131 F.4th 350
6th Cir.2025Background
- In 2021, HHS promulgated a rule requiring Title X grant recipients to provide neutral, nondirective counseling and referrals for abortion if requested by a patient.
- Tennessee, a longtime Title X recipient, criminalized most abortions after Dobbs v. Jackson Women’s Health Organization, but continued to commit only to offering counseling and referrals for options legal under state law.
- HHS found Tennessee's position noncompliant with the 2021 Title X regulations and opted not to renew its grant.
- Tennessee sued to block the decision, seeking a preliminary injunction and reinstatement of Title X funding.
- The district court denied the injunction, finding Tennessee unlikely to succeed and that the balance of equities favored HHS; Tennessee appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Did HHS’s enforcement of counseling/referral rules violate the Spending Clause? | HHS added requirements not clearly authorized by Congress, infringing on states' Spending Clause rights. | Congress unambiguously delegated authority to HHS to set conditions and Tennessee voluntarily accepted them. | No violation; delegation was clear, Tennessee knowingly accepted terms. |
| Did HHS exceed its statutory authority under Title X and the APA by requiring abortion referrals/counseling? | HHS’s interpretation of § 1008 is impermissible; referrals make abortion a 'method of family planning,' forbidden by statute. | Agency regulations have long permitted such requirements; neutral, nondirective counseling is consistent with Title X and appropriations riders. | HHS acted within statutory authority; the regulation is a permissible construction of § 1008. |
| Did HHS’s enforcement improperly burden Tennessee's sovereignty/state law? | Federal rule compels undermining of Tennessee’s abortion laws. | Nothing compels Tennessee to participate; state laws can diverge, but grant conditions apply. | No burden—Tennessee could decline funding; no conflict shown. |
| Did Tennessee show irreparable harm justifying a preliminary injunction? | Loss of funding and reputational harm are irreparable, given funding shortfall and future grant risks. | Harm is speculative or mitigated by state legislative appropriations; compliance with conditions is not new. | No, harm is not of sufficient magnitude or certainty to warrant injunction. |
Key Cases Cited
- Rust v. Sullivan, 500 U.S. 173 (1991) (upholding HHS authority to interpret Title X as barring abortion counseling/referrals due to statutory ambiguity)
- Pennhurst State Sch. & Hosp. v. Halderman, 451 U.S. 1 (1981) (detailing Spending Clause requirements for state acceptance of federal grant conditions)
- Bennett v. Kentucky Dep’t of Educ., 470 U.S. 656 (1985) (upholding agency authority to clarify ambiguous statutory terms with regulations in grant context)
- Chevron U.S.A., Inc. v. Nat. Res. Def. Council, Inc., 467 U.S. 837 (1984) (establishing Chevron deference, since overruled by Loper Bright)
- Loper Bright Enterprises v. Raimondo, 603 U.S. 369 (2024) (overruling Chevron, instructing courts to independently interpret statutes)
- Dobbs v. Jackson Women’s Health Organization, 597 U.S. 215 (2022) (holding no federal constitutional right to abortion)