By PATRICK WHITTLE and GEOFF MULVIHILL

PORTLAND, Maine (AP) — An item in Republicans’ sweeping policy and tax bill intended to block Medicaid dollars from flowing to Planned Parenthood, the nation’s biggest abortion provider, is also hitting a major medical provider in Maine.

Maine Family Planning filed a lawsuit against the Trump administration Wednesday seeking to restore the reimbursements.

Accessing health care in Maine — one of the Northeast’s poorest states and its most rural — is a challenge in areas far from population centers such as Portland and Bangor.

Vanessa Shields-Haas, a nurse practitioner, said the organization’s clinics have been seeing all patients as usual and completing Medicaid paperwork for visits — but not submitting it because it appears the provision took effect as soon as the law was signed.

“Knowing how hard it is to access care in this state, not allowing these community members to access their care, it’s cruel,” Shields-Haas said.

Maine clinics appear to be only others included in cuts

Republican lawmakers targeted Planned Parenthood in one piece of what President Donald Trump dubbed the “big beautiful” bill that Congress passed and the president signed earlier this month.

While advocates focused on Planned Parenthood, the bill did not mention it by name. Instead, it cut off reimbursements for organizations that are primarily engaged in family planning services — which generally include things such as contraception, abortion and pregnancy tests — and received more than $800,000 from Medicaid in 2023.

The U.S. Senate’s parliamentarian rejected a 2017 effort to defund Planned Parenthood because it was written to exclude all other providers by barring payments only to groups that received more than $350 million a year in Medicaid funds. The not-for-profit Maine organization asserts in its legal challenge that the threshold was lowered to $800,000 this time around to make sure Planned Parenthood would not be the only affected entity.

It is the only other organization that has come forward publicly to say that its funding is at risk, too.

Federal law already bars taxpayer money from covering most abortions. Instead, the money in question involves other health services, such as cancer screenings and tests, and treatment for sexually transmitted infections.

Proponents of that wrinkle in the law say abortion providers use Medicaid money for other services to subsidize abortion.

“This has never been just about Planned Parenthood,” Autumn Christensen, vice president of public policy for Susan B. Anthony Pro-Life America, said in a statement. “It’s about any Big Abortion business or network that performs abortions. Taxpayers should never be forced to prop up an industry that profits from ending human lives.”

The U.S. Department of Health and Human Services, which is named in the lawsuit, declined to comment because it’s a legal matter.

Maine Family Planning goes beyond abortion

Maine Family Planning operates 18 clinics across the state.

In 2024, it had about 7,200 family planning patients, plus another 645 who obtained abortions. Services include pregnancy testing, contraception, family planning counseling, breast exams, cancer screenings and treatment of sexually transmitted infections.

Some of the sites also offer primary care services, where there are another 600 or so patients. There are about 800 gender-affirming care patients and about 200 who use its upstart mobile clinic, said George Hill, the president and CEO of the organization.

Hill said that for about two-thirds of its patients, Maine Family Planning is the only place they get medical care in a typical year.

About half of the patients not seeking abortions are enrolled in Medicaid, and the clinics have been receiving about $1.9 million a year in reimbursements, which accounts for about one-fourth of the organization’s budget.

“It’s a difficult state to provide care in and now we’re facing this,” Hill said. In its lawsuit, the group says it has enough reserves to keep seeing patients covered by Medicaid without reimbursement only through October.

Finding health care can be a struggle in this rural state

Maine Family Planning says that if it had to turn away patients, it would be more complicated for them than simply finding another provider. There aren’t enough in rural areas, the group notes — and many don’t accept Medicaid.

One patient, Ashley Smith, said she started going to Maine Family Planning about five years ago when she could not find other health care she could afford. While she’s not enrolled in Medicaid, she fears clinics could be shuttered because of cuts.

“I am so worried that if my clinic closes, I don’t know what I’ll do or if I’ll be able to see another provider,” Smith said.

Maine Family Planning also supports care at more than 40 other health care facilities. Other than the Planned Parenthood locations that receive money from Maine Family Planning, those other providers don’t stand to lose their Medicaid reimbursements.

But, Hill said, the loss of Medicaid funding for Maine Family Planning would mean the group would have less to send to partners.

The Maine clinics say the law violates their right to equal protection

The Center for Reproductive Rights, which is representing Maine Family Planning in the challenge, says in its legal filing that the defunding denies it equal protection under the law because it would have funding cut off, but organizations that provide similar services would not.

“The administration would rather topple a statewide safety network than let a patient get a cancer screening at a facility that also offers abortion care,” Meetra Mehdizadeh, a Center for Reproductive Rights lawyer, said in an interview.

Planned Parenthood already sued and won a reprieve from a judge, preventing its Medicaid payments cutoff — at least until July 21 — while a court considers that case.

Planned Parenthood has warned that the law could put 200 of its affiliates’ roughly 600 clinics across the U.S. at risk of closing.

Mulvihill reported from Cherry Hill, New Jersey.

This article has been corrected to show that the 645 abortion patients in 2024 were in addition to 7,200 family planning patients.