Appeals court partially stops Biden rollback of family planning program restrictions

A divided federal appeals court struck down some Biden administration rules regarding the Title X family planning program, but will continue to allow health providers who refer patients for abortion to apply for federal funding. 

A U.S. Court of Appeals for the Sixth Circuit panel in a 2-1 ruling on Thursday granted a preliminary injunction that blocks the Biden administration from rolling back a Trump-era restriction requiring recipients of Title X grants to maintain “strict financial and physical separation” between the grant recipient and any entity providing abortions. 

The restriction means that family planning clinics like Planned Parenthood must have different buildings, staff and billing systems if they want to provide abortions and still receive federal funding. Those providers must foot the bill for the separate services. 

Though limited, the ruling likely creates confusion around the future of the program in states where providers for low-income patients are already stretched thin. 

Judge Joan Larsen, appointed by President Trump, was joined in the majority by Judge Amul Thapar, another Trump appointee. 

Judge Karen Nelson Moore, appointed by former President Clinton, concurred with the majority’s conclusion on the referral rule, and dissented on the separation provision.  

But the injunction only applies in Ohio, even though 11 other GOP-led states joined the lawsuit. According to the court, Ohio was the only state to show it was harmed by the Biden administration’s rule change — the state said it lost one-fifth of its Title X funds in 2022, due to Planned Parenthood resuming its participation in the program, and taking some of those government grants.

The court also left intact a provision of the rule that requires Title X projects make abortion referrals upon request. 

Title X is the only federal program that provides money for family planning services. Title X funds thousands of providers across the country offering contraception, cancer screenings and other services to millions of low-income women and men.  

Advocates argue Title X disproportionately serves Black, Latino and Indigenous patients, as well as patients with low incomes and those who live in rural areas. 

In 2019, the Trump administration changed the rules of the program by disqualifying family planning clinics that provided abortions in the same location. It also effectively prohibited clinics that referred patients for abortions from receiving federal funding.  

The changes decimated the program. 

After the rules took effect, about one-quarter of nearly 4,000 providers left the program, including Planned Parenthood affiliates, who served about 40 percent of the program’s patients. 

As a result, several states were left with no Title X providers. The number of patients served fell from 3.9 million in 2018 to 1.5 million in 2020, according to health policy research group KFF. 

Reproductive health advocacy groups had mixed reactions. 

Planned Parenthood Action Fund called it “yet another attack on reproductive freedom” following the Supreme Court’s decision to overturn Roe v. Wade. 

But Clare Coleman, President and CEO of the National Family Planning & Reproductive Health Association (NFPRHA), called the ruling a “win for the Title X” program. 

“This ruling is surprisingly good news, albeit with some unclear implications for Ohio and the network down the road,” Coleman said in a statement. 

“The bottom line is that today’s decision keeps the Biden administration’s rule fully in effect and has no immediate impact on the full network – that should bring welcome relief for patients and providers alike.”