A federal judge in Boston has issued a new order blocking the Trump administration from enforcing a Medicaid provision in the One Big Beautiful Bill Act that would cut off funding to Planned Parenthood and similar providers in more than 20 Democratic-led states. The ruling, in a lawsuit brought by a multistate coalition, finds that the law likely violates constitutional limits on federal spending by failing to give states clear notice of how to comply.
The latest legal challenge targets a key section of the One Big Beautiful Bill Act, President Donald Trump’s wide‑ranging domestic policy package that includes a one‑year restriction on Medicaid payments to certain abortion‑related providers.
According to legal analyses and court filings, the law bars Medicaid funding for “prohibited entities” that are organized as tax‑exempt nonprofits, qualify as essential community providers, primarily provide family planning and reproductive health services, perform abortions (with narrow exceptions), and received more than $800,000 in Medicaid funding in fiscal year 2023. Those criteria are written broadly enough that they primarily affect Planned Parenthood affiliates, though other providers can also fall within the definition.
U.S. District Judge Indira Talwani, who sits in Boston and was nominated to the bench by President Barack Obama, issued a preliminary injunction this week in a case brought by more than 20 Democratic‑led states and the District of Columbia. As Politico and Reuters report, the states — including California, New York and Connecticut — argue that the provision violates the Constitution’s Spending Clause because it is both vague and retroactive, and does not give states clear notice of which providers will lose Medicaid funding or how they are expected to administer the program going forward.
Talwani agreed that the states are likely to succeed on at least some of their constitutional claims. In her ruling, described in coverage by Politico and Reuters, she faulted the Department of Health and Human Services for failing to provide clear guidance on how to apply the “prohibited entity” definition and noted that the law reaches back to providers’ Medicaid reimbursement levels in 2023, even though it did not take effect until 2025. She warned that the provision, as written, could force states to renegotiate existing Medicaid contracts and either disrupt patient care or absorb higher costs if they are forced to cover services formerly provided by defunded clinics.
The injunction temporarily prevents the Trump administration from enforcing the defunding measure in the suing states and the District of Columbia. Judge Talwani allowed a short stay of her order — seven days, according to Politico and Reuters — so the Justice Department can seek emergency relief from the First U.S. Circuit Court of Appeals.
This multistate case follows an earlier round of litigation brought by Planned Parenthood Federation of America itself. As detailed by Washington Post and law‑firm summaries, Planned Parenthood first sued shortly after Trump signed the bill, and Talwani initially issued a temporary restraining order, then a preliminary injunction, blocking the defunding provision as applied to Planned Parenthood affiliates nationwide. In September 2025, however, the First Circuit lifted that earlier injunction, allowing the Trump administration to begin enforcing the restriction while appeals continue.
In the wake of the First Circuit’s decision, Planned Parenthood and outside analysts have warned that the loss of Medicaid reimbursement has already led to clinic closures in several states and reduced access to services such as cancer screenings, STI treatment and contraception. Precise national closure figures vary by source, and federal officials have not confirmed a specific total.
The Trump administration has maintained that the law is aimed at any provider that meets the statutory criteria, not just Planned Parenthood. Supporters argue that, because the definition of “prohibited entity” is spelled out in detail, identifying affected organizations should be straightforward for states and managed care plans.
Anti‑abortion advocates reacted sharply to Talwani’s latest order. In comments reported by conservative outlet The Daily Wire, Marjorie Dannenfelser, president of SBA Pro‑Life America, characterized Talwani as part of a bloc of liberal judges and accused Democrats of trying to “thwart the will of the people” and “bail out the Big Abortion industry, led by Planned Parenthood.” She emphasized that the One Big Beautiful Bill Act was passed by Congress and signed by the president, and vowed that anti‑abortion groups would continue pushing to ensure federal taxpayers do not fund organizations involved in abortion care.
The new lawsuit by state attorneys general, led in part by New York and California, asks the court to permanently invalidate the Medicaid provision on multiple grounds, including the Spending Clause, the First Amendment and the Constitution’s ban on bills of attainder. Legal commentators note that if the First Circuit again upholds enforcement of the law, the dispute could ultimately reach the Supreme Court, where the current conservative majority has recently narrowed avenues for challenging state Medicaid decisions.
In the meantime, the litigation keeps the defunding fight in the spotlight ahead of the 2026 midterm elections. Planned Parenthood has been seeking to offset lost federal dollars with state appropriations and private donations, but has warned that alternative funding is unlikely to fully replace the hundreds of millions of dollars the organization previously received each year through Medicaid.
