Tennessee is the latest state to attempt to prohibit abortion care providers from receiving reimbursements for serving patients with low incomes through the state’s Medicaid program.

Congressional Republicans and GOP-majority state legislatures have long sought to block funding to Planned Parenthood, which received $543.7 million in government funding through federal reimbursements and grants during fiscal year 2016, according the organization’s annual report.

The Hyde Amendment already prohibits the use of federal Medicaid funds for abortion services, except in limited circumstances.

The Trump administration in January rescinded Obama-era guidance that stated excluding Medicaid funding for health-care providers that offer abortion care violates federal law. The Obama administration issued the guidance in response to state-level GOP efforts to defund Planned Parenthood—attacks on health care for people with low incomes.

Danielle Wells, assistant director of state advocacy media for Planned Parenthood Federation of America, told Bloomberg Law that the efforts by state lawmakers are a “backdoor attempt” to block the health-care organization from providing reproductive care.

“State politicians, in lock step with the Trump-Pence administration, are bending the rules to take away women’s health and rights any way they can,” Wells said.

Tennessee Gov. Bill Haslam (R), a staunch opponent of abortion rights, signed legislation in April to avoid the “direct or indirect use of state funds to promote or support elective abortions.”

HB 2251, sponsored by Rep. Jimmy Matlock (R-Lenoir City), directs the state to seek a waiver from the Centers for Medicare and Medicaid Services (CMS) to exclude providers from participating in the state’s Medicaid program if inclusion of the provider in the program would result in the use of state funds for abortion.

The bill, which was passed by wide margins in the GOP-dominated state legislature, is based on copycat legislation drafted by Americans United for Life (AUL), the self-described “legal architect” of the anti-choice movement.

Dr. Wendy Long, director of TennCare, on August 10 submitted a request to exclude from the state’s Section 1115 Medicaid waiver any provider or affiliates of any provider that has performed more than 50 abortions in the previous year.

Sarah Tanksley, spokesperson for TennCare, told Nashville Public Radio that seven providers, including Planned Parenthood, would be prohibited from participating in TennCare. Tanksley declined to identify the other providers.

“I cannot disclose that,” Tanksley said. “Under state law, that is confidential information about reports made to the state regarding abortions, and the identity of the providers is confidential.”

CMS responded to Tennessee officials’ request on Friday to say that the agency had “completed a preliminary review” of the request and “determined that the state’s amendment request has met the requirements for a complete amendment.”

The amendment application has been posted online for public comment, and as of Wednesday only 65 responses were posted. One of the public comments charged that Tennessee “is effectively making abortion services unavailable to the Medicaid insured population. … It is a gross overstep of the state to believe they know more about any women’s health decision than the woman herself. Passing this amendment will only serve to put more women’s lives at risk.”

Another commenter said this anti-choice effort is “not about abortion services as we know federal funds are not used for abortion services. It is about abridging the rights of citizens, particularly women, and this should never be the role of government.”

The public comment period will end on September 23.

After reviewing the public comments, CMS will make a final determination on Tennessee’s request.