OAKLAND, CA — California Attorney General Rob Bonta, joined by Hawai‘i Attorney General Anne E. Lopez and 19 other state attorneys general, is calling on the Trump administration to immediately reinstate tens of millions of dollars in Title X family planning funding that was suddenly revoked by the U.S. Department of Health and Human Services (HHS) on March 31, 2025. In a sharply worded letter sent to HHS Secretary Robert F. Kennedy, Jr., the multistate coalition warned that the decision will result in widespread clinic closures, layoffs, and dramatic reductions in access to essential health services for low-income communities.
The Title X program, signed into law by President Richard Nixon, remains the only federally funded initiative solely focused on family planning and reproductive health services for uninsured and underserved populations. According to the letter, the Trump administration’s abrupt decision has cut off funding to organizations that support nearly 25 percent of all Title X clinics in the United States. The consequences have already begun to cascade through state healthcare systems.
In California, Hawai‘i, and Maine, where Title X funds were wholly allocated to the now-defunded grantees, funding has entirely ceased. In California alone, nearly half of Title X providers have reported likely or immediate staff layoffs, while more than 60 percent expect reductions in family planning services. At least one clinic has announced plans to close. In Hawai‘i, a majority of facilities are preparing for immediate cuts in sexual and reproductive health services. And in Maine, Title X providers in rural areas say patients may be forced to travel hours to access contraception—if they can access it at all.
Attorney General Bonta emphasized that the decision will not only hurt patients but also burden states financially. “Exactly one month ago, the Trump Administration decided to withhold tens of millions of dollars in Title X funding. Today, my fellow attorneys general and I are urging the Trump Administration to do the right thing,” Bonta said. “HHS Secretary Kennedy claims to want to ‘Make America Healthy Again’ — restoring Title X funding would do just that.”
The letter cites the disastrous precedent of the 2019 Trump-era Title X rule changes, which caused a mass exodus of healthcare providers from the program and led to a more than 60 percent drop in the number of patients served nationwide. Between 2018 and 2020, the number of Title X service sites fell by nearly 1,000. Title X patients dropped from 3.9 million to 1.5 million, with some states experiencing reductions of more than 80 percent. The letter warns that the 2025 funding freeze is likely to replicate and worsen these outcomes. The Guttmacher Institute estimates that 834,000 people—around 30 percent of all Title X recipients—will lose care within a year if the funding is not restored.
The health consequences are already predictable and quantifiable. During the 2019 reductions, Title X clinics performed over one million fewer STI tests, 276,000 fewer HIV tests, and 90,000 fewer cervical cancer screenings. Clinics provided significantly fewer contraceptives, resulting in more unintended pregnancies. The majority of these patients were low-income or uninsured, and, for many, Title X clinics were their only access point for comprehensive reproductive healthcare.
States are now being asked to fill the void. During the last crisis, emergency appropriations were required to backfill lost services. New York alone allocated $14.2 million; California, $348,000 in grants; and other states, including Colorado, Hawai‘i, Illinois, Michigan, New Jersey, and Oregon, made similar commitments ranging from hundreds of thousands to tens of millions of dollars. Bonta and his fellow attorneys general argue that states should not be forced to subsidize the consequences of an ideologically motivated policy shift that lacks any evidentiary justification.
Adding to the concern is the legal ambiguity surrounding HHS’s justification for the terminations. While the agency vaguely alluded to potential civil rights violations, the letter asserts that no actual evidence has been presented. Some of the statements cited as grounds for termination were general affirmations of anti-racist values or unrelated comments pulled from public websites. The letter characterizes these citations as “utterly pedestrian” and concludes that the federal government is using civil rights concerns as a pretext to eliminate funding to organizations that offer or refer patients for services disfavored by the administration.
“There is no basis to cause these public health harms that disproportionately affect individuals with low income—HHS has failed to identify any actual wrongdoing by the affected grantees,” the attorneys general wrote. “The suggestion of violations unsupported by any evidence cannot outweigh the immediate and empirically validated harms to patient care and state budgets that will result from the abrupt terminations.”
The financial toll of this decision is staggering. According to Guttmacher, publicly funded family planning services saved governments $11.9 billion in 2016 alone, translating to $4.83 saved for every $1 spent. The public cost of each unintended pregnancy averages $7,950. Even miscarriages cost taxpayers over $1,200 each. Colorado’s family planning initiatives alone are credited with avoiding nearly $70 million in public assistance costs by improving access to long-acting contraception.
The letter concludes with a stark warning: the damage from these terminations is already being felt and could become irreversible within weeks. Clinics facing payroll deadlines are preparing to lay off staff and suspend services. “We accordingly request that HHS immediately reinstate the withheld funding, restoring funding to the Title X program,” the attorneys general wrote.
The letter was signed by attorneys general from California, Hawai‘i, Arizona, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, and Washington.
