Reproductive health providers call for more state funding as federal threats loom
Providers of reproductive and gender-affirming health care are returning to the Legislature on Monday to call for more funding as state allocations have remained stagnant for about a decade.
This is not the first attempt, but providers and lawmakers are upping their ask particularly amid looming federal threats of funding cuts.
LD 143, sponsored by Senate Majority Leader Teresa Pierce and nine Democratic co-sponsors, including both presiding officers, would provide an annual allocation of $6.18 million for what are considered family planning services, which include routine gynecological and well exams, testing and treatment for sexually transmitted infections, birth control, cancer screenings, gender-affirming and behavioral health care, among others. Such funding is not used for abortions.
These funds would be in addition to the baseline $978,000 the state annually provides for family planning, which providers argue has been stagnant for a decade and is no longer adequate to meet needs.
Last session, Pierce sought a nearly $3.4 million increase. While that bill received initial support from both chambers and was approved to receive funding by the Appropriations and Financial Affairs Committee, it ultimately failed because it wasn't taken up for final enactment votes before session ended.
Pierce said more funding is necessary now because each year the state waits to deliver support is another year the cost of meeting needs goes up. The higher ask also comes as the state faces a budget deficit for the first time in years.
'It is a difficult time for us to financially decide how to spend the state's treasure,' Pierce said. 'But spending it to help people stay healthy in rural communities and urban communities is an absolute priority for us.'
While federal cuts have yet to impact Maine Family Planning, the nonprofit that currently administers funds for family planning services, its leadership and network of providers cautioned about funding levels being further strained if congressional Republicans cut Medicaid as well as if President Donald Trump limits Title X funding, the country's only federally funded program that supports family planning services, like he did during his last term.
Over the summer, local Planned Parenthood offices warned of a multi-million dollar deficit driven by systemic underfunding of reproductive care compounded by impacts from the COVID-19 pandemic, insufficient reimbursement rates and increased demand for free and discounted care.
'The reason the numbers are higher is because it reflects the current reality,' said Lisa Margulies, vice president of public affairs for Planned Parenthood Maine Action Fund and Planned Parenthood of Northern New England.
Margulies and other providers say they're serving more patients and facing higher costs to deliver care.
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Olivia Pennington, director of advocacy and community engagement at Maine Family Planning, said the nonprofit's 61 clinical sites throughout the state have also seen increased demand for particular services in certain areas.
For example, they've seen increased demand in response to a cluster of human immunodeficiency virus, or HIV, in the Bangor area. Testing and treatment for sexually transmitted infections is also another vital service Maine Family Planning sites provide, Pennington said, particularly in light of rising syphilis infections.
'After about 30 years of reporting no congenital syphilis cases, we are on the second year of reporting newborns born with congenital syphilis, which not only is a serious diagnosis for a newborn but also suggests undetected infections in adults,' Pennington said.
Given high incidences, the Maine Center for Disease Control and Prevention has recommended that sexually active people in particular areas get tested.
'We have done the best we can to ensure that folks can continue to access the care that they need at our current funding levels,' Pennington said. 'Some of our rural clinics are only open one or two days a week, so that leaves folks in a position where they either have to travel great distances to get the care they need, or simply go without.'
Pennington and Margulies said their clients are some of the most vulnerable to federal cuts because their organizations serve patients regardless of their ability to pay.
Maine Family Planning and its subgrantees, one of which is Planned Parenthood, serves roughly 31,000 patients across the state each year and more than 70% qualified for free or reduced-cost care in 2023.
Last year, 47% of the patients served by Maine Family Planning were on some type of MaineCare, the state's Medicaid program, which is a joint federal-state program that helps cover medical costs for some people with limited incomes.
Planned Parenthood of Northern New England's four health centers in Maine — Biddeford, Portland, Sanford and Topsham — served 7,120 patients from July 2023 through June 2024 and 2,046 were on MaineCare. However, PPNNE also sees patients without insurance and sometimes patients will opt not to use their insurance due to high copays and deductibles.
Given as much, those at PPNNE and Maine Family Planning are keeping a close eye on federal budget negotiations.
House Republicans approved a budget resolution in late February that instructed the energy and commerce committee, which is responsible for federal healthcare, to cut spending by $880 billion to pay for tax cuts, mass deportations and other measures. The non-partisan budget assessor concluded that such cuts are not feasible without slashing Medicaid.
Another looming possibility is restrictions for Title X funding, the country's only national federally funded program that supports family planning services, which providers had already raised concern about immediately after Trump's reelection.
Maine Family Planning is Maine's statewide grantee for Title X funding, and during Trump's previous term, the organization dropped out of the network after the president barred providers from so much as mentioning abortion care to patients if they wanted to continue receiving funding, what they referred to as the 'domestic gag rule.' Former President Joe Biden reversed the rule in 2021.
Providers in the Title X network have never been able to use the funds for abortion services, however providers who offer such services are eligible to receive and use the funds for family planning services.
'We are currently receiving $2 million in federal Title X dollars,' Pennington said, 'and access to those dollars is increasingly unstable and we've heard some explicit threats.'
During the first week of his second term, Trump reinstated what critics call the 'global gag rule,' which prevents nongovernmental organizations that receive federal global health funding from providing access to abortion-related information and care. Maine's congressional delegation reintroduced a bill to permanently repeal it.
Broadly, Trump has threatened to withhold federal funding to Maine over allegations that the state is in violation of Title IX due to its policy of allowing transgender athletes to compete on sports teams consistent with their gender identity.
While Maine Family Planning has yet to see federal funding for Title X or Medicaid change during Trump's second term, the organization and its affiliates are waiting to see what could come from the president's executive order restricting gender-affirming care for people under 19 years old.
Maine Attorney General Aaron Frey joined a coalition of AGs around the country in denouncing the order, which seeks to ban federally-run insurance programs, including Medicaid, from covering care for transgender, nonbinary or gender nonconforming youth seeking medical interventions that affirm their gender identity.
Under Maine law, MaineCare is required to cover abortion and several medically necessary gender-affirming treatments for people with the clinical diagnosis of gender dysphoria, but federal changes would likely supersede that.
'The urgency was there last year,' Margulies said of needing more funding, 'but is even more pressing because of the federal landscape and the potential challenges there.'
While family planning services have become swept up in political debates, Maine's network started as a bipartisan effort, Pennington pointed out, referring to the late Sherry Huber, a moderate Republican state representative from Falmouth who helped found Maine Family Planning.
'We're really hoping that folks see the urgency of this issue and understand that this is not about party,' Pennington said. 'This is about people accessing basic health care.'
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