Just days after President Donald Trump signed a sweeping new budget into law, Planned Parenthood filed a major lawsuit against the administration over a provision that could force hundreds of clinics to close—leaving over a million patients without access to essential care.

Filed Monday in U.S. District Court in Massachusetts, the lawsuit targets a measure buried deep in the 1,200-page reconciliation bill. On page 597, the new law prohibits Medicaid reimbursements to any reproductive health clinic that both provides abortion services and received more than $800,000 in Medicaid funding in the last fiscal year. While framed broadly, the rule disproportionately impacts one organization: Planned Parenthood.

“This case is about making sure that patients who use Medicaid to get birth control, cancer screenings, and STI testing can continue to do so at their local Planned Parenthood center,” said Alexis McGill Johnson, president of Planned Parenthood Federation of America.

According to internal calculations, the restriction could affect more than 1.1 million patients across 200 clinics in 24 states, nearly all in areas where abortion is still legal. In 12 of those states, the majority of Planned Parenthood locations offering abortion services could be forced to shut down.

The budget provision is already being described by reproductive rights advocates as a “backdoor national abortion ban.” But the damage would extend far beyond abortion services. Many clinics that primarily offer routine gynecological and preventive care are also at risk of losing funding.

Planned Parenthood’s attorneys argue that the provision is unconstitutional, saying it singles them out for political reasons and violates both equal protection laws and First Amendment rights.

“The Defund Provision is a naked attempt to use the government’s spending power to punish Planned Parenthood—not just for providing legal abortion care, but for advocating for reproductive rights,” the complaint reads.

The lawsuit also points to a pattern. Trump made repeated promises to defund Planned Parenthood during his 2016 campaign and throughout his first term. Project 2025, the radical right-wing blueprint created by the Heritage Foundation and widely adopted by the Trump administration, explicitly calls for defunding the organization.

The Biden administration had previously blocked similar defunding attempts. But Trump’s return to power has revived efforts to dismantle access to reproductive care, even for patients using Medicaid for services unrelated to abortion.

One of the most jarring elements of the provision is its impact on independent clinics that affiliate with—but are not controlled by—Planned Parenthood. In Utah, for example, the Planned Parenthood Association operates independently and does not even provide abortion services at some locations. Still, because of its association with the national network, it faces defunding.

“These members are not affiliates or subsidiaries in any legal sense,” the complaint argues, “but they will be punished anyway.”

Shireen Ghorbani, interim president of Planned Parenthood Association of Utah, called the move “devastating.”

“As the Trump administration guts our public health system, we know millions will suffer,” she said. “We haven’t backed down before, and we won’t now.”

Independent providers like Maine Family Planning and Desert Star Institute in Arizona echoed concerns. They warn that even where abortion is not the central service, clinics may not survive without Medicaid reimbursements. The ripple effects, they say, will devastate patients’ ability to access contraception, annual exams, and STD treatment.

For many, this is not just about abortion—it’s about basic access to care.

Whether the courts will stop the defunding provision remains uncertain. But Planned Parenthood has made clear: this is just the beginning of the fight.