Supreme Court Allows Feds to Withhold Title X Funding from Oklahoma

Washington — The Supreme Court has officially declined to consider a request from Oklahoma state officials aimed at restoring federal family planning grant funding to the state’s health department. The refusal is a consequence of the department’s decision not to provide patients with a hotline number, which would offer counseling on pregnancy options, including abortion services.

The justices chose not to grant emergency relief to Oklahoma, which was seeking an immediate halt to the Department of Health and Human Services’ (HHS) withholding of $4.5 million in federal Title X funding. Only Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch indicated they would have supported the request from Oklahoma.

This latest dispute surrounding abortion follows the Supreme Court’s June 2022 decision that overturned Roe v. Wade. Since the ruling, many states, including Oklahoma, have enacted strict measures either banning or severely limiting access to abortion. In contrast, the Biden administration has been actively working to safeguard access to reproductive healthcare at the national level, particularly through emergency care laws that have sparked legal challenges, including this recent case.

The rule that triggered this controversy regarding Title X funding was introduced in October 2021, prior to the Supreme Court’s reversal of Roe. It mandates that Title X projects must provide “nondirective counseling” about all family planning options to pregnant patients, including abortion, and inform patients about where they can access these services.

The Oklahoma State Department of Health had received a Title X grant in 2022 to assist local health departments financially. However, discussions arose between the department and the Biden administration after Oklahoma enacted legislation that effectively bans abortion. This new law also imposed felony charges for anyone advising or assisting a woman in obtaining an abortion.

Initially, the state and the federal government reached an agreement permitting the health department to comply with the Title X rule by providing patients with the option to call a national hotline for counseling. As a result, HHS agreed to continue the funding for the period from April 2023 to March 2024.

However, the Oklahoma health department later reneged on this agreement, deciding it would not offer the hotline number to patients seeking counseling. This shift led to the Biden administration terminating the funding, asserting that the state was not adhering to the 2021 mandates.

In response, Oklahoma officials filed a lawsuit seeking to prevent the federal government from terminating the funding and pressed for continued future support. The state contended that the Biden administration’s actions violated the Constitution’s Spending Clause and a federal statute known as the Weldon Amendment, which protects entities from being forced to facilitate abortions.

In previous rulings, both a federal district court and the U.S. Court of Appeals for the 10th Circuit sided with the Biden administration. The appeals court ruled that Congress allows the federal government to set the stipulations for Title X grants based on conditions deemed appropriate by the HHS secretary.

The appeals court also found that the Biden administration’s actions were not in violation of the Weldon Amendment, as Oklahoma could not demonstrate evidence of discrimination tied to its refusal to offer abortion referrals.

As Oklahoma sought Supreme Court intervention, officials claimed that the state’s health department lost the $4.5 million “solely” because it would not provide referrals for abortions. They highlighted that Title X funds are essential for family planning services delivered by local health departments, warning that cutting off these resources would have severe consequences for Oklahoma’s communities.

Oklahoma maintained that the federal government cannot impose obligations on the state regarding abortion referrals that are not explicitly mandated by Title X.

The Justice Department countered, emphasizing that Oklahoma still retains the authority to regulate abortion and questioning how providing a referral to a hotline could conflict with the state’s abortion law.

Furthermore, the state health department was advised that it could voluntarily decide to opt-out of Title X funding altogether. HHS justified it’s stance, arguing that counseling and referrals are vital for ensuring comprehensive, patient-centered care. Without them, patients would be deprived of crucial neutral information regarding all pregnancy options, which contradicts Title X’s primary objective.

Oklahoma had requested a swift decision from the Supreme Court, hoping to resolve the matter before August 30, the date when HHS planned to distribute the federal funds to other entities.

Meanwhile, a similar dispute is unfolding in Tennessee, where the federal administration withheld a $7 million Title X grant due to the state’s refusal to provide a hotline for patients. After the Supreme Court’s overthrow of Roe v. Wade, Tennessee also established strict abortion laws and proposed only to offer information on legal options available within the state.

Both the district court and the 6th Circuit Court of Appeals have rejected Tennessee’s request to retain the funding.