UPDATE, September 11, 9:15 a.m.: On Wednesday, the North Carolina House voted to override Gov. Roy Cooper’s veto and approve the budget that includes record funding for anti-choice fake clinics. Republicans pushed through the vote over the vocal protests of Democrats, who said the move was a surprise. The budget now goes to the Senate.

Last year, Rewire.News revealed that anti-choice pregnancy centers in North Carolina illegally bought religious propaganda with federal funds. State regulators vowed in response to strengthen oversight and moved to recoup the misused money.

But even as the North Carolina Department of Health and Human Services (DHHS) confirmed the anti-choice Carolina Pregnancy Care Fellowship (CPCF) had misspent public money—to the tune of $50,000—on sectarian content in violation of federal law, the agency continued to allow the use of federal funds for some religious materials, Rewire.News found. Documents obtained through a public records request revealed the state approved materials that encouraged parents to pray with their children, told men whose partners have had abortions to “handle your personal guilt before God,” and exhorted women to embrace the “blessing” of marriage as “a sacred institution created by God in the Garden of Eden.”

The records provide a window into the monthslong scramble by state officials to determine how much federal block grant money—intended to address maternal and infant mortality in a state with some of the worst outcomes in the country—CPCF had misused on Bible study courses and other religious materials. After it concluded in late 2018 that CPCF had misspent approximately $50,000 in public funding over five years, DHHS never informed the state legislature. Amid a budget battle between the Republican-led legislature and Democratic Gov. Roy Cooper, lawmakers are poised to give more than a dozen anti-choice fake clinics a record amount of at least $2.64 million in state funds this year. Many of those clinics are under the CPCF umbrella.

Following six years of federal block grant funding, CPCF is set to see that money cut off; instead, legislators’ most recent budget designates $400,000 for it annually in state funds, which come with fewer requirements. (Bobbie Meyer, state director of CPCF, which now goes by LIFElink Carolina, called the shift a “mutual decision” with the legislature.) The budget also gives CPCF permission to spend money left over from the 2019 fiscal year, when DHHS confirmed the group spent only $600,000 of its $1 million in state funds. By far the biggest winner in the budget is the Texas-based Human Coalition, which is set to see its funding quadruple to $1.2 million a year, even though documents show it has failed to meet basic reporting requirements over the past two years. In fact, records obtained by Rewire.News show the group was so uncommunicative about how it used a $300,000 state grant in the 2018 fiscal year that CPCF, which was supposed to administer the grant, asked the state to intervene and take over the contract for 2019. When the sparse reporting continued, DHHS wrote in a report to lawmakers this April that Human Coalition “has not provided all of the required information for the full and timely completion of this report,” and the group’s model “cannot be identified as evidence-based or even a best practice.”

It’s unclear which lawmakers saw that report.

“I didn’t even know the report existed until you notified me today,” Sen. Mike Woodard (D-Durham), a member of the Joint Legislative Oversight Committee on Health and Human Services—the body to which the report was addressed—told Rewire.News last week. “I would have liked to have had that information and the department’s findings presented in the report before we had our budget discussion.”

Three days after the date on the report, lawmakers voted to quadruple Human Coalition’s funding.

“Whether you agree or disagree with the Human Coalition’s mission or their goals this is just bad government,” Rep. Julie von Haefen (D-Wake County) told Rewire.News. “I mean, we’re putting more money into a program that we have had no oversight over.”

Records show another anti-choice group, Mountain Area Pregnancy Services in Asheville, was so unprepared to handle budgeting and performance requirements for the $250,000 federal grant it received from lawmakers for the 2019 budget year that it ultimately turned down all but $46,235—less than a fifth of what the legislature has sought to give it annually for the next two years.

Both of these groups have faced their own questions about whether they are promoting religious ideology with public funds. In a statement of faith displayed prominently on its website, MAPS declares: “We believe the Bible to be the inspired, the only infallible, authoritative Word of God.” “Most everything about Mountain Area Pregnancy Services reminds visitors that it is a Christian organization,” the Asheville Citizen Times wrote last year.

Human Coalition calls itself a “ministry,” and its volunteer application asks if applicants have made “a personal profession of faith in Jesus Christ,” according to the watchdog organization Campaign for Accountability, which called on DHHS in March to end its contract with the group. In reports to DHHS on how it was using its 2019 state grant, Human Coalition said it was connecting clients to “spiritual support” and had referred at least one client to a “faith community.”

“It’s hard to say what the non-religious purpose of that would be,” Alice Huling, counsel at the Campaign for Accountability, told Rewire.News. “When you have any state or federal money that is coming from taxpayers of all persuasions that is then being funneled into an institution that is using that money to promote a particular religious ideology, that is just diametrically opposed to how our government is supposed to work,” she said.

“I Feel Like Running Away”

Hours after Rewire.News published our investigation on CPCF’s misuse of federal funds on April 26, 2018, Tara Owens Shuler, perinatal health unit manager in the Division of Public Health at DHHS, wrote a distressed email to a colleague.

“I am sure you have gotten the update about CPCF!” she wrote. “I feel like running away…”

The email reflected tensions within the agency after Rewire.News revealed DHHS had allowed the anti-choice groups to use federal money for religious content, including materials intended to help men “discover authentic manhood as modeled by Jesus Christ.”

“FYI…..I plan to call CPCF tomorrow morning and request they review their FY19 budgets for religious content and resubmit,” Belinda Pettiford, head of the women’s health branch in the Division of Public Health at the agency, wrote to colleagues hours after the article published.

“I’ll remind them of the federal language,” Pettiford added. That language allows faith-based groups to receive federal funding as long as they don’t use it to “support or engage in any explicitly religious activities (including activities that involve overt religious content such as worship, religious instruction, or proselytization).”

Since the 2014 budget year, CPCF has used a portion of the federal Maternal and Child Health block grant allocated by the North Carolina legislature to buy anti-choice curricula. Many of the lessons came from Earn While You Learn, a program designed to help anti-choice centers “share Christ” and convince “abortion-minded” people to carry pregnancies to term. Those who participate in CPCF’s program are rewarded with basic necessities like diapers and car seats—also supported by the federal funds.

When Rewire.News told North Carolina’s DHHS about our findings ahead of publication, officials in the highest ranks of the agency, including, at times, its director, Secretary of Health Mandy Cohen, hastened to formulate a response.

“Wondering if we should go ahead and begin making arrangements for payback of federal funds for the non allowable items …. So the reporter can’t say we didn’t seek to rectify once they were brought to our attention,” Jeneen Preciose, business director of the agency’s Division of Public Health, wrote to Pettiford and another colleague the day before the story published.

Under pressure over the group’s spending, Bobbie Meyer, state director of CPCF, accused the state of failing to inform CPCF about the federal ban on religious materials until it was added to the group’s contract for the 2018 budget year.

“By our own decision in previous years, most material that was strongly religious (such as Bible studies) was not in budgets,” Meyer wrote on May 9, 2018. “Not because we were aware of a Federal restriction per se. A few things did slip through.”

Meyer was “likely correct that program staff may not have reiterated this language to them,” Pettiford acknowledged in a subsequent email to colleagues.

After the Rewire.News investigation, the agency vowed to increase oversight. It added a 1,100-word swath of the statute banning the use of federal funds for “explicitly religious materials” to its federal contract with CPCF and said it would do so for other groups. Shuler also wrote that the Rewire.News findings would help her prepare the next staff person and “make me be more observant/critical of what CPCF includes in their budgets.”

“Some of the Materials Are Disconcerting”

Over the course of more than seven months after our investigation, records show Shuler and colleagues painstakingly combed through purchases made by CPCF with federal funds over the five preceding years, requesting specific titles and other detailed information from CPCF.

Internal emails show officials grappled with which materials were religious enough that the federal government might need to be reimbursed for them. When it came to costs associated with attending conferences run by the anti-choice organizations CareNet and Heartbeat International, for example, officials reviewed the agendas and estimated that between 9 percent and 21 percent of the content was religious.

CPCF director Meyer tried to placate officials about the conferences.

“The specific religious content is definitely overshadowed by non-religious content,” she wrote. “Only this year, in advertising the 2018 Care Net conference theme: Each One Reach One, Uniting Evangelism & Discipleship did the balance of content definitely shift. We had already decided that could not be supported by grant funds in 2018-2019.”

In a statement to Rewire.News, DHHS said it had prohibited reimbursement for all Heartbeat and CareNet national conferences because of the “difficulty in accurately gauging the non-allowable portions.” But the change had only become effective in the 2019 budget year. “We did not seek recoupment for previous years because we are unable to determine the unallowable portions and/or if attendees participated in those sessions,” the agency wrote. It added that state-level training had been developed that was “devoid of overt/explicit religious messages”; DHHS staff had reviewed the agenda and attended that training to confirm it “did not involve worship activities, religious instruction or proselytizing.”

When it came to the Earn While You Learn curriculum, created by anti-choice activist Dinah Monahan as a way to “share Christ” with “abortion-minded” clients, DHHS’ Belinda Pettiford noted in an email to colleagues that “some of the EWYL educational materials” were “disconcerting.”

Meyer again sought to defend the purchases.

“The Earn While You Learn Curriculum, which came under fire in a recent article, is a main component to the prenatal & parenting educational program of most of the pregnancy resource centers across the US,” she wrote. “With a very few exceptions, the curriculum itself is not religious in content (exceptions are the Bible Study Module and The Quest for Authentic Manhood) despite the statements of the program founder, Dinah Monahan in an intro video on the website.”

In total, the agency flagged $50,368.71 worth of wrongfully purchased items, including some with titles like A Mom After God’s Own Heart, LifeGuide Topical Bible Studies, and God and Pregnancy. It struck some sections of the Earn While You Learn program, including the Bible Study and Life Skills curriculum—which features material “written from a Christian perspective.”

But it allowed other EWYL components, including many that, while not overtly religious, are clearly aimed at coercing people to continue pregnancies.

While many of the lessons focus on benign topics like toilet training or smoking, some weave in religious references and lies about abortion. Even the most mundane-seeming DVDs and pamphlets feature jolts of proselytizing. On the EWYL website, for example, the description for a breastfeeding brochure notes: “The miracle of life is one of God’s greatest gifts to us. But, interestingly, your breast milk rates pretty high on His list of gifts, too.” (There does not appear to be religious content in the brochure itself.) A DVD about sudden infant death syndrome (SIDS) opens with a testimonial from parents who turned to the Bible to cope with their son’s death. A lesson on tantrums encourages parents to “make up by talking and praying together.” A pamphlet on older siblings says pregnant parents should invite the sibling to “pray over his brother or sister.”

All of the lessons mentioned above were deemed eligible for purchase with federal funds, according to a spreadsheet of past purchases and a list of “allowable items” that the state said it shared with CPCF in April 2019. Also included on that list—and purchased in the past—was an ultrasound-themed DVD titled “Eyewitness & Window to the Womb 2”; an online preview includes the host discussing “God’s grace and healing,” and another speaker telling those who have had abortions, “Your babies, they’re watching you from heaven, and they love you.”

In another of the approved DVDs, “Bonding With Your Unborn Baby,” the narrator falsely claims a fetus can feel pain at 18 weeks, noting, “She’s not just a mass of tissues growing into what will eventually become a baby, she IS a baby.”

Perhaps the most eyebrow-raising item greenlit by the state’s review is an EWYL supplement called Positive Partnerships that centers on the “wonderful blessing” of marriage and urges troubled couples to seek counseling at church.

“Marriage makes a relationship unusually lovely,” a brochure approved for purchase with federal funds called “Why Marriage? For Women” reads. “It is a sacred institution created by God in the Garden of Eden. At the heart of God’s design is companionship and intimacy.”

When Rewire.News questioned its approval of these items, DHHS responded in a statement: “The process of identifying activities, practices or publications that involve or promote overt religious content can be subjective and vary from person-to-person.”

After Rewire.News requested a current version of the “allowable purchases” list, DHHS sent a revised version dated June 27, eight days after we sent the agency questions about religious items on the list. The SIDS DVD, “Eyewitness & Window to the Womb 2,” and “Hidden Tears”—the brochure that advised men whose partners have had abortions to“handle your personal guilt before God”—had been removed from the list. The “Why Marriage?” brochure had also been removed, although the Positive Partnerships pack including it remained.

The list’s impact is unclear, since CPCF is not set to receive new federal funding—but lawmakers say that raises bigger concerns.

“If we’re going to be spending money on these programs, for me, federal block grant money is a better way to go, because there is a lot more oversight,” Rep. von Haefen said.

Ultimately, DHHS said, the federal government will decide how much it must be reimbursed for the approximately $50,000 misspent on religious content. A spokesperson said in a statement that the state had informed the U.S. Department of Health and Human Services’ Health Services and Resources Administration (HRSA) of its review.

“We understand that they are working to finalize and submit to HRSA the tally of any potentially misspent federal funds,” the spokesperson said, adding that the review was expected “within the next 2-3 weeks.”

Once the total is settled, DHHS told Rewire.News it would reimburse the federal government and then “seek payment” from CPCF.

“A $400 Chair Will Send Up a Red Flag”

In June 2018, far from curbing its funding of anti-choice groups for the upcoming year in the wake of the Rewire.News report, the North Carolina legislature allocated $1.4 million to CPCF, $300,000 to Human Coalition, and $250,000 in federal maternal health funding to MAPS, the Asheville crisis pregnancy center whose mission is to “be a relevant Christ-centered outreach ministry partnering with [area] churches.”

No one was more surprised by the funding to MAPS than the organization itself, according to executive director Kristi Brown.

“It was a surprise to everyone here,” Brown told Rewire.News in an interview last week. “We didn’t ask for it.”

The windfall came from anti-choice Sen. Ralph Hise (R-Mitchell), who told the Asheville Citizen Times he advocated for it because MAPS provides “valuable services for women in crisis pregnancies.”

But MAPS was woefully unprepared to handle federal funding requirements. Brown, who said she took over as executive director on July 2, 2018, a few weeks after the budget passed, had never written a grant. After she submitted her first budget attempt, DHHS’ Tara Owens Shuler wrote back: “The prices look very inflated to me throughout the budget …. For example a $400 chair will send up a red flag immediately without documentation of the cost.”

The group did not “fully [understand] when they were named in the budget bill that the funds had to be used in accordance with Federal and DPH guidelines,” state regulators summarized in an internal report.

“Yeah that’s probably true,” Brown acknowledged. “I mean, we didn’t know what the guidelines were to be honest with you.”

Brown was also concerned about the organization’s ability to maintain its religious mission given the federal constraints; she considered using the funds to support a fatherhood program, for example, but decided against it because the instructors were “believers” who “would naturally weave in faith” to the state-approved curriculum, she told Rewire.News. Ultimately, the organization accepted a fraction of what the legislature had offered: $46,235.

This year, the legislature wants to offer MAPS five times that amount: $200,000 each year in state funds plus $50,000 in federal maternal health block grant funds. Brown didn’t know about the money; when Rewire.News told her that it was at least $200,000, she laughed.

“OK, um, hmm,” she said. “So to answer your question, are we prepared to receive that? Yes. Would I at the end of the day write the documents up for the full $200,000 if that’s what we’re awarded this budget season? I can’t answer that right now.”

Brown had assumed last year’s allocation was “a one-time thing” and had not prepared for more, she said.

MAPS isn’t the only anti-choice group on which the North Carolina legislature has heaped funding despite a demonstrated failure to meet requirements.

The Human Coalition received $300,000 in state funding in the 2018 budget year for a pilot project to “provide care coordination and medical support to women experiencing crisis pregnancies” at its fake clinic in Raleigh. The money was part of a $1.3 million allocation to CPCF, which was supposed to administer the grant. All of Human Coalition’s quarterly reports that year were submitted late, records provided to Rep. von Haefen by DHHS confirm.

By August 2018, CPCF was so fed up with trying to communicate with the Human Coalition headquarters in Texas that the group asked the state to take over administration of the grant for the following year, when Human Coalition was due to receive another $300,000.

“Due to challenges in working with the Human Coalition headquarters office in Texas, we requested their funding be handled directly by DHHS for the 2018-19 budget year,” CPCF wrote in a status report at the time.

“Wow,” Rep. von Haefen said when Rewire.News shared this finding. “If [CPCF] can’t even get information from a group that they’re supposed to be kind of working with to reach the same goal, then I don’t know how DHHS thought that they were going to get the information.”

Indeed, things didn’t improve much once the state took over; records show Human Coalition continued to submit some reports late or incomplete. On April 30, 2019, in a report to North Carolina lawmakers, DHHS wrote that, “Despite the Department’s best efforts, the Human Coalition has not provided all of the required information for the full and timely completion of this report.”

Much of Human Coalition’s reported work, the regulators noted, consisted of referring pregnant people to outside agencies like WIC and drug rehab programs.

“Although connecting people to existing programs like WIC or housing assistance can be helpful, the model being piloted by the Human Coalition has not been subject to independent research or evaluation,” they wrote. “Therefore, it cannot be identified as evidence-based or even a best practice.”

Three days later, the North Carolina House approved the budget that quadrupled funding to Human Coalition, offering it $1.2 million for each of the next two years to “extend and expand the pilot program” that the state had been unable to vouch for. It’s unclear how many legislators even read the report before voting on the budget.

“The only people I have heard discuss this report … [are] myself and Rep. Julie von Haefen,” Sen. Natasha Marcus (D-Mecklenburg County) told Rewire.News in late June. “I have yet to hear a Republican address it in any way.” Marcus and von Haefen, who reached out to DHHS on their own to get information about anti-choice groups, are freshmen Democrats who defeated Republican incumbents in the election that broke the state’s Republican supermajority last November. That set the stage for an ongoing budget showdown; Democratic Gov. Roy Cooper vetoed the budget in large part because it doesn’t expand Medicaid.

Without that expansion, hundreds of thousands of people in North Carolina lack health insurance and rely on county health departments that could use more money from the state legislature, Marcus said.

“Instead we put millions of dollars aside every year—and more and more it seems each year— for these fake organizations that mislead women, do not provide medical care, and are based on a religious point of view that’s not appropriate for state funding,” she added.