New York Attorney General Letitia James is leading a coalition of 23 state attorneys general in a new federal lawsuit filed Thursday to block Department of Health and Human Services rules that would reshape how Title X family planning grants are awarded nationwide. The suit, filed in the U.S. District Court for the District of Maryland, targets a policy that Title X clinics in New York and beyond say would upend how they serve patients.
James announced the filing in a post on X, writing that Title X “provides reproductive health care, cancer screenings, and affordable contraception for millions of Americans” and that the federal government “is trying to strip this funding to force states to carry out its agenda.” She added, “We stopped them before, and we'll do it again: I'm suing,” according to NY AG James. Her office says the lawsuit was filed alongside multi-state partners specifically to preserve program funding, according to the Office of the New York State Attorney General.
What the New Federal Rules Require
The challenged HHS policy, issued in April 2026 and modified in July 2026, requires Title X grant applicants to eliminate diversity, equity and inclusion programs, recognize only male and female as sexes, encourage abstinence and “natural family planning” over contraception, and deny gender-affirming care, as reported by the Maryland Daily Record. The outlet notes federal health officials added these ideological requirements as conditions for receiving grant money.
In New York alone, Title X funding supports 165 clinics that serve more than 250,000 mostly low-income patients annually, per figures from the attorney general's office reported by the same outlet. Those clinics provide low-cost or free preventive healthcare across the state, and advocates warn the new conditions could disrupt that access.
Legal Arguments Center on Process and Spending Power
The lawsuit alleges federal officials violated the Administrative Procedure Act by imposing the grant conditions without a public notice-and-comment process, and that they violated the Constitution's Spending Clause by attaching unclear political conditions to federal funding, according to Mass.gov. The states argue federal agencies cannot unilaterally attach unrelated conditions to money Congress has already appropriated.
The coalition's complaint also asserts the new federal conditions conflict directly with existing Title X regulations, which mandate that grant recipients offer a broad range of contraceptive methods, deliver non-directive pregnancy counseling, and serve all patients inclusively, per Mass.gov. Massachusetts, a co-leading state in the litigation, reported that Title X-supported providers facilitated more than 150,000 family planning visits for 100,000 patients in 2025, preventing an estimated 16,200 unintended pregnancies and saving $155 million in public healthcare costs.
A Program With a Five-Decade History
Title X was created under President Richard Nixon in 1970 as part of the Public Health Service Act and remains the nation's only federal grant program dedicated specifically to family planning and preventive healthcare, providing roughly $286 million in annual grants, according to the attorney general's office. Federal law has always explicitly prohibited Title X money from funding abortion services, restricting funds strictly to preventive care such as contraception, cancer screenings, and testing and treatment for sexually transmitted infections, the Maryland Daily Record notes.
This is not the first time James has fought over the program's rules. She previously co-led a 21-state lawsuit in March 2019 challenging the first Trump administration's so-called “domestic gag rule,” which sought to withhold Title X grants from clinics offering abortion referrals, according to the Office of the Attorney General for the District of Columbia. In November 2021, she also co-led a 24-state amicus brief supporting a Biden administration HHS rule that repealed those restrictions and expanded Title X grant eligibility, per her office's 2021 announcement.
Hoodline previously covered James's pushback against earlier federal suspensions of Title X funding. Thursday's filing extends that yearslong tug-of-war, with the future of grant conditions for New York's 165 clinics now in the hands of a federal court in Maryland.
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