HHS conditioned FY2027 Title X family-planning grants on anti-DEI, anti-contraception, and anti-trans compliance, risking total funding loss

On April 3, 2026, the U.S. Department of Health and Human Services' Office of Population Affairs (OPA) posted a Notice of Funding Opportunity, PA-FPH-27-001, for the next five-year cycle of Title X family-planning grants. The notice required applicants to pass a non-appealable "alignment review" tying eligibility to department priorities that included ending diversity, equity and inclusion practices; "reducing overmedicalization" of hormonal contraception in favor of natural family-planning methods; counseling patients toward marriage and parenthood; and delivering care consistent with what OPA called "biological reality" rather than gender-affirming treatment for transgender patients. Recipients found out of compliance risked losing their Title X funding entirely.

Title X, enacted by Congress in 1970, is the only federal grant program dedicated to family planning and reproductive health services, and has historically prioritized low-income and uninsured patients; Congress appropriated $286 million for it in fiscal year 2026. A similar conditioning strategy was used during the first Trump administration, when a 2019 rule barring Title X providers from discussing abortion caused nearly a quarter of the program's grantees nationwide to drop out before the Biden administration rescinded it in 2021, ahead of a Supreme Court ruling.

Updates

2026-06-18 — Family-planning provider organizations sued over the funding notice [3]

The National Family Planning and Reproductive Health Association and the Family Health Council of Central Pennsylvania sued HHS in federal court, arguing the notice's conditions conflicted with Title X's own statutory award criteria and that its non-appealable "alignment review" could disqualify longstanding grantees on political grounds.

2026-07-09 — HHS released a revised version of the funding notice [4]

OPA released a revised Notice of Funding Opportunity for the FY2027 Title X cycle, again conditioning grant eligibility on the department's political-alignment priorities.

2026-07-28 — Planned Parenthood Federation of America sued over the revised funding notice [4]

Planned Parenthood Federation of America sued HHS in the U.S. District Court for the District of Columbia, arguing the revised notice's "alignment" priorities were unconstitutionally vague, conflicted with Title X regulations on contraceptive access and gender-identity nondiscrimination, and violated the Administrative Procedure Act and the Spending Clause.

2026-08-27 — 23-state coalition sued over the revised notice [5, 6, 7]

A coalition of 23 states and territories led by New York Attorney General Letitia James, co-led by Maryland and Massachusetts, sued HHS in the U.S. District Court for the District of Maryland. The states said the revised notice's conditions -- which they characterized as discouraging contraception, "excluding and stigmatizing transgender people," and requiring clinics to counsel patients toward marriage and parenthood -- were imposed "arbitrarily and capriciously" without notice-and-comment rulemaking, in violation of the Administrative Procedure Act and the Constitution's Spending Clause. HHS declined to comment on the pending litigation.