The Trump administration has backtracked on an announcement five days earlier that had required federal funded family planning centers to immediately stop referring women for abortions, giving the clinics two more months to comply.
In a rare Saturday night notice to Planned Parenthood affiliates, state governments and other organizations that receive federal family planning grants, Health and Human Services Department officials wrote that no group would be penalized yet for failing to obey with this and other rule changes.
The department announced it was postponing the new rules shortly after a federal health official overseeing the family planning program told more than 200 leaders of reproductive health organizations gathered this week in Washington that she wanted to give them 60 days to adhere to the new abortion restrictions and that federal lawyers were reviewing the idea, according to three participants in the closed meeting and others who were told afterward.
Those comments Thursday, by HHS official Diane Foley at a conference for recipients of the family planning grants, and the Saturday night revisions to the time frame created new turmoil in the administration's efforts to restrict the government program, known as Title X, that started in 1970 and pays for reproductive health services for about 4 million poor women and girls annually.
The administration's rewrite of the program's rules, appealing to social conservatives crucial to President Donald Trump's base, became final last winter and were to have taken effect in March. But they were blocked by federal judges issuing temporary injunctions in response to lawsuits opposing the changes. Those were recently overturned by an appeals court in California that decided the rules could begin while the litigation plays out.
On Monday evening, as conference participants from around the country were arriving in Washington, HHS sent out a notice saying that the federally funded family planning organizations were expected to comply with the changes, derided by critics as "abortion gag rules," by the workday that had just ended. The department did not issue written guidance on how to comply with the changes.
"Many of us landed in D.C. and turned our phones on, and there's the email with all of the confusion," one conference participant said.
A few of the 90 grant recipients swiftly announced that they would either stop accepting the federal money or would withdraw from the program altogether to continue to serve women seeking counseling that includes discussion of abortion as an option. They include Planned Parenthood, the largest recipient of federal family planning money and a target of social conservatives.
Illinois Gov. J.B. Pritzker, D, announced Thursday that the state would forfeit its estimated $2.4 million in family planning funds, shared by 28 organizations.
"Under my administration, Illinois will always stand with women and protect their fundamental right to choose," the governor said in a statement, believing the state already was compelled to follow the new federal rules.
Foley, who oversees the program for HHS' Office of Population Affairs, had said hours earlier that she thought grant recipients should get more time to meet the requirements, according to the participants, who spoke on the condition of anonymity about a private meeting.
It is unclear what would happen to the states and organizations that have forgone the money if courts rule HHS changes are illegal.
Foley's comments came after grant recipients said they were frustrated that the department had failed to follow through on its promise this spring to send out detailed, written instructions about how to comply with the new rules, participants said.
Three participants said Foley told the gathering that HHS would issue written guidance soon.
The two-page notice issued Saturday night did not include detailed information about how the federally funded organization should interpret parts of the rules, such as a section that bans referrals for abortion but says that family planning centers may provide "nondirective counseling" that mentions abortion among options.
The notice says that the grant recipients must provide within a month assurance that they do "not include abortion as a method of family planning" - even with outside money, as has been allowed until now. They also must submit an "action plan" describing the ways they will comply with all aspects of the new rules, except for one to take effect next spring. Everyone needs to be in compliance by Sept. 18, the notice said.
An HHS spokeswoman who said late on Saturday that the updated time frame had just been sent to the 90 grant recipients did not answer questions about whether additional instructions were being written and, if so, when they would be issued.
The long-scheduled conference that ended Friday was the department's first for federally funded family planning organizations since 2015, and participants said Foley told them that "she, too, had very little notice" that family planning organizations would be being expected to comply with the new rules immediately.
This article was written by Amy Goldstein, a reporter for The Washington Post.