The Trump administration is threatening to strip Illinois of federal health dollars over a state law requiring medical providers to refer patients for abortion services, even if the providers oppose abortion.
The 2017 measure violates federal conscience protections, according to a notice to state officials sent Wednesday by the Department of Health and Human Services Office of Civil Rights (OCR).
The action is the Trump administration’s latest signal it’s willing to use federal funding as a cudgel to advance its priorities. The administration is under heavy pressure to further restrict abortion by antiabortion activists, who are gathering Friday for their annual March for Life and have been critical of the administration’s handling of the issue.
During the first Trump administration, antiabortion pregnancy centers, doctors and a medical association representing antiabortion obstetricians and gynecologists filed five complaints to OCR, saying they were morally opposed to any involvement in helping a patient get an abortion. Under the law, providers don’t have to provide abortions but must refer patients who request them to professionals who do. OCR waited to take action until after a lawsuit filed by several of the parties advanced.
OCR Director Paula Stannard said the administration is “reinvigorating” enforcement of federal religious freedom protections for health care providers after they were “neglected” in the Biden administration.
“We recognize that faith-based organizations are the first and sometimes the only source of quality care and support services in a community,” Stannard said in an interview. “We are committed to work to ensure … they’re not penalized by such programs for their religious beliefs or moral convictions.”
Illinois has 30 days to assure the administration it will follow the federal laws or risk losing some federal funding, according to the letter sent by OCR to the state. Stannard said HHS would consider withholding a wide range of funding, including grants or Medicaid dollars. Illinois receives about $20 billion in federal Medicaid money annually.
Illinois officials did not immediately return a request for comment.
Religious freedom for health care providers was a major focus under the first Trump administration, which issued a sweeping conscience protection regulation in 2019 that allows individuals and entities to raise religious or moral objections to offering services including abortion, sterilization and assisted suicide. It issued similar notice of violation to California in 2020, asserting that its law requiring health insurers to cover abortions violated federal law.
The Biden administration walked back those actions, withdrawing the notice of violation from California and amending the conscience protection rule.
OCR also issued notices on Wednesday rolling back Biden administration guidance on its interpretation of federal nondiscrimination and conscience protections.
Stannard acknowledged a future administration could reverse the action against Illinois but said her office believes it was a “well-reasoned determination.” The notice cites federal provisions that protect providers and insurers that refuse to provide, refer for or pay for abortions.
A federal district court upheld most of the Illinois law last year, and an appeals court is set to rule this year.
Illinois argued the law sufficiently balanced conscience protections for providers with a need for patients to be able to get timely, accurate information about medical options.
The Trump administration has repeatedly withheld federal health funds. Earlier this month, health officials announced they would pause federal child care funding to five states run by Democrats, citing concerns of fraud in family assistance programs. Last year, HHS, the Department of Education and the Justice Department stripped millions of research dollars from universities, claiming antisemitism on their campuses.
Stannard said OCR is investigating two other states, two hospitals and a health system in Michigan for violating federal conscience protections but declined to name them.
“We are going to be aggressively investigating complaints; we’ll be vigorously conducting compliance reviews across the board,” Stannard said.
The office spends much of its time investigating complaints from patients about violations of medical privacy and typically targets individual providers for discriminating against patients or mishandling medical records.
The action against Illinois is a nod to religious conservatives, who at times have felt sidelined by the second Trump administration.
Trump issued an executive order early last year directing federal agencies to roll back Biden-era directives he said were funding or promoting abortion through federally funded programs. Federal health agency leaders have promised a review of medication abortion, which antiabortion advocates want restricted.
But Trump rejected national abortion restrictions during his campaign, saying the issue should be left up to the states. Trump this month urged congressional Republicans to be “a little flexible” on a ban on federal funding for abortion in order to secure a deal on health insurance subsidies, infuriating antiabortion groups.
Abortion isn’t a top priority for Health and Human Services Secretary Robert F. Kennedy Jr., who long supported abortion rights before joining the administration.
Stannard said Kennedy, who is Catholic, “has been a vocal supporter” of conscience and religious freedom protections.
“His family has a history of supporting religious freedom,” Stannard said, noting that Sen. Ted Kennedy (D) — Kennedy’s late uncle — was a lead sponsor of a major religious freedom bill passed by Congress in 1993.
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