Maine Family Planning will forgo hundreds of thousands of federal dollars rather than move its abortion services or close its clinics.

The decision was a response to a Trump administration rule that puts new restrictions on abortion providers that receive federal family planning grants. Despite pending legal challenges across the country, the federal government announced Monday it would begin to enforce the rule. Critics including the American Medical Association say the restrictions will limit access to abortion and other medical care for low-income patients, while supporters say taxpayer dollars should not go to abortion providers even though the money is used for other services.

So Maine Family Planning announced Tuesday that it will not accept any more federal money and instead dip into its reserves to maintain its existing services across the state. The nonprofit has been part of the federal Title X program for 50 years and is one of the first to leave it over the new restrictions. Planned Parenthood, which is the largest grant recipient, also has told news outlets that it will not comply with the rule. Others have made similar statements since the rule was proposed earlier this year.

“I just can’t believe that they are so arrogant as to impose this rule on trusted medical providers in our state while the litigation is happening,” said George Hill, president and CEO of Maine Family Planning.

He said he did not want to prevent medical providers at Maine Family Planning clinics from discussing abortion with patients.

“It came down to a mind’s-eye picture of a young person, 15 or 16 years old, getting a pregnancy test result that she doesn’t want and asking one of our providers what her options were and might she be able to get an abortion,” he said. “I don’t want to put our providers in the position of having to respond with simply a referral for prenatal care or the statement that they cannot talk about abortion.”

An official from the U.S. Department of Health and Human Services said the government is working with grantees to help them come into compliance with the rule. She said she has not heard from other grantees about withdrawing from the program.

“While the final rule prohibits referral for abortion as a method of family planning, nondirective counseling on abortion is permitted,” Mia Heck, director of external affairs in the Office of Assistant Secretary for Health, wrote in an email. “The final rule protects Title X healthcare providers so that they are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.”

Federal money cannot pay for abortions except in the case of rape, incest or to save the life of the woman. The Title X program pays for birth control, STD tests and cancer screening for low-income people.

Maine Family Planning is the only Title X grantee in the state and receives nearly $2 million from the program each year. It runs 18 clinics and shares the federal funds with Planned Parenthood clinics and other health centers in Maine. The money represents more than a quarter of the agency’s annual revenue, and more than 23,000 patients in Maine access services through the program ever year.

The new rule bans family planning clinics that receive Title X funds from making abortion referrals – what critics are calling a “gag rule.” The clinics also will be barred from providing abortion services in the same buildings where they provide health services paid for by Title X funds, a requirement that would increase costs for many providers.

Maine Family Planning has said that expense would force it to stop offering abortion services at all but one of its clinics. Under that scenario, Mainers would have only three publicly accessible locations for abortion care across the state – the flagship Maine Family Planning Clinic in Augusta, the Mabel Wadsworth Center in Bangor and the Planned Parenthood location in Portland.

Maine Family Planning and the national Center for Reproductive Rights sued the federal government in U.S. District Court in Maine, and that lawsuit is one of several filed across the country. Federal judges in different courts have alternately blocked the rule and allowed it to take effect, but Hill said no order currently blocks it.

So the federal government announced Tuesday that it would begin to enforce the rule. Hill said he was about to board a plane to Washington, D.C., for a national meeting of Title X grantees when he got the news. Instead, he canceled his flight and spent three hours at the airport organizing the organization’s response. The board agreed to dip into reserves to maintain operations as usual, he said.

“This is the rainy day,” Hill said. “There’s no better use for it than now.”

Hill was unsure whether Maine Family Planning would be required to return any money to the federal government. The nonprofit has received nearly $880,000 so far this year, and it will forgo $825,000 through the end of 2019.

Tax documents show the nonprofit has relied on those reserves to cover operating losses in recent years. It had net assets of $4.7 million at the end of 2016, the most recent year available. Its expenses that year were more than $8.2 million. Hill said the board would need to look for new funding sources if the rule does hold up to pending legal challenges.

“It’s unsustainable in the long term, that’s for sure,” Hill said. “The situation is urgent.”

Some Maine elected officials released public statements Tuesday in support of Maine Family Planning. They included Maine House Speaker Sara Gideon, a Democrat, and U.S. Sen. Angus King, an independent.

“The Trump Administration’s gag rule is a misguided, backward effort to deny Maine people critical health care like cancer screenings and reproductive health services,” said Gov. Janet Mills, a Democrat. “Further, it is an attack rooted in ideology – not in concern for public health – and it will only result in reduced access to health care and less healthy people. …

“I applaud Maine Family Planning for their commitment to keep their health centers open for as long as possible, and my administration will work with them to evaluate if there is any way state government can be helpful.”

Teresa McCann-Tumidajski, the executive director of the Maine Right to Life Committee, said that low-income families can still access free contraceptive services at federally qualified heath centers that provide an array of health care services, but do not perform abortions.

“We are pleased that the 9th Circuit has upheld this ruling which protects our hard-earned tax dollars being used by organizations that promote and provide for the wholesale destruction of innocent human life,” she said.

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