A federal appeals court this week refused to reinstate federal family planning grants to Oklahoma after the state refused to provide abortion referrals in its family planning services. 

The state in November filed a lawsuit against the U.S. Department of Health and Human Services (HHS) after the Biden administration suspended “millions of dollars” in Title X federal family planning funding. 

Oklahoma said in the lawsuit that HHS “overreached by unlawfully suspending and terminating millions of dollars of Title X grant funding” to the state after it would “not commit to providing referrals for abortion” in its own family planning programs.

Title X is a Nixon-era federal family planning program enacted in 1970. It distributes federal grants to community clinics and health departments in order to provide contraception services and other family planning and health services. Federal law forbids Title X funding from being used to directly procure abortions. 

A U.S. district court had earlier rejected the state’s request for an injunction against HHS. In a decision on Monday, the U.S. Court of Appeals for the Tenth Circuit upheld the lower court’s decision, agreeing that “the combination of Title X and the HHS requirements” doesn’t violate the spending power of Congress, and that the state “acted voluntarily and knowingly when accepting HHS’ conditions” regarding the federal funding. 

Citing the lower court’s ruling, the appeals court said in part that the “act of sharing the call-in number” wouldn’t constitute “a referral for pregnant women to get abortions.” 

In a dissent to the Monday ruling, Judge Richard Federico argued that Oklahoma was entitled to the injunction due in part to the “irreparable harm” the state will suffer from the loss of about $4.5 million in Title X funds.

“The termination of the financial grant is actual, irreparable harm that will occur before the district court rules on the merits of the case, warranting relief,” Federico wrote.

In a statement on Tuesday, Oklahoma Attorney General Gentner Drummond told CNA he was “disappointed by the ruling.” 

“As the dissent rightly points out, ‘rather than complying with its statutory obligations,’ the federal government stripped millions in funding from the Oklahoma Health Department because it refused to refer women for abortions,” Drummond said. 

“Moreover, the dissent wrote, this ‘violation of’ federal law ‘reduces access to health care for those who need it most,’” the prosecutor added. 

“We will appeal the court’s decision,” he said. 

The dispute is part of a larger back-and-forth series of abortion regulations issued first by the Trump administration and then the Biden administration. 

In 2019, the Trump administration issued a rule “prohibiting referral for abortion as a method of family planning,” directing that Title X recipients were “not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.”

In 2021 the Biden administration reversed that rule. Oklahoma’s lawsuit last year said the White House now requires that Title X recipients offer pregnant women “the opportunity to be provided information and counseling regarding” abortion.