UPDATE, January 3, 2020, 10:18 a.m.: New Jersey Gov. Phil Murphy (D) signed legislation Thursday that would provide an additional $9.5 million in state funds to family planning clinics that were forced to withdraw from Title X amid the Trump administration’s anti-choice restrictions on the program. For the aid to continue after July 1, Murphy and the state legislature will “have to allocate the funds again in the next state budget,” NJ.com reports.

A handful of states are withdrawing from Title X and replacing the funding so reproductive health clinics won’t have to comply with the Trump administration’s restrictions on the family planning program that serves 4 million low-income patients across the United States.

Meanwhile, Planned Parenthood Federation of America will withdraw its clinics nationwide from Title X if the U.S. Court of Appeals for the Ninth Circuit doesn’t intervene before August 19. The national nonprofit will lose around $60 million by withdrawing from the program, according to the Washington Post.

The restrictions, which went partly into effect in mid-July, ban federal family planning money from going to health-care clinics that refer patients for abortion care. Just a few days later, the administration created confusion by announcing that it “does not intend to bring enforcement actions” against health-care clinics making “good-faith efforts” to comply with the restrictions.

The National Family Planning and Reproductive Health Association called the notice “wholly insufficient.” It said in a statement, “It’s just absurd to think that a few bullet points amount to guidance.” Michelle Kuppersmith, director of Equity Forward, in a statement said the administration’s mixed signals on Title X are “meant to hinder clinics’ ability to operate and encourage health care providers to drop out of the grant program.”

Another domestic “gag rule” restriction that requires clinics maintain physical separation between abortion services and all other health-care services will go into effect next year.

Three states have already stepped in to compensate clinics for the lost federal funding. Officials in other states have said they would assist clinics but haven’t yet clarified their plans. Hawaii Gov. David Ige (D) said in 2018 that the state would reject Title X funding if the administration’s “gag rule” went into effect, and on Friday a spokesperson for the Hawaii State Department of Health said the department is “discussing options and evaluating alternatives for funding services affected by the changes to Title X requirements.” New York Gov. Andrew Cuomo (D) also pledged last year to withdraw from the family planning program if the rule survived court challenges. A spokesperson for the New York State Department of Health told Rewire.News, “We are thoughtfully weighing options that will allow organizations to provide access to critical services without interruption.”

Illinois

Illinois Gov. J.B. Pritzker (D) said July 18 that the state would reject the federal government’s family planning funding, allowing the state’s Title X clinics to continue providing the full spectrum of reproductive health care.

The Illinois Department of Public Health will step in and fund the Title X clinics, which will lose around $2.4 million when the state leaves the program, according to NPR. That money does not include Planned Parenthood of Illinois, which had already announced its plans to reject the Title X dollars. Planned Parenthood served more than 50,000 “female contraceptive patients” in 2015 at its Title X-funded health centers in the state, according to a statement from the organization.

“We will not let that stand in the state of Illinois,” Pritzker said, NPR reported last month. “Under my administration, Illinois will always stand with women and protect their fundamental right to choose. While I’m committed to bringing as many federal dollars to the state as possible, I refuse to sacrifice our values and allow vital care to lapse. In this state, we trust women to make their own health care decisions and will guarantee access to reproductive health care for all of our residents.”

Maryland 

After the administration indicated through its early staffing decisions that it would go after Title X funding, Maryland’s Democratic-held legislature passed a 2017 law to create a state-funded family planning program to help fill any potential gap. Since then, the legislature has continued to support the state’s Title X clinics.

Maryland Democrats passed legislation this year that would fund family planning clinics at the same level as last year despite the state’s loss of federal funding. The move will cost around $4.2 million starting in fiscal year 2021.

The state’s Title X clinics serve more than 67,000 female contraceptive clients, according to 2015 data from the Guttmacher Institute.

“Maryland is very fortunate that our legislators safeguard a woman’s right to access family planning services,” Karen Nelson, CEO of Planned Parenthood of Maryland, told the Associated Press in April. “Our state has to step in far too often to fulfill the responsibility of the federal government.”

Vermont 

Vermont has withdrawn from Title X and will use a contingency fund that the state’s Democratic-majority legislature created for health clinics that rely on federal family planning dollars. The emergency funding will last until the end of June 2020, VTDigger reports.

Complying with the Trump administration’s anti-choice restrictions would violate state law, according to Vermont’s health department. Vermont Gov. Phil Scott (R) has opposed the “gag rule,” saying in an August 19 statement that it’s “important that we maintain women’s rights and access to health care.”

Around 10,000 people in Vermont receive Title X-funded health-care services at ten Planned Parenthood clinics across the state.

“These changes by HHS will disrupt one of our state’s most essential public health programs,” Vermont Health Commissioner Mark Levine said in a statement announcing the state would reject federal funds for Planned Parenthood of Northern New England.

Vermont Attorney General T.J. Donovan in March joined a lawsuit against Trump’s domestic “gag rule.”

“Thousands of low-income Vermonters rely on these funds for their basic healthcare,” Donovan said in a statement after joining the lawsuit. “It’s unreasonable to ask healthcare providers to withhold crucial information from their patients.”

Washington

Washington Gov. Jay Inslee (D) announced in late July that the state would ensure Title X clinics receive state funds, shielding the health-care facilities from complying with the Trump administration’s “gag rule.”

Officials said the state began reimbursing Title X clinics July 15, shortly after the administration started enforcing the restriction. More than half of the people who benefit from Title X funding in Washington state live at or below the poverty line, an Inslee spokesperson told Rewire.News.

Title X funds allowed 18,000 people in Washington state to avoid unintended pregnancies in 2017, according to the state’s lawsuit against the “gag rule.” The lawsuit calls the rule “arbitrary and capricious.”

“It reverses longstanding policies and agency interpretations of Title X with no rational explanation or evidentiary support, backtracks from evidence-backed standards of care included in HHS’s own Program Requirements and guidance, and adds unsupported, illogical, and counterproductive new requirements, while ignoring contrary record evidence and failing to consider the grave public health harms the new requirements will cause,” the lawsuit says.

State officials have been among the most vocal opponents of the restrictions.

“The Trump Administration’s effort to muzzle doctors and keep patients from receiving medically sound care and advice is simply not something we will tolerate in Washington state,” Inslee said in a statement shortly after the Ninth Circuit gave the green light to the rule.

State Attorney General Bob Ferguson called the family planning restrictions “outrageous and unlawful.”

This piece will be updated as more states announce plans to circumvent Trump’s domestic “gag rule.”