LANSING — Michigan Attorney General Dana Nessel has joined a coalition of 21 attorneys general in sending a letter (PDF) to the Trump Administration to express serious concern with the U.S. Department of Health and Human Services’ (HHS) decision to withhold tens of millions of dollars in Title X funding. Signed into law by President Richard Nixon, Title X is the nation’s only federal program dedicated to family planning for low-income and uninsured individuals. On March 31, HHS issued letters to a wide range of grant recipients that fund nearly 25% of all Title X clinics, indicating that these grantees’ Title X grants were being withheld. In the letter, the attorneys general write that the withholding of funds will lead to more unintended pregnancies, more sexually transmitted infections (STIs), increased rates of undiagnosed HIV, increased rates of cervical cancer, and a higher burden on over-stretched state budgets. The attorneys general urge HHS Secretary Robert F. Kennedy, Jr. to immediately reverse this decision and fully fund these critical programs.   

“Millions of Americans rely on the essential health care services supported by Title X funds, including breast and cervical screenings, well-woman exams, STI screenings and treatment, and many reproductive health services,” Nessel said. “Withholding this critical funding from states is just another irresponsible and unjustified move by the Trump White House, especially in the absence of any evidence that the states and providers affected violated federal law. While Michigan has not yet been impacted by this move, our providers could be next. I am proud to stand with my colleagues in urging the Trump Administration to immediately restore Title X funding.” 

Withholding vast amounts of Title X funding is the latest move by HHS to terminate critical funding. Attorney General Nessel recently sued HHS for abruptly and illegally terminating nearly $11 billion in critical public health grants nationwide, including $379.3 million in grant funding awarded and owed to the State of Michigan. In certain states — including California, Hawai‘i, and Maine — all Title X funds were withheld, meaning that Title X funding has now completely ceased in those states. Everywhere, states must scramble to fill the gaps as healthcare providers who have long been a cornerstone of the Title X program have been suddenly shut out. If state and local governments are not able to make up for the federal shortfall, patients will see a reduction in services as clinics close and providers are terminated. This will fall particularly hard on poor and rural communities that are the primary beneficiaries of the Title X program. In many areas, a Title X clinic is the only source of pre-natal services and screening for STIs.  

In the letter, the attorneys general write that: 

• Recent history demonstrates that cutting Title X grants will worsen care. In 2019, the Trump Administration changed the rules governing Title X, leading to a mass loss of healthcare providers. As a result, the number of patients receiving Title X services fell drastically. Nationwide, the number of Title X patients fell more than 60%, from 3.9 million to 1.5 million. This recent history demonstrates what happens — and how quickly — when the federal government slashes access to Title X. Unfortunately, there is every reason to think that the Trump Administration’s recent withholding will have at least as bad an impact on patient care. In total, the Guttmacher Institute estimates that as a direct result of HHS’s action in withholding funds, at least 834,000 patients, representing 30% of the total population served, will lose care in the first year alone. 

• The states will be harmed by HHS’s decision. While the 2019 rule was in effect, many states were forced to make emergency appropriations to cover for the loss of providers. They made these expenditures because Title X programs are a critical component of vital public health infrastructure. An important example is the role of Title X programs in detecting and preventing STIs. Between 2006 and 2010, 18% of all women who were tested, treated, or received counseling for an STI did so at a Title X clinic, as did 14% of women tested for HIV. Now, states are once again faced with an impossible choice: dip once again into depleted public coffers to make up the difference, or deal with a surge in new STIs and unintended pregnancies.   

• There is no justification for the terminations. Although HHS suggested Title X grantees violated federal civil rights laws, HHS has provided absolutely no evidence supporting this suggestion.  

In sending the letter, Attorney General Nessel joins the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, Hawai‘i, Illinois, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, and Washington.