Some 1,000 in Maine Could Lose Access to Primary Care Following Court Ruling

Up to 1,000 people in Maine may lose access to primary care at the end of September after a federal judge ruled on Aug. 25, 2025 that the Trump administration does not have to restore Medicaid funding to a network of health-care clinics in the state. The underlying lawsuit over a cut to its Medicaid reimbursements will proceed for now.

Maine Family Planning sued the government on July 16, 2025, with the help of the nonprofit abortion advocacy group the Center for Reproductive Rights, after learning that a provision of President Donald Trump’s “big, beautiful bill” would strip its Medicaid funding.

Maine Family Planning is the largest network of sexual and reproductive health providers in the state, said Olivia Pennington, the organization’s director of advocacy and community engagement. It currently operates 18 clinics and one mobile medical unit, serving a patient roster of roughly 10,000. About half its patients are covered by Medicaid.

The Maine nonprofit provides abortion care, but the Hyde Amendment has barred abortion providers from receiving federal dollars for abortions since the 1970s, except in rare exceptions. Medicaid patients who get care at Maine Family Planning have typically gone there for annual exams, HIV testing, and cancer screenings.

As a result, the Medicaid patients who rely on three of the network’s rural clinic locations for primary care may no longer be able to access those essential preventive services, according to Maine Family Planning. A Republican-backed law—seen as targeting Planned Parenthood because it provides abortions where they remain legal—is having broader impacts on the reproductive health-care landscape.

Targeting abortion providers

Judge Lance Walker, a Maine federal district judge appointed by Trump during his first presidency, ruled that the nonprofit organization failed to show that it would likely succeed in the case. This is one of the criteria judges consider when deciding whether to take preliminary action in a lawsuit before it is tried.

In his ruling, Walker cited Dobbs v. Jackson Women’s Health Organization, the 2022 Supreme Court case that ended the federal right to abortion. Since abortion is no longer considered a constitutional right, Walker wrote, Maine Family Planning’s claim that Congress unconstitutionally overstepped in passing the “big, beautiful bill” is unlikely to win in court.

“We’re disappointed,” said George Hill, Maine Family Planning’s president and CEO, of Walker’s ruling against a preliminary injunction.

“This particular provision in [the bill] is aimed directly at abortion providers, and basically aimed at their sources of support from Medicaid as a way of preventing them from providing abortion care,” Hill added.

The anti-abortion “big, beautiful bill” provision that prompted Maine Family Planning’s lawsuit was widely reported as a targeted action to strip Planned Parenthood and its nationwide network of clinics of all their federal funding. And so far, Planned Parenthood appears to be facing the most outsized impact: The organization has said 200 of its clinics are at risk of closure.

But at least two smaller clinic networks—including Maine Family Planning—have also been impacted, Rewire News Group found. That’s because for a year beginning July 4, 2025, the bill strips federal Medicaid dollars from nonprofit organizations that are “primarily engaged in family planning services, reproductive health, and related medical care,” provide abortions outside of exceptions for rape, incest, or for the physical health of the pregnant person, and received more than $800,000 in Medicaid reimbursements between October 2022 and September 2023.

The cumulative fallout of the provision, experts and advocates told RNG, will make it harder for patients to get a wider variety of health care. Resulting delays in preventive care—like Pap smears to check for cervical cancer, or testing and treatment for sexually-transmitted infections like chlamydia or HIV—could mean patients will be sicker by the time they get in to see a provider, they said.

Maine Family Planning has already decided to stop accepting new primary care patients with Medicaid at its three clinics in “medically-underserved areas of the state” that provide the care. And it may soon have to make tougher decisions.

“If we don’t get any relief between now and the end of September, we will have to start discharging [existing] primary care patients” covered by Medicaid, Hill told Rewire News Group.

Hill estimated that would be about 1,000 people.

It’s not just Planned Parenthood

Signed into law on July 4, 2025, Trump’s “big, beautiful bill” legislated sweeping changes to federal programs that previously incentivized green energy, helped families afford food, and expanded health-care access. Some of the largest cuts were made to Medicaid, which combines federal and state funds to provide health insurance for roughly 78 million low-income people nationwide.

The bill added work requirements and additional eligibility checks as part of its attempt to cut $1 trillion in health spending over the next ten years. It also increased the overall financial and bureaucratic burden on states’ Medicaid programs. More than 10 million people nationwide could lose their health insurance coverage by 2034 as a result, according to recent Congressional Budget Office estimates.

“This bill is incredibly devastating to not just Planned Parenthood, but to the whole abortion access landscape,” said Brittany Fonteno, president and CEO of the National Abortion Federation (NAF), a professional association for abortion providers. “The bill was targeting Planned Parenthood, but we know that it will have a really seismic impact on independent abortion providers and others within the community.”

When the bill was being negotiated in Congress, Pennington said, it was hard to know whether it would affect Maine Family Planning.

“But when it was signed and finalized, we really sort of knew concretely that we were going to be deeply impacted from this,” she said.

Because about half of Maine Family Planning patients use Medicaid, according to Pennington, the organization’s reimbursements—about $1.9 million a year—put it well above the $800,000 threshold set by the GOP’s budget reconciliation bill.

Medicaid accounts for roughly 20 percent of the organization’s annual budget.

“This is a huge chunk of our annual revenue,” Pennington said.

For many patients, Pennington said, “we are also their first and only health-care provider that they see in a year.”

For the Medicaid patients Maine Family Planning is still seeing, the organization is racking up claims in the hopes that it may eventually be able to be reimbursed in the future. Hill said that the organization has up to a year to bill the program for past visits should the courts restore its Medicaid funding.

But if it isn’t, “we are going to be forced to make some difficult decisions,” Pennington said. This could include closing clinics, reducing services, or decreasing patient numbers.

“If we do, many of our patients will have no place left, no place to turn,” Pennington added.

Steamrolling ‘an already profoundly-broken health-care system’

A network of health-care clinics in Massachusetts is in a similar position.

Health Imperatives, a nonprofit operating seven health clinics in the state, found out it would be impacted by the budget bill’s anti-abortion provision a few weeks after the spending package became law, when state officials informed the organization it could no longer bill Medicaid. Health Imperatives President and CEO Julia Kehoe said the organization was told that the Trump administration had named Health Imperatives in a court filing as an example of a health organization that would be affected by the cuts. The filing was meant to demonstrate that the “big, beautiful bill” provision was not designed to solely target Planned Parenthood.

Health Imperatives sees about 10,000 people at its clinics each year; about 3,000 of them are on Medicaid, Kehoe said. In addition to direct sexual and reproductive health care, including abortions, Health Imperatives operates a domestic violence shelter, a rape crisis center, mental health care for and other programming for people “who fall through the cracks of the mainstream systems of care,” Kehoe said.

“One of the things that we’re most concerned about is that this most recent action is going to have an impact not just on the people we serve in our clinics, but on the people who receive services from us in the other programs as well,” she added.

Kehoe estimated that Medicaid reimbursements account for 8 to 10 percent of the organization’s annual budget, or roughly $1.8 million. Like Maine Family Planning, Health Imperatives said it could also be forced to close clinics or reduce the number of patients it can see if it can’t make up its anticipated funding losses.

Health Imperatives has yet to join the growing body of lawsuits challenging new cuts to abortion providers. But it’s keeping its options open, Kehoe said.

Meanwhile, Health Imperatives is working to try to offset the expected loss in funding. Kehoe said Massachusetts Gov. Maura Healy’s recently-introduced supplemental funding package could—if passed by the state legislature—help close the gap. The nonprofit is also trying to increase donations from the private sector, she said. They typically raise about $1.5 million a year. But to completely offset the “big, beautiful bill” cuts, the organization would essentially have to double its fundraising over the next few months.

“As it is, we’re raising money to continue to provide the highest-quality health services in one of the most expensive states in the country,” Kehoe said. “It’s a big lift.”

Many other independent reproductive health clinics that provide abortions don’t appear to have been impacted by the legislation, Rewire News Group’s reporting found. Their Medicaid reimbursements likely don’t surpass the $800,000 annual threshold outlined in the law.

But even clinics that weren’t directly impacted by the targeted funding cut will likely face its consequences at some point, Fonteno said. She added that even though Planned Parenthood is the country’s largest abortion provider, independent abortion providers deliver the majority of care in the U.S., especially for abortions that happen later in pregnancy.

Under federal law, Medicaid plans must cover certain family planning services including contraceptives, STI testing, and routine exams. But providers don’t have to accept Medicaid plans, and research shows doctors are less likely to accept Medicaid than private health insurance. That means patients with already-limited financial resources have fewer provider choices.

Private fundraising and support from abortion funds—organizations that help people pay for abortion-related health care and travel—might help offset some of the losses. But it’s unlikely that they “will be enough to fully meet the need and fill in the massive gap that will be created from this legislation,” Fonteno said. “It’s like taking a bulldozer to an already profoundly-broken health-care system.”

Other reproductive health care could be on the chopping block

The Trump spending bill’s long-term impacts on reproductive health more broadly are still unknown, experts told RNG. But at a minimum, they said, the stricter eligibility standards and onerous work requirements in the law mean fewer people will be insured.

“Medicaid is one of the most important sources of sexual and reproductive health-care services for millions of people of reproductive age,” said Cat Duffy, a policy analyst at the National Health Law Program, a nonprofit health-care advocacy organization. “Something that’s particularly cruel about this bill is that it not only makes health-care coverage harder to get, it also makes it easier to lose.”

As a result, patients will have less consistent access to care. That will have an outsized impact on low-income people, people of color, and others who have historically faced barriers to care, said Megan Kavanaugh, a principal research scientist at the Guttmacher Institute.

Additionally, patients may lose access to the highly-specialized reproductive health care they receive at Planned Parenthood and similar clinics if they can’t be seen there, Kavanaugh said, meaning the overall quality of Medicaid patients’ reproductive health care could decline.

Some states are reporting that the “big, beautiful bill” will worsen budget deficits. And as one expert told the news site Axios, Medicaid programs are a place states could try to cut from. It’s unclear what coverage areas would be most at risk, Duffy said—some benefits and programs must remain covered under existing federal law. But it’s possible that some reproductive health-care programs or coverage could end up on the chopping block.

That’s especially true for states participating in Medicaid expansion, an Affordable Care Act provision that increases eligibility and coverage. These states faced harsher requirements and penalties in Trump’s spending package than the handful of states that have not opted to improve their eligibility requirements and coverage options.

Medicaid expansion, which increased access to prenatal and postpartum care, has played a crucial role in the fight against maternal mortality, Duffy said. And women in Medicaid expansion states have higher levels of both overall contraceptive and long-acting birth control use, Kavanaugh added.

“States are in deeply unprecedented territory,” Duffy added.

So is Maine Family Planning, which opened its doors in 1971.

Hill, the organization’s CEO and president, said it is still weighing its options in its lawsuit against the Trump administration’s cuts with its legal team—including appealing Walker’s decision. In the meantime, Maine Family Planning—like Health Imperatives in Massachusetts—is trying to fundraise to make up some of the nearly $2 million in federal funding it stands to lose. He added that fundraising alone “is not sustainable.”

“You know,” Hill said, “continuing to put this level of pressure on a health-care infrastructure in a state that is one of the most rural in the country is really unconscionable, I think.”

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