Twenty-Three States Sue Over New Title X Grant Conditions

Twenty-three states and state executive officials sued the U.S. Department of Health and Human Services in federal court on August 27, asking a judge to block conditions attached to the next Title X family-planning grant competition.

The complaint, filed in the U.S. District Court for the District of Maryland in New York et al. v. HHS, case 1:26-cv-03405, challenges provisions in HHS’s July 2026 Notice of Funding Opportunity for grants covering the 2027-2032 cycle.

The states allege that the conditions exceed HHS’s authority and could pressure states and health-care providers to change contraception, counseling, referral and nondiscrimination practices to remain eligible for federal funding. The lawsuit seeks declaratory and injunctive relief; the court has not ruled on those claims.

What the HHS grant competition covers

HHS’s Office of Population Affairs lists the upcoming competition as offering up to $257 million through as many as 90 awards. Applications are listed as due January 11, 2027, making the litigation important for states and providers preparing their bids.

Title X is the federal government’s dedicated family-planning grant program. It supports services for low-income, uninsured and underinsured patients, including contraception, sexually transmitted infection testing and treatment, cancer screening, fertility care and pregnancy counseling.

Federal law bars Title X funds from being used for abortions. The dispute instead concerns conditions attached to the upcoming grants, including counseling, referrals and broader program requirements.

What the states are challenging

According to the complaint, the July notice requires applicants and grantees to address administration priorities that include ending diversity, equity and inclusion practices; ending what the notice calls support for “gender ideology”; and reflecting the notice’s stated position that sex is determined by objective biology.

The states also challenge language about ending “overmedicalization,” which the complaint says includes hormonal contraception, as well as provisions involving enforcement of the Hyde Amendment and “life-affirming” program delivery. They object to what they describe as directive counseling toward marriage and parenthood and to other priorities they say are unrelated to Title X, including references to crime, autism, Long COVID and foreign-funded institutions.

New York and Maryland are among the plaintiffs. The coalition consists of 23 states or state executive officials, represented by 21 attorneys general and two governors, according to the complaint and state announcements.

The legal fight

The states argue that the challenged conditions conflict with Title X’s statutory purpose and with requirements for a broad range of family-planning methods and nondirective pregnancy counseling. They also point to regulations requiring services to be provided in an inclusive, equitable and nondiscriminatory manner, including protections involving gender identity and marital status.

The complaint alleges that HHS violated the Administrative Procedure Act by imposing substantive requirements through a funding notice without using the notice-and-comment process generally required for changes to regulations.

The states also raise constitutional concerns under the Spending Clause. In plain terms, they argue that the conditions are too vague and are not sufficiently related to Title X’s purpose, which is to provide family-planning services to low-income patients.

The requested relief includes an order vacating the challenged conditions in the funding notice and an injunction preventing HHS from imposing them on Title X applicants and recipients. Those are requests by the plaintiffs, not current court orders.

What patients and providers should watch

The filing does not immediately cancel existing grants or establish a nationwide cutoff in services. Any effect on patients will depend on the grant competition, HHS’s response, and future court rulings.

The states warn that providers could face a choice between changing established programs and risking rejection in the next funding cycle. They also describe possible clinic closures, reduced services and increased state costs, but those are projected consequences alleged by the plaintiffs rather than confirmed nationwide disruptions.

Maryland officials said the state’s Title X network currently supports 19 local health departments and four private nonprofits, serving 51,561 Maryland residents in state fiscal year 2025. The state also projected that losing Title X support could mean 1,447 fewer Pap smears annually and 25 high-grade cervical precancers going undetected each year. Those figures describe Maryland’s stated risk assessment, not an announced service reduction.

The next major steps are likely to include a request for preliminary relief, an HHS response and a court schedule before the January 11, 2027 application deadline. The case will test how broadly a federal agency may define policy conditions for a congressionally funded health program while the grant competition is pending.

For now, the lawsuit creates uncertainty around the next Title X funding cycle rather than an immediate change for patients. Its central question is whether HHS may use the grant notice to impose the disputed policy conditions while the existing statutory and regulatory framework remains in place.

Sources

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