At least one family planning provider is not backing down from a plan to reject federal dollars after the Trump administration said it would delay enforcement of its new abortion rule.

Days after announcing that recipients of federal family planning grants would have to immediately stop referring patients for abortions, Department of Health and Human Services officials sent a rare Saturday night notice to Planned Parenthood affiliates, state governments and other organizations that they would now have two months to comply with the contentious Title X rule change, The Washington Post's Amy Goldstein reported. That announcement came after a federal health official told more than 200 reproductive health organization leaders last week that she wanted to give providers 60 days to comply with the change once the department issued guidance on how to do so, Amy reported.

Maine Family Planning was one of the first organizations to say it would no longer accept federal money, withdrawing from the federal family planning grant program it has been part of for nearly five decades after the Trump administration initially said it would immediately enforce the referral ban. George Hill, the president and chief executive of the independent provider, told me the "gag rule" is "completely at odds with our mission," and said the administration's backpedaling won't change his mind.

"It does not change our decision at all," Hill told me. "It's sort of symptomatic of the administration's treatment of the family planning network over the last however many months. They issue a directive, and neglect to provide direction on it, any analysis on it, and then they pull it back, and then they move forward. We're done. We're going to withdraw from the program and rely on local resources for as long as we can."

The network that serves about 23,000 people in Maine will sacrifice nearly a million dollars in funding for the rest of the year, Hill said. It will dip into reserves to make up for a pot of cash that usually accounts for nearly 30 percent of its annual budget. It was one of a few grant recipients that announced last week they would stop taking federal money or withdraw from Title X funding altogether, a group that includes Planned Parenthood, the largest recipient of the money, and its Illinois affiliate, both of which said they would not comply with the rule.

The Trump administration's delay is just the latest twist for family planning providers who say they will ultimately be forced to choose between rejecting federal dollars or compromising on an ethical obligation to provide a range of reproductive health services for patients, including abortion referrals.

Alina Salganicoff, senior vice president and director of women's health policy at the Kaiser Family Foundation, said she expects most Title X grantees to make the same decision as they would have before the delay.

"At the end of the day, the decisions I think are going to remain the same," she told me.

Movement on the Title X rule changes had been quick leading up to the administration's initial announcement last week, she pointed out. A panel of federal appeals court judges last month said the administration could implement the rules while lawsuits opposing them played out.

"The timeline was very tight, clinics were not expecting the courts to rule so soon, and we don't have the final ruling on these cases," Salganicoff said. "So [the delay] gives time for that whole process to work itself out. It gives the grantees and clinics more time to figure out their contingency plans if they decide they're not going to take federal money."

Providers now have more time to adhere to the new restrictions. But before the Saturday night change, grant recipients had been split on whether to stop accepting federal money or to continue to do so because forgoing funds could force them to cut critical services, beyond abortion referrals, for vulnerable patients.

Caroline Hoke, the chief clinical officer at Erie Family Health Centers in Illinois, told me last week that its providers had planned to keep taking Title X funding. "We found ourselves in an untenable position of trying to decide whether to provide vital services or honor our providers' commitment and belief to provide thorough, clear and non-biased counseling that our patients expect and deserve," she said in an interview.

Illinois Gov. J.B. Pritzker, D, announced Thursday the state would refuse about $2.4 million in federal funds for 28 grantees and direct the Illinois Department of Public Health to provide that funding instead - an announcement that left another question mark for Hoke's organization about whether that would fill the gap for Erie and other providers.

Hoke later said the administration's rule delay hadn't changed any plans for the Erie centers.

"We're grateful that [Pritzker] has promised funding that would allow us to continue to care for the patients who need us and depend on Title X funding without asking our providers compromise their values or integrity," Hoke said in an email, saying she's waiting for additional guidance about the state's assistance this week.

Mary Kate Knorr, the executive director of Illinois Right to Life, called Pritzker's response "purely political."

"For him to say that the state will essentially cover the costs, I'd like to know where they're going to get the money for that," she said. She also challenged concerns from family planning providers who say the Title X rule change could jeopardize health services. "It's a purely political move. Women aren't going to lose care as a result of the Title X change, especially not in Illinois," she said, saying there were hundreds of federally qualified health centers in the state that provide "all the services" that organizations such as Planned Parenthood provide. "They actually provide more than Planned Parenthood provides but they don't provide abortions," she said.

Hoke said last year, Erie Family Health Centers received about $440,000 in Title X funding, which enabled it to help 5,800 Title X clients out of a total of 7,700 patients with services including contraceptives as well as STI and cancer screenings.

Title X is considered the "payer of last resort," Hoke said. Patients who come to these clinics are low-income but may not qualify for Medicaid or otherwise have access to private insurance. She criticized the Trump administration's rule for what she called "villainy." "The strategy is targeted at vulnerable groups, women who are poor who rely on public insurance who already disproportionately suffer higher rates of unplanned pregnancies and STIs," she said.

Hill said Maine Family Planning would consider reapplying for federal funding "if and when the gag rule is completely off the table." "Raising private dollars to support public health services is not a long-term solution," he said. "It's just a necessity under these circumstances."

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