Continued Efforts to Exclude Immigrants from Title X Threaten Access to Essential Reproductive Health Services and Undermine Health Equity
April 28, 2026
Overview
Amidst a wave of anti-immigrant policies, recent changes impacting the Title X Family Planning Program, an essential source of free and low-cost reproductive health services, are likely to further impede access, exacerbate health risks for immigrant communities, and undermine health equity. It remains crucial for clinics, community groups, policymakers and others to zealously advocate for inclusive services that promote reproductive health and health equity within immigrant communities.
Immigrants have long faced barriers to reproductive health care such as lack of health insurance, language differences, and fear of interacting with the health care system. Research suggests that these and other factors result in lower levels of preventative reproductive health care services, prenatal care, and abortion access. Amidst a wave of anti-immigrant policies, recent changes impacting the Title X Family Planning Program, an essential source of free and low-cost reproductive health services, are likely to further impede access, exacerbate health risks for immigrant communities, and undermine health equity.
A federal grant program established in 1970, Title X provides comprehensive and confidential family planning services and preventative reproductive health care through a network of clinics primarily serving low-income people and other underserved populations. Historically, Title X services have been provided without regard to immigration status. Immigrants, who are more likely to be uninsured, disproportionately rely on safety-net family planning centers like Title X clinics.
Recent Attempts to Undermine Title X’s Inclusive Mission
Since January 2025, Title X has weathered various attacks, the most recent of which came in April 2026, when the U.S. Department of Health and Human Services (HHS) released guidance for Title X funding applicants seeking FY 2027 grants. Among other marked departures from prior approaches, the guidance appears to direct funding recipients to restrict access based on immigration status, stating that, to the extent permitted by law, HHS will “prioritize programs, partnerships, and funding mechanisms that further the agency’s priority to ensure that federal resources are not used to facilitate or incentivize illegal immigration.”
This guidance follows a July 2025 HHS notice that similarly seeks to limit the availability of Title X services, along with 12 other federal programs that have been provided regardless of immigration status for decades. Other programs targeted by the notice include critical safety-net providers, like the Health Center Program. The dramatic change stems from a reinterpretation of the term “federal public benefits” under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which governs immigrant eligibility for federal benefit programs. Under PRWORA, only “qualified” immigrants are eligible for programs deemed “federal public benefits.” Immigrants who are “not qualified” include undocumented immigrants, as well as many categories of lawfully present noncitizens, such as holders of work and student visas and people with Temporary Protected Status.
In 1998 guidance, HHS identified 31 health and social programs it considered to be “federal public benefits” but excluded Title X, among other community health programs. In its July 2025 notice, HHS departed from this longstanding guidance and reinterpreted the term “federal public benefits” to include Title X, thereby excluding from the program immigrants deemed “not qualified” under PRWORA.
Soon after, twenty states and D.C. filed a lawsuit in the United States District Court for the District of Rhode Island, challenging the notice and parallel actions by other federal agencies. In a September 2025 order, the court granted the plaintiffs’ motion for a preliminary injunction, finding that the plaintiffs are likely to succeed in showing that the HHS notice violates the Administrative Procedure Act and the Spending Clause of the U.S. Constitution. The court preliminarily barred HHS from enforcing the notice in the plaintiff jurisdictions, which now include Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and D.C. The parties have both filed motions for summary judgment, the outcome of which will likely determine enforcement of the notice moving forward. Those motions are currently pending before the court.
Resultant Barriers to Care
Even with the preliminary injunction in place, barriers to essential Title X services remain for many immigrants, particularly those in the 29 other states where the restrictions are still in effect. And even in the plaintiff jurisdictions, Title X recipients and clients face uncertainty with respect to the ultimate outcome of the lawsuit, which is likely to move through a lengthy appeals process following a district court decision.
The uncertainty is only exacerbated by HHS’s April 2026 guidance for Title X applicants. While the guidance acknowledges potential legal limits on restriction of services, including the preliminary injunction, it sows confusion as to Title X recipients’ obligations when it comes to serving immigrants. Recipients left with the unanswerable question of what exactly it means to “facilitate or incentivize illegal immigration” may err on the side of restricting services to protect their funding.
In addition to generating uncertainty for Title X recipients, these changes sow confusion for immigrants, who may be deterred from accessing reproductive health services (including those for which they are eligible) out of fear that they will be punished for doing so. Recent policy changes that discourage access to health-promoting services already create similar chilling effects. These include the rescission of protected area guidelines, which limited ICE arrests in locations like health clinics; the use of Medicaid data for immigration enforcement purposes; and a proposed public charge rule that would penalize immigrants for using any public benefits. Harmful on their own, these developments intersect to intensify barriers and compound health risks for those in need of reproductive health care.
Key Steps to Protect Title X Access
Amidst these attacks on Title X’s core purpose of caring for underserved communities, it is crucial for Title X recipients, advocates, community groups, and others to take the steps they can to protect access.
Title X recipients can safeguard access to essential services by refraining from imposing restrictions absent clear direction to do so. All Title X recipients should stay abreast of the litigation and consult with their legal counsel to determine how they can comply with legal and funding requirements while continuing to provide services for immigrants to the extent possible. Title X recipients in jurisdictions covered by the preliminary injunction should be aware of the injunction’s effect—namely that HHS may not enforce the notice excluding people from Title X services based on their immigration status while the litigation proceeds.
Title X recipients can also revisit their data collection and verification practices to ensure that they are not unnecessarily collecting information in ways that could exclude clients from services or deter them from seeking care. Even in places where Title X is considered a “federal public benefit,” certain Title X recipients may not be required to verify clients’ immigration status for eligibility purposes. Specifically, under PRWORA, nonprofit charitable organizations are not required to verify eligibility for federal public benefits. Title X recipients should consult with their legal counsel to determine whether they qualify as a nonprofit charitable organization under HHS guidance and, if so, avoid implementing verification practices that are not legally required.
In this time of increasingly complex restrictions and powerful chilling effects, clinics and community groups can support clients in understanding eligibility requirements and making informed decisions about where to access reproductive health care. And it remains crucial for clinics, community groups, policymakers and others to zealously advocate for inclusive services that promote reproductive health and health equity within immigrant communities.
This post was written by Emma Kaeser, J.D., Senior Attorney, Network for Public Health Law—Mid-States Region.
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