In a landmark decision, the Supreme Court has permitted the Department of Health and Human Services (HHS) to withhold millions in Title X funding from Oklahoma over the state's refusal to comply with federal Title X requirements applicable to providing pregnant clients with information regarding abortion. Despite Oklahoma's argument that these requirements conflict with its strict anti-abortion laws, the Court upheld HHS's authority to impose such conditions—reaffirming the federal government's authority to impose conditions on Title X funding, even when they clash with state legislation.
The dispute began in 2021, when HHS updated Title X rules to mandate that Title X projects offer neutral information on all pregnancy options, including abortion. Oklahoma received a Title X grant for April 2022 to March 2023, which included a requirement to comply with these updated rules. Initially, the state agreed to provide a national call-in number offering neutral information on all pregnancy options. However, Oklahoma later ceased sharing this information, leading HHS to terminate the grant for non-compliance.
Oklahoma brought a lawsuit challenging the termination on three grounds. First, it claimed that HHS had exceeded its authority by imposing conditions on federal funding not clearly specified in Title X. Second, Oklahoma argued that the federal mandate violated the Weldon Amendment, which protects health care entities from discrimination for refusing to provide, perform, or refer for abortions. Lastly, the state asserted that HHS's decision was arbitrary and capricious, claiming that the federal agency had deviated from Title X's statutory framework without proper consideration of the legal implications.
In July 2023, the U.S. Court of Appeals for the Tenth Circuit upheld the federal government's authority to impose the conditions on Title X funds. A divided three-judge panel ruled that HHS had acted within its rights when it terminated Oklahoma's funding, noting that the state had agreed to the conditions of the grant when it applied. The court also found that the federal government had provided a clear and reasonable alternative—offering a hotline number—that would have allowed Oklahoma to remain in compliance with Title X without violating its own abortion laws.
Oklahoma then appealed to the Supreme Court, seeking emergency intervention to prevent HHS from withholding another year's worth of funding. However, the Supreme Court declined, leaving the Tenth Circuit's decision in place. As is typical in emergency orders, the Supreme Court majority did not explain its reasoning; though three conservative Justices (Clarence Thomas, Samuel Alito, and Neil Gorsuch) indicated they would have granted Oklahoma's request.
This decision leaves the Title X funding requirements intact, underscoring the federal government's power to enforce conditions on grants despite conflicting state laws. Title X funds, which total $286 million annually, have long been a point of contention between federal administrations and states over the issue of abortion.
Organizations facing a conflict as between state law and federal funding requirements may want to seek legal advice to navigate the complex regulatory environment and ensure they remain compliant.
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