Missouri’s Republican-majority legislature on Wednesday night approved a state budget that strips Planned Parenthood of Medicaid funding.

The proposal prohibits Missouri’s Department of Health and Senior Services, which administers the state’s family planning program, as well as the Department of Social Services, which administers Medicaid in the state, from allocating funds to any abortion facilities. The language denies funds to any affiliate of a facility that provides abortion care, denying Medicaid funds to the state’s 11 Planned Parenthood health centers that do not offer abortion services, but provide preventive health care, such as well woman exams, sexually transmitted infection testing and treatment, birth control, and cancer screenings.

“This at time when Missouri has one of the highest infant and maternal mortality rates and is going in the opposite direction of many states,” said M’evie Mead, director of policy and organizing with Planned Parenthood Advocates of Missouri. “This Republican lead administration is really creating an unbelievably hostile environment for access to reproductive health care in Missouri.”

Cutting Planned Parenthood out of the Medicaid program harms the 7,000 Medicaid patients who visit Planned Parenthood health centers every year in Missouri, and leaves them with few options to access basic preventive health care, Mead said. Planned Parenthood says 95 percent of non-Planned Parenthood providers in Missouri don’t offer evening or weekend hours, 75 percent of non-Planned Parenthood providers do not offer long-acting reversible birth control methods like intrauterine devices, and 49 percent of non-Planned Parenthood providers don’t offer birth control and pap tests.

“Planned Parenthood plays a critical role for people seeking preventive care, so removing that option for patients has a very significant impact,” Mead said. “Politicians say there are other places patients can go and that is simply not true.”

Under federal law, Medicaid funds can’t be used for abortion care, yet anti-choice legislators across the United States have tried for years to strip Planned Parenthood of public funds. Between July 2015 and the end of 2016, mostly Republican lawmakers in 24 states have tried to adopt some kind of funding restriction on Planned Parenthood, according to the Guttmacher Institute.

Missouri has some of the most restrictive anti-choice policies in the United States, including a 72-hour forced waiting period for abortion care. However, Planned Parenthood was able to extend abortion services last year to its health centers in Kansas City and Columbia after the U.S. Court of Appeals for the Eighth Circuit denied a motion from the state to continue enforcing a medically unnecessary law requiring doctors to maintain hospital admitting privileges and abortion clinics to be outfitted like mini-hospitals.

For the third year in a row, Missouri Republicans have attempted to deny Planned Parenthood public funds. This most recent effort to block Planned Parenthood patients from using Medicaid comes months after the Eight Circuit upheld a similar ruling in Arkansas prohibiting Planned Parenthood’s participation in the state’s Medicaid program, even though federal law ensures patients covered by Medicaid have the right to see “any willing provider” of their choice.

Courts have prevented implementation in several states that have attempted similar efforts, including Kansas, Louisiana, Alabama, Mississippi, Arizona, and Indiana.

“The legislative leaders in Missouri have been very supportive of playing politics with reproductive and preventive health care in the budget for the last three years,” Mead said. “Now that there is full Republican control of the political process in Missouri, the house, the senate, and the governorship, those entities are increasing their focus and are not really concerned with the rule of law around discrimination and Medicaid provider rules. They are emboldened both by the eighth circuit as well as the 2016 election.”

The budget now goes to virulently anti-choice Gov. Eric Greitens (R). Mead said Planned Parenthood will pursue any action, including possible litigation, to ensure their patients have access to care.

Missouri GOP legislators have included tax credits for fake clinics in the state budget, joining a host of state legislatures giving tax breaks and government funding to clinics that use anti-choice propaganda to manipulate people seeking abortion care. This comes after Missouri lawmakers in 2015 approved legislation that significantly restricted access to public assistance for families with low incomes.