9th Circuit Court of Appeals Releases Devastating Decision for Millions of Title

“This is a devastating decision for the millions of low-income patients who rely on the Title X program to receive comprehensive, quality sexual and reproductive health care nationwide. We are committed to ensuring that Title X patients are able to get the essential services they want, when they need them. We will continue to discuss next steps with our legal team and litigation partners over the coming days. 

 “Despite today’s ruling, the facts remain the same – the Trump regulations are unlawful and harmful and clearly put politics over public health.

 “The federal government has no business getting in the way of a woman’s ability to make personal decisions about her health.

 “Trump’s Title X regulations have already devastated the Title X family planning safety net nationwide. In California, there has been a 40% reduction in patients served by the program – disproportionately impacting underserved and rural areas, and communities of color. California’s statewide Title X network could be dismantled even further, if the regulations are not halted prior to March 4, when the physical separation requirements are scheduled to take effect.

“This year is the 50th Anniversary of Title X – a program that’s been hailed as one of the biggest public health achievements of the last century. California has the largest Title X provider network in the nation, and we will fight to the end to protect Title X’s mandate to provide comprehensive family planning services for all, for generations to come.”


Essential Access Health has been the statewide Title X grantee in California since the program was established 50 years ago in 1970. Essential Access distributes Title X funding to a statewide provider network to support the delivery of essential health services including birth control, STD and pregnancy tests, and life-saving cancer screenings.

Our lawsuit, Essential Access Health v. Azar, includes co-plaintiff Dr. Melissa Marshall, a family medicine doctor practicing at a Title X-funded health center in Yolo County, California. Essential Access Health and Dr. Marshall are represented by a team at the law firm Keker, Van Nest & Peters, led by Michelle Ybarra[1].

Case Timeline

  • May 22, 2018 – The United States Department of Health and Human Services released proposed Title X regulations that introduced some of the most sweeping and extreme changes in the history of the program
  • July 30, 2018 – Essential Access Health submitted public comments outlining the harms the proposed regulations would cause in California and across the country
  • February 22, 2019 – Final Title X regulations released on the Office of Population Affairs website
  • March 4, 2019 – Final regulations officially published in the Federal Register; Essential Access Health v. Azar, et al filed in federal court
  • March 21, 2019 – Essential Access Health filed preliminary injunction motion
  • April 18, 2019 – Oral arguments presented in preliminary injunction hearing
  • April 26, 2019 – Preliminary injunction granted
  • May 3, 2019 – Date regulations were scheduled to take effect
  • June 20, 2019 – 9th Circuit Court of Appeals motions panel lifts preliminary injunctions
  • July 4, 2019 – 9th Circuit Court of Appeals grants Motion for En Banc Reconsideration and reinstates preliminary injunctions
  • July 11, 2019 – En banc panel of Ninth Circuit judges denied the request to restore the preliminary injunction that had been set aside by the motions panel’s stay while the rehearing process moved forward
  • July 26, 2019 – Planned Parenthood Federation of America, joined by litigation partners including the American Medical Association and National Family Planning & Reproductive Health Association, file a petition requesting full 9th Circuit reconsideration of the en banc panel’s July 11 order
  • September, 23, 2019 – En banc panel of 9th Circuit judges heard oral arguments on the request for reconsideration of the June 20 motion’s panel’s decision lifting the preliminary injunctions
  • February 20, 2020 – Hearing in Federal District Court on Essential Access Health’s motion for summary judgment
  • February 24, 2020 – 9th Circuit Court of Appeals decision issued


Essential Access Health champions and promotes quality sexual and reproductive health care for all. Essential Access achieves its mission through an umbrella of programs and services, including health center support initiatives, provider training, advanced clinical research, public policy and outreach, and awareness campaigns. Essential Access leads the statewide Title X program in California – the largest Title X system in the nation – that collectively served 650,000 low-income Californians in 2019.

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