The Trump administration wants family-planning providers to embrace its anti-trans ideology—or risk losing federal funding. New Jersey and 22 other states are asking a judge to stop it.
The New Jersey Title X lawsuit joins the Garden State with 22 other states challenging the Trump administration’s attempt to attach sweeping ideological conditions, including restrictions targeting transgender people, to federal family-planning grants.
Filed Thursday in the U.S. District Court for the District of Maryland, the lawsuit challenges a new Department of Health and Human Services funding policy that could deny money to states and healthcare providers unless their programs align with the administration’s positions on gender, contraception, marriage and diversity.
The coalition is asking the court to declare those conditions unlawful and block HHS from using them to distribute Title X funding.
The case is led by the attorneys general of New York, Maryland and Massachusetts. New Jersey Attorney General Matthew J. Platkin joined officials from 19 other states, along with the governors of Pennsylvania and Kentucky.
Healthcare funding with an ideological loyalty test
Title X is the country’s only federal grant program specifically dedicated to family planning and related preventive healthcare.
For more than 50 years, the program has helped low-income and uninsured patients obtain birth control, pregnancy testing and counseling, cancer screenings, and testing and treatment for sexually transmitted infections.
Congress provides approximately $286 million annually for the program. Federal law already prohibits Title X funding from being used to pay for abortions.
But HHS introduced an additional “alignment review” for the next five-year grant cycle. Before applications are evaluated on their merits, political appointees can determine whether a proposed program sufficiently reflects the administration’s priorities.
Those priorities include:
- Treating male and female as the only recognized sexes
- Eliminating diversity, equity and inclusion practices
- Excluding or stigmatizing transgender people
- Promoting abstinence and “natural family planning” over contraception
- Counseling patients toward marriage and parenthood
- Complying with unrelated administration priorities, including “ending crime and disorder on America’s streets”
Applicants that fail the review may be denied funding altogether, reportedly without a formal opportunity to appeal.
In other words, HHS is not simply asking clinics to provide effective family-planning care. It is demanding ideological conformity before their healthcare applications are even judged.
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The anti-trans condition is not incidental
Although Title X is principally a family-planning program, the administration’s anti-trans policy is deliberately embedded in the funding process.
Providers could be penalized for recognizing transgender patients, maintaining LGBTQ-inclusive nondiscrimination practices or rejecting the administration’s decree that gender identity cannot be distinct from sex assigned at birth.
That places clinics in an impossible position: discriminate against patients and compromise medically appropriate care, or risk losing the federal support that keeps services affordable for vulnerable communities.
The states argue that Title X’s governing laws and regulations require exactly the opposite. Participating providers must serve patients without discrimination, offer a broad range of contraceptive options and provide neutral, patient-centered counseling.
The administration is attempting to turn those obligations inside out.
It is using a program designed to expand access to care as leverage to pressure healthcare providers into adopting a political definition of who their patients are allowed to be.
The states say HHS exceeded its authority
The lawsuit argues that the conditions conflict with the federal law creating Title X and have little or no relationship to the purpose of the program.
It also alleges that HHS bypassed the notice-and-comment rulemaking process required by the Administrative Procedure Act. That process ordinarily requires an agency to publish a proposed policy, explain it and allow affected organizations and members of the public to respond.
The coalition further contends that the conditions are unconstitutionally vague. Providers cannot make a knowing choice about accepting federal funds, the states argue, when phrases such as “gender ideology” and “alignment” do not clearly explain what conduct is prohibited.
Federal agencies have discretion in administering grant programs. But they generally cannot invent unclear conditions, unrelated to the purpose Congress established, and then use them to force states or recipients to carry out the president’s political agenda.
That distinction is especially important here. Congress created Title X to ensure that income would not determine whether someone could access family-planning care. It did not create a mechanism for presidential appointees to decide whether healthcare organizations are politically obedient enough to receive funding.
More than one attack on trans people
The funding conditions are part of a broader administration strategy: attach anti-trans requirements to federal money, then force states, schools, healthcare providers and community organizations to choose between discrimination and financial survival.
This lawsuit also shows why attacks on transgender rights rarely remain confined to transgender people.
The same funding notice that stigmatizes trans patients also attempts to steer people away from contraception, replace neutral counseling with government-approved messaging about marriage and parenthood, and threaten clinics providing cancer screenings and STI treatment.
Trans people may be the administration’s preferred political target, but the damage spreads outward—to anyone who depends on affordable, confidential and medically appropriate reproductive healthcare.
Why it matters
New Jersey’s participation matters because it rejects the premise that protecting transgender people is somehow separate from protecting healthcare access.
The administration is trying to make discrimination a prerequisite for public funding. If that strategy succeeds, similar conditions can be copied across healthcare, education, housing and other federal grant programs.
The immediate question before the Maryland court is whether HHS can impose these particular conditions on Title X funding. The larger question is whether a president may use essential federal programs as enforcement tools for an ideological campaign against transgender Americans.
New Jersey and the other plaintiffs are asking the court to answer no.
The coalition includes California, Colorado, Connecticut, Delaware, Hawaiʻi, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, Washington and Wisconsin, along with the governors of Kentucky and Pennsylvania.
HHS had not publicly responded to the lawsuit as of Thursday afternoon.
Planned Parenthood and several family-planning organizations have filed separate challenges to the Title X application process.
Primary details of the multistate case are available through the Rhode Island Attorney General’s Office. The new Title X process is also being challenged by the National Family Planning & Reproductive Health Association and ACLU and by Planned Parenthood.
Read More
- New Jersey Is Back in the Fight, Challenging Trump Medicaid Ban on Trans-Youth Care
- HHS Turns Anti-Trans Report Into Federal Referral List for DOJ Investigations
- DOJ Forces Third Children’s Hospital to End Trans Youth Care as Federal Pressure Campaign Expands
- Mount Sinai Abandons Its Young Trans Patients, Agrees to End Gender-Affirming Care