Planned Parenthood Keystone is banned for one year from billing Medicaid, the federal health insurance program for the poor. That’s because the Republican Party’s tax and spending bill signed by President Donald Trump in July includes a section preventing Medicaid dollars going to health care providers that also offer abortions.
The ban remains in place while it’s challenged in the courts, leaving health centers around the country that provide both preventive health care and abortion services without a key source of funding. Most of those providers are operated by Planned Parenthood or associated members, and they argue in their legal challenge to the ban that Congress is targeting them specifically.
Planned Parenthood bills Medicaid for prenatal care, birth control, breast and cervical cancer screenings, testing for sexually transmitted diseases, and other family planning, maternal health care and sexual health services.
For Planned Parenthood Keystone, with seven clinics covering central and eastern Pennsylvania outside of Philadelphia, the Medicaid ban creates a $1.7 million hole in its budget, or about 5% of total operations, according to Melissa Reed, the group’s president and CEO. Keystone has also been proactive in preparing for budget crunches, including by reducing staffing in recent years and cutting back on costs.
“ We will do everything we can to maintain continuity of care and ensure our doors stay open,” Reed said.
According to Planned Parenthood, its Pennsylvania clinics saw 17,577 Medicaid patients in the 2024 fiscal year, with Keystone serving 5,253 of the total.
For patients with Medicaid, Planned Parenthood Keystone currently is providing care at no cost. Depending on the success of the legal challenge to the ban on federal health insurance coverage at organizations that provide abortions, either Keystone will go back to billing Medicaid, or will transition patients to self-pay on a sliding scale without turning anyone away, Reed said.
Trump cut off separate federal funding for family planning services, called Title X, in his first administration. He did so again earlier this year, though Keystone has so far kept that money even while the federal government withheld payments to other providers in the state. That funding freeze is also part of ongoing litigation. Since Title X money is distributed from the federal government to family planning councils and then to providers, Keystone officials do not know why their funding has stayed intact. The Family Health Council of Central PA, which distributes money to Keystone, did not respond to questions by the time of publication.
The offices of U.S. Sens. John Fetterman, a Democrat, and Dave McCormick, a Republican, did not respond to questions for this story. Neither did Republican Congressmen Scott Perry or Lloyd Smucker, who together represent most of Cumberland County and all of Dauphin, Lancaster and York counties. Questions to each lawmaker included whether they supported the specific Medicaid measure within the larger budget law and whether they planned to take action to address the loss of medical care.
Gov. Josh Shapiro’s office also did not respond to questions, including whether his office would take any independent action to address the loss in funding. Washington Gov. Bob Ferguson announced his state will backfill the lost Medicaid payments for providers like Planned Parenthood, though no other state has taken such action.
Knowing the consequences
This is not the first time changes to the Medicaid program have been used to target Planned Parenthood. Several states have already stopped funding from going to the organization, including Texas, which did so in 2013. Because they’ve seen this ban before, researchers know the likely consequences, said Julia Strasser, a professor at The George Washington University in Washington, DC, who studies family planning and reproductive health.
“Usage of contraceptive methods that are effective will go down, use of STI screening and testing will go down and cancer screening will go down and that will result in more STI’s, higher birth rates and higher rates of cancer in the community,” Strasser said.
Without early screening or easy access to tests, fewer cancers and STIs are caught early, making them harder and more expensive to treat. There are also spillover effects, not just for the person who gets pregnant or who delays detection of cancer or an STI, but to their family members and partners, Strasser said.
She, along with the American Public Health Association and a number of other health groups and researchers, laid out those arguments in an amicus brief filed to the U.S. Supreme Court, in which the six conservative justices allowed South Carolina to remove Planned Parenthood from receiving Medicaid benefits.
While the Republicans’ spending law cut funding nationally, it did not expand care through other services such as federally qualified health centers, which already operate with minimal margins. Preventing people from using Medicaid to access care at their preferred provider is likely to reduce the number of people who seek care, Strasser said.
“We’re going to see forced parenthood for people who don’t want to become parents,” Strasser said.
In the short term, Keystone Planned Parenthood’s clinics are seeing an increase in patients seeking long-acting, reversible contraception, such as a birth control implant or an intrauterine device commonly called an IUD, according to Casi Scully, Keystone’s associate medical director.
Unlike other health care providers, where it can take two to three months to get an implant or IUD, Planned Parenthood often offers same-day appointments, Scully said.
Part of a 15-year strategy
Since 1977, the Hyde Amendment has prevented federal dollars from being used to pay for abortions unless the medical procedure is needed to save the life of the pregnant person or the pregnancy results from rape or incest.
Republicans have sought to block any funding that could help keep abortion providers operating since 2012, according to Rachel Rebouché, a law professor at the University of Texas at Austin and former head of Temple University’s law school. That means targeting federal programs like Medicaid which, until now, were still allowed to pay for services at medical providers like Planned Parenthood that also provide abortion services.
“ It strikes a financial blow to clinics,” Rebouché said.
The idea behind Republican opposition to Medicaid coverage for basic services like cervical and breast cancer screenings is that any money to help keep the doors open at Planned Parenthood or its affiliates is money that helps provide abortions, Rebouché said. Even for affiliates that do not provide abortion care, they’re seen as part of the larger movement, she said.
Rebouché echoed Planned Parenthood lawyers’ objection to the Medicaid ban included in the GOP tax and spending law – that Congress is using its power to discriminate against the healthcare provider, which is unconstitutional. The Trump administration is arguing the language is neutral and the government has the authority to regulate how its money is spent.
The people who access Medicaid, in addition to being poor, are typically young and disproportionately people of color, per federal data.
If the courts let the ban stay in effect, Medicaid funding will resume in summer 2026, unless Congress extends the ban in another budget bill. During Senate debate over the bill, Washington Sen. Patty Murray, a Democrat, said even the single year cut to Medicaid would “shutter at least 200 health centers” around the country, especially those serving rural areas.
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