An Ohio affiliate of Planned Parenthood said it will not accept Medicaid insurance because of uncertainty around a judge’s ruling ordering the Trump administration to continue sending Medicaid reimbursements to all Planned Parenthood health centers.
The operator of four clinics said it was concerned the administration could try to claw those payments back if the ruling is overturned. A second group of a dozen health centers is not offering long-acting contraceptive devices for Medicaid patients for similar reasons.
The moves come after US district judge Indira Talwani blocked a provision of the sweeping tax bill that “defunds” abortion providers for one year if they received more than $800,000 in Medicaid reimbursements in 2023. (The payments would be for non-abortion services like birth control and STI testing, as federal law already prohibits the program from covering abortions outside a few exceptions.)
The order prevents the administration from enforcing the law against Planned Parenthood; an independent provider in Maine filed a separate suit and a hearing is scheduled for next week.
The Trump administration filed notice on Tuesday that it would appeal the ruling to the first circuit court of appeals; the case will almost certainly make it to the US supreme court. Roughly a dozen Planned Parenthood clinics have announced closures since the bill was signed into law, with the latest including the organization’s only two health centers in Louisiana.
Planned Parenthood Gulf Coast said its New Orleans and Baton Rouge clinics would close on 30 September.
Planned Parenthood Southwest Ohio (PPSWO), one of two affiliates in the state, said in a statement that, while it was “relieved” to see Talwani’s order, it would not resume accepting Medicaid, though it was seeing Medicaid patients who self-pay.
“Unfortunately for many smaller affiliates, the risk of the federal government requesting back pay if the injunction expires is still too great,” a spokesperson said, citing legal filings in which the Trump justice department said it would seek to “claw back” payments if it ultimately wins the case.
“We’re trying to mitigate that risk to preserve our capacity to offer the other critical services south-west Ohioans and hundreds of patients from the south come to us for,” a PPSWO spokesperson added, mentioning abortion and gender-affirming care.
PPSWO closed two health centers at the end of July, leaving it with four clinics. The spokesperson said the judge’s injunction did not allow it to reopen the shuttered clinics in Springfield and Hamilton.
“Across the country and even within a state we may see different strategic approaches to this devastating loss [for affiliates],” the affiliate said. “This course of action was ultimately the best option for us with long-term sustainability in mind.”
The other Ohio affiliate, Planned Parenthood of Greater Ohio (PPGOH), said that, while it was accepting Medicaid at its 12 clinics after the injunction, it would not provide intrauterine devices or birth control implants to Medicaid patients – unless they self-pay for the devices and the insertion appointments. These forms of long-acting reversible contraception are some of the most effective, but they are costly and can be hard for low-income patients to access.
Nearly all Planned Parenthood clinics offer same-day insertions of IUDs and implants, compared with 60 to 70% of other family-planning clinics and health departments, per the Guttmacher Institute.
In a statement to the Guardian, PPGOH said it would not offer IUDs or Nexplanon implants to patients with Medicaid over fears that the Trump administration will demand that money be repaid if it ultimately wins in court.
“These are the most expensive services we provide and to protect the organization from the risk of extreme financial loss, we can’t risk providing these services now and then never having the claims paid,” a PPGOH spokesperson said.
Planned Parenthood Federation of America is the umbrella organization that oversees a network of nearly 50 independent regional affiliates, which run roughly 600 clinics across the US. The budget bill defines abortion clinics as “prohibited entities” for Medicaid if they hit the aforementioned reimbursement threshold and perform abortions as of 1 October.
During negotiations for the bill, when the “defund” period was 10 years, PPFA’s accreditation board informed affiliates about new waivers to seek approval to cease providing abortions; doing so may allow them to remain in Medicaid. It’s not known if any affiliates have submitted such waivers after the one-year provision was signed into law, but some are changing their billing practices, such as in Ohio.
Other affiliates, meanwhile, have said they are back to processing Medicaid insurance claims as they typically would following the preliminary injunction. Planned Parenthood of Wisconsin’s chief strategy officer, Michelle Velasquez, told NPR that the judge’s 28 July ruling “means that there is no doubt about whether or not we can provide that care” to patients with Medicaid.
Planned Parenthood of the Rocky Mountains and Planned Parenthood of Maryland confirmed to the Guardian that they had resumed billing the health insurance program.
Some are proceeding with caution. As of Thursday, Planned Parenthood of Orange and San Bernardino Counties in California had a notice on its website saying that Planned Parenthood “has been blocked” from receiving Medicaid funds.
When contacted for comment, a spokesperson said: “PPOSBC is in the process of carefully resuming its billing for California Medi-Cal services it has provided since the defunding provision was passed, tracking all legal and regulatory updates from the court and the state, and modifying its approach as changes occur to ensure ongoing compliance with currently applicable law.”