On December 30, 2023, the 1st U.S. Circuit Court of Appeals in Boston ruled in favor of the Trump administration, permitting the enforcement of a provision from the One Big Beautiful Bill Act that restricts Medicaid funding for Planned Parenthood health centers that perform abortions. This decision overturns an earlier injunction issued by U.S. District Judge Indira Talwani, which had blocked the law's enforcement across 22 states and the District of Columbia.

The provision specifically targets tax-exempt organizations like Planned Parenthood that received over $800,000 in Medicaid funding during the 2023 fiscal year. Since the enactment of this law in July, Planned Parenthood has reported the closure of at least 20 of its health centers, with potential projections indicating that up to 200 centers could close, particularly in states where abortion services remain legal. Advocates have described this legislative action as a form of indirect abortion ban, which threatens access to essential reproductive health services, including STI testing, cancer screenings, and contraception.

In 2024, Planned Parenthood documented over 1.5 million visits from individuals relying on Medicaid for these critical health services. Experts have raised concerns that the withdrawal of funding could significantly limit healthcare options for many individuals. Following the First Circuit's decision to pause Talwani's injunction, a coalition of Democratic attorneys general sought to challenge the law's enforcement again, arguing that it imposed unconstitutional conditions on state participation in the Medicaid program. However, the First Circuit panel, composed solely of judges appointed by Democratic presidents, concluded that the Trump administration was likely to succeed in its appeal, asserting that Congress has the authority to implement such changes.