23 States Sue Over Trump's Family Planning Rules

Twenty-three states sued the Trump administration Thursday to strike down new conditions attached to Title X family planning grants, arguing the White House is using public health money to force through unrelated policy demands.

The suit was filed in U.S. District Court in Maryland and asks a judge to vacate the requirements for states applying under Title X of the Public Health Service Act — including mandates to end diversity, equity and inclusion programs and to end "support for gender ideology."

New York Attorney General Letitia James, Maryland Attorney General Anthony Brown and Massachusetts Attorney General Andrea Campbell are leading the case.

What Title X Pays For

Title X has been, for more than 50 years, the only dedicated federal funding stream to states for family planning services, according to the complaint. It covers cervical cancer screening, testing for sexually transmitted infections, and fertility and contraceptive care, largely for low-income and uninsured patients. Funding flows mostly through Medicaid.

The Conditions Being Challenged

In July, the Office of Population Affairs at the U.S. Department of Health and Human Services published terms for the 2027-2032 grant cycle and opened applications. The listed priorities include:

Ending DEI policies and procedures.

Ending support for "gender ideology," including language requiring applicants to "accurately reflect 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.

Enforcing the Hyde Amendment, which blocks federal tax dollars for abortion.

Adopting counseling policies that favor parenthood and marriage, plus a set of priorities the states call unrelated to family planning — "understanding autism," caring for long COVID patients, and ending crime.

Applications are judged "disproportionately" on their ability to advance those priorities, the complaint says, and grantees must "demonstrate ongoing compliance with these priorities" or lose funding.

The Legal Claims

The states say the conditions exceed the Office of Population Affairs' authority because Congress never approved them, conflict with the statutory requirement that all pregnancy counseling be non-directive, and undercut the program's core purpose of offering a broad range of family planning methods.

They also call the conditions "arbitrary and capricious" and so vague as to be 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.

A further claim invokes the Constitution's Spending Clause, which the states say bars funding conditions that are ambiguous, coercive, unconstitutional or unrelated to the general welfare. Losing Title X money, they argue, would be devastating for providers and patients.