As the Trump administration's new Title X rule goes into effect, 41 clinics in L.A. County that get the federal funding are walking away rather than comply with the rule, which prevents health care providers from referring patients to abortion providers.
Planned Parenthood announced Monday the organization would pull out of the Title X program. The reproductive health organization lists 23 clinics in L.A. County.
Another 18 Title X-funded clinics in L.A. County are following suit, according to statistics provided by Essential Access Health, which manages California's Title X program.
That leaves 77 clinics in the county in the program and 250 statewide, according to Essential Access Health, which says between 600,000 and 650,000 people -- mostly women -- receive care in L.A. County from clinics that have received Title X funds.
Title X funding covers a variety of care, including birth control, cancer treatment and screening for sexually transmitted infections. Federal funding cannot be used to pay for abortions.
Planned Parenthood leaders say they cannot provide robust health care and also comply with the "unethical and harmful gag rule," said Jennifer Wonnacott, a spokeswoman for Planned Parenthood Affiliates of California.
"It is contrary to our mission and the core services that we are dedicated and committed to providing to our patients," she said.
Planned Parenthood, the American Medical Association and Essential Access Health have sued to block the new rule.
"This will be very fluid as this goes through the judicial process," said Julie Rabinovitz, president and CEO of Essential Access Health.
"Title X-funded entities are evaluating what's best for them and what's best for their patients at this time," she said. "We've heard from many members of our network that they will continue being Title X providers while our legal challenge advances."
The 14 clinics that make up Northeast Valley Health Corporation (NEVHC) are in that group.
Federally Qualified Health Centers, like those in the Northeast Valley group, typically have multiple sources of funding.
Northeast Valley's total annual budget is over $100 million; Title X funding represents just $300,000 of that amount.
The organization hasn't ruled out rejecting Title X funding for a portion of its clinics at a future date.
"It's by no means a completely set in cement decision, but at this point we believe we can comply," said Northeast Valley President and CEO Kim Wyard, adding that her organization is also awaiting the outcome of the legal challenge to the rule.
Northeast Valley has changed the way it trains its staff, she said, noting community health workers won't talk to patients about pregnancy options.
"Our OB-GYNS or nurse practitioners are prepared to do the options counseling, and they're allowed to do that under the new rule," said Wyard.
Unable to make referrals for women who opt for an abortion, Northeast Valley uses referral lists that don't point out which outside reproductive health providers offer abortion services. But those providers may be listed for the other services provided.
"We want to be sure that in the process of complying, we're still providing appropriate education and resources to patients who need them," said Wyard.
She says there are other pieces of the puzzle clinics like hers are working out.
For example, Wyard said at a recent meeting a provider asked whether clinics would be resticted in the way they treat a patient who had an abortion and then presented with complications in a Title X-compliant clinic.
"Is that okay? Or is that an extension of a termination service that you're not supposed to be involved in?" she asked. "So we still have questions and these still need to get clarified."
