of the conditions, the suit claims, also violates the Spending Clause of the U.S. Constitution, which requires the use of conditions on federal funding to advance policies to benefit the “general welfare,” be unambiguous, demand action that would be unconstitutional or be coercive.

New York Attorney General Letitia James, Maryland Attorney General Anthony Brown and Massachusetts Attorney General Andrea Campbell are leading the suit. They are joined by attorneys general for California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin; and Kentucky Gov. Andy Beshear and Shapiro.