California Could Lose $300 Million in Medi-Cal Funding Under Project 2025's Abortion Plan

If President-elect Donald Trump goes forward with Project 2025, California could lose out on at least $300 million a year in funding for abortions, family planning and contraception for millions of lower-income residents.

Project 2025, a right-wing blueprint for the next president, targeted the state with an ultimatum that would require California to start reporting abortion data to the Centers for Disease Control or risk losing critical Medicaid funding.

Despite Trump’s attempts to distance himself from the plan during the campaign, at least 140 of his allies produced the report, and he’s appointing key figures from the project to his administration. As California leaders rush to shield the state from a Trump agenda, preserving reproductive freedoms stands as a top priority.

Newsom called a special session for next month to “Trump-proof” California, and he’s hiring lawyers to prepare for Day 1 of the Trump presidency.

“Whether it be our fundamental civil rights, reproductive freedom, or climate action — we refuse to turn back the clock and allow our values and laws to be attacked,” Newsom said in a statement.

When CalMatters first reported on the ultimatum in September, the California Department of Health Care Services didn’t provide specific figures detailing how much the state receives in federal reimbursements for reproductive health care provided through Medi-Cal. The department now says the federal government reimbursed California about $310.7 million for reproductive health care last year, according to California Department of Health Care Services figures. In the previous year, the state received $334.5 million. That funding supports Medi-Cal, the single largest payer of maternity care in the country. Medi-Cal covers about 14.2 million Californians. All told, the federal government reimbursed the state $90.9 billion for Medi-Cal last year.

Under Project 2025, all 50 states would be mandated to report detailed abortion-related data to the federal government, including information such as the reason for the abortion, the fetus’ gestational age, the birthing parent’s state of residence, whether the procedure was surgical or medication-induced, and more.

Currently, California, Maryland, and New Hampshire do not require abortion providers to share patient data with the federal government. Shortly after the overturning of Roe v. Wade, the California Department of Public Health said that it does not report abortion data federally because it is not legally obligated to do so. States that do collect abortion data typically use it for public health analyses, which can help identify gaps in care and improve access to services.

Newsom’s office did not provide details on the projected costs of lawyering up but said the governor plans for legislation to give additional resources to the California Department of Justice and other state agencies.

These resources are intended “to pursue robust affirmative litigation against any unlawful actions by the incoming Trump administration, as well as defend against federal lawsuits aimed at undermining California’s laws and policies,” the governor’s office said. “The funding will support the ability to immediately file litigation and seek injunctive relief against unlawful federal actions.”

Trump tapped two individuals associated with Project 2025 for roles in his administration. Brendan Carr, who authored Project 2025’s section on the Federal Communications Commission, will lead the agency.

Tom Homan, an immigration hawk who’s listed in Project 2025’s credits as having assisted in developing and writing the playbook, will serve as the border czar, overseeing immigration policies and implementing mass deportation strategies. The spot is not an official cabinet position.

To lead the Department of Health and Human Services, Trump tapped Robert F. Kennedy Jr., an environmental lawyer who previously fought California over vaccine mandates. The department controls oversight of Medicaid spending and plays a critical role in abortion reporting by setting federal guidelines and enforcing privacy protections under HIPAA.

Kennedy does not appear to have endorsed Project 2025. His stance on abortion has been notably inconsistent over time. In May, he expressed support for unrestricted abortion access, stating he opposed any government restrictions, “even if it’s full term.”

However, he later revised his position, advocating for legal abortion up to the point of fetal viability, the stage at which a fetus can potentially survive outside the womb.

Roger Severino, who served as the Department of Health and Human Services director of the Office for Civil Rights under Trump, authored Project 2025’s abortion surveillance plan. He is now the vice president of domestic policy at the Heritage Foundation, the conservative think tank behind Project 2025. He declined an interview request.

Severino’s vision for remaking the department is a cornerstone of Project 2025’s effort to impose stricter federal oversight on abortion practices, particularly targeting states like California, which offers greater access to abortion services than most other states.

“Because liberal states have now become sanctuaries for abortion tourism, [the Department of Health and Human Services] should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method,” reads the chapter (PDF) on abortion reporting.

The potential fallout isn’t limited to California. Experts have warned that other states with progressive abortion policies may face similar funding threats, amplifying the national debate over reproductive rights under Trump’s second term.

After Election Day, Newsom traveled to Washington, D.C., for meetings with the Biden administration and congressional leaders to “discuss strategies for safeguarding health care access,” said Anthony Cava, a spokesperson for the California Department of Health Care Services.

Cava would not elaborate on those strategies. He said the department “cannot speculate on the future of these programs under a new federal administration, but the Newsom administration is working to protect the health and well-being of all Californians.”

California has long positioned itself as a national leader in reproductive rights, actively opposing federal restrictions on abortion access. The state’s proactive policies, such as safeguarding providers who serve out-of-state patients, stand in stark contrast to the goals of Project 2025. As policymakers and advocates brace for how Trump plans to “Make California Great Again,” they’re treating Project 2025 as a looming possibility.

Planned Parenthood, one of California’s leading providers of reproductive health care services for lower-income communities, said the organization is preparing for “a variety of scenarios.”

Shelby McMichael, a spokesperson for Planned Parenthood Affiliates of California, said “while specifics remain under wraps,” the group is prioritizing expanding California’s abortion provider workforce, increasing investments in abortion funds and infrastructure as well as analyzing data to “improve abortion care access and education.”