Maine is one of almost two dozen states suing the U.S. Department of Health and Human Services over new conditions for family planning funds.

For more than 50 years, states have been receiving public funds through Title X that have helped low-income and underinsured patients access pregnancy testing, contraception, testing for sexually transmitted diseases and cervical cancer screening. In 2026, the Family Planning Association of Maine received more than $1.78 million in Title X funds, which have paid for services at 63 locations, according to the lawsuit.

When HHS announced it was accepting requests for the next five-year cycle of Title X funding, the lawsuit says the department incorporated several new conditions, including requirements to end the use of diversity, equity and inclusion policies and that Title X recipients not recognize patients based on gender identity instead of biological sex.

The states also argued that the conditions seek to impose additional restrictions on referring patients to abortion services on request. Federal law already bars Title X funds from paying for abortions, and requires that recipients offer “nondirective” pregnancy counseling.

The states argue that their Title X recipients are required to offer “neutral counseling” and provide referrals to abortion services upon request.

The 23 states — represented by 21 Democratic attorneys general and two Democratic governors — are asking a federal judge in Maryland to deem the new conditions unlawful and to stop them from being enforced. The states said in the lawsuit that the new conditions were “unlawful several times over” and that they contradict the “core statutory and regulatory requirements” of Title X, as well as the states’ own program rules.

Under Maine law, the state must provide funding to offset any reduction in Title X funds, according to the lawsuit.

The lawsuit states that clinics in the 23 states will close, services will end, and the states “will bear the substantial costs of increased health care needs caused by worsened immediate and long-term health outcomes.”

HHS said in a statement Thursday that it could not comment on pending litigation.

In a statement Thursday, Maine Family Planning said the conditions would “set reproductive freedom back decades” and harm people who need care the most.

“The vision for Title X laid out in the funding announcement would erase patients’ contraceptive choice, create more barriers to care, and lower the standard of health care services that patients have always received through the family planning program,” Olivia Pennington, the group’s associate vice president of public affairs, said in a statement. “The Trump administration’s reimagined Title X program is not what’s best for our patients, our communities or our country.”