HHS Silence on Medicaid Cuts Leaves Planned Parenthood in Limbo

Planned Parenthood affiliates and other health centers remain in the dark on cuts to their federal Medicaid reimbursements as the government shutdown delays the Trump administration’s enforcement of a pause on funds to certain abortion providers.

The provision, part of Republicans’ tax-and-spending package signed into law this summer, removes funding for one year from large health centers that as of Oct. 1 provided abortion care.

Providers say they’ve yet to receive guidance from the Centers for Medicare & Medicaid Services on who falls under the law’s definition of a “prohibited entity,” and when the pause will officially begin.

The threat of enforcement, along with an ongoing freeze on federal family planning grants, has forced Planned Parenthood affiliates to announce closures of more than 30 clinics so far this year, according to a Bloomberg Law analysis. Some affiliates have stopped accepting Medicaid as a form of payment, while others opted to end abortion services altogether.

As sweeping staffing cuts hit the Department of Health and Human Services, abortion providers say it’s unclear when they will receive federal guidance. The uncertainty and anti-abortion advocates’ push for an extension to the reimbursement pause will further disrupt low-income Americans access to contraception, STI testing, and other care long after next year, policy analysts say.

“You can’t just turn this off and then turn it back on again,” Christina Chang, executive director of the US governors’ coalition Reproductive Freedom Alliance, said of the federal Medicaid funding.

“The damage that is going to be done with even a temporary pause on reimbursement is going to have a lasting impact in terms of people’s access,” Chang said in an interview.

Planned Parenthood has received funding from Bloomberg Philanthropies, the charitable organization founded by Michael Bloomberg. Bloomberg Law is operated by entities controlled by Michael Bloomberg.

Open Questions

The provision pausing federal Medicaid funds, which courts have allowed to go into effect while litigation is ongoing, applies to family planning centers that provide abortions as of Oct. 1 and received more than $800,000 from Medicaid in 2023.

But the law leaves HHS wide latitude on when to start cutting off Medicaid reimbursements, and which health centers will be included, analysts say.

One of the lingering questions is whether individual Planned Parenthood affiliates that have stopped offering abortions will continue receiving federal funding, said Alina Salganicoff, senior vice president and director of the Women’s Health Policy Program at KFF.

The statute says any “affiliates” of a prohibited entity could be subject to the reimbursement pause. The CMS hasn’t outlined how it’s defining “affiliate,” leaving Planned Parenthood’s 47 affiliates “guessing” on “whether they are entitled to receive federal Medicaid reimbursements,” the organization wrote in an Oct. 13 brief in one of the ongoing cases.

HHS said in an Oct. 3 status report filed in the US Court of Appeals for the First Circuit that the shutdown “may nonetheless delay the development of implementation guidance,” noting that the government “has not made any specific designations to date.”

HHS Press Secretary Emily Hilliard said in an email that “mission-critical activities at CMS will continue” during the shutdown but didn’t address whether this included the implementation guidance.

With recent mass layoffs at HHS, however, “it’s not clear that there’s adequate staffing at HHS to answer some of these questions that the states and providers have,” Salganicoff said in an interview.

‘Worst-Case Scenario’

The ambiguity is forcing Planned Parenthood affiliates and reproductive health providers to make legal and logistical determinations on how to move forward.

“Each member is making their own best decision given their individual circumstances,” said Brittany Fonteno, president and CEO of the National Abortion Federation. The organization represents Planned Parenthood affiliates, independent clinics, and other abortion providers.

Democratic governors in Colorado, Massachusetts, and other states have committed to supporting Planned Parenthood and are preparing for the “worst-case scenario and assuming that providers are not going to be eligible for Medicaid,” Chang said.

Planned Parenthood of Illinois is planning to continue operating with support from the state legislature, despite facing a potential $4 million loss in federal Medicaid reimbursements, said Adrienne White-Faines, the affiliate’s president and CEO. White-Faines said she’s seen a 50% increase in the number of abortion patients from Wisconsin since that state’s affiliate announced a pause on abortion services earlier this month.

“The need doesn’t change because the eligibility or because the coverage has changed,” White-Faines said.

Future Threats

The longer the shutdown persists, the more pressure providers face as other federal programs are threatened.

Family planning grants under Title X of the Public Health Service Act that the Trump administration paused earlier this year, as well as health education grants issued by the CMS and Centers for Disease Control and Prevention, “all come into question if you look down the road,” White-Faines said.

Providers also face an anti-abortion lobbying campaign to make the pause on federal Medicaid reimbursements to major abortion centers permanent.

“We are preparing a huge push for debarment of Planned Parenthood at the federal level,” Kristi Hamrick, vice president of media and policy for the anti-abortion group Students for Life of America, said in an email.

The Hyde Amendment already prohibits federal dollars from paying for abortions, but anti-abortion groups argue that no taxpayer dollars should be going to help support centers that provide abortion care.

States should be thinking about long-term responses to reproductive health-care disruptions, which will continue even if a court blocks the Medicaid funding pause or once it expires after a year, Chang said.

“It’s going to make sweeping changes in terms of access for the most vulnerable patients, on cancer screening, on contraception, on STI care,” Chang said.