(CN) — A three-judge panel of the Tenth Circuit on Monday declined Oklahoma’s request to restore millions of dollars in Title X funds, which the federal government pulled after the state’s Department of Health refused to give patients the number for a national hotline that provides information on abortion.

Oklahoma had requested a preliminary injunction requiring the U.S. Health and Humans Services Department to restore the funds, meant to help provide family planning services to low-income and rural communities. The federal appeals court panel Monday upheld a lower court’s decision denying the request, finding that Oklahoma was unlikely to succeed on the merits of its case.

In 2021, HHS mandated Title X recipients provide “neutral, factual information and nondirective counseling” on all pregnancy options and “a referral regarding all options when requested.”

Oklahoma followed the requirement at first, but after the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization allowed the state’s abortion trigger ban to take effect, Oklahoma stopped referring patients to services that provide abortion. The federal Health and Human Services Department told the state that it could satisfy the requirement by giving patients the number for a national hotline that provides neutral information on all pregnancy options, including abortion. Oklahoma initially agreed, but shortly afterward stopped following the policy, causing HHS to pull Title X funding from the state.

Oklahoma argued requiring it to provide the hotline number violates the Weldon Amendment, a federal law prohibiting HHS funds from going to government agencies that discriminate against health care entities for refusing to provide abortions or abortion referrals. The state further argued that its health department should be considered a health care entity and that providing the hotline number would constitute an abortion referral.

In a 2-1 decision, the Tenth Circuit panel disagreed.

“The call-in number offered an opportunity to supply neutral information regarding an abortion,” U.S. Circuit Judge Robert Bacharach, appointed by Barack Obama, wrote for the majority. “Oklahoma rejected the option of a national call-in number, but didn’t question the neutrality of the information provided.”

Senior U.S. Circuit Judge David Ebel, a Ronald Reagan appointee, joined Bacharach’s opinion.

But U.S. Circuit Judge Richard Federico, appointed by Joe Biden, argued in a dissenting opinion that requiring Oklahoma to provide the hotline number is the equivalent of forcing it to provide abortion referrals. Oklahoma had offered to provide nondirective counseling regarding all pregnancy options available in the state, he argued, so the only reason a patient would need to be given the hotline number would be to obtain information about abortion.

“If the patient desires information about options that are not abortion, there would be no need for a referral to a national hotline,” Federico wrote. “On the other hand, if a patient requests a referral, an Oklahoma provider would reasonably assume it is solely to explore the option of pregnancy termination, which OSDH concluded would run afoul of Oklahoma law and policy.”

The panel also rejected Oklahoma’s argument that the regulation violates the Constitution’s Spending Clause, which the Supreme Court has held requires the conditions Congress imposes on the receipt of federal funds to be unambiguous. Oklahoma argued the Title X statute is ambiguous because it does not specifically include the abortion counseling requirement, but the panel found that the statute gives HHS the authority to impose requirements on grants and that Oklahoma had clearly been aware of the requirement when it accepted the grant.

The Constitutional Accountability Center, a liberal advocacy group that filed an amicus curiae brief supporting HHS’s position, put out a news release celebrating the ruling, praising the Tenth Circuit panel for “rejecting Oklahoma’s attempt to distort the Spending Clause against reproductive rights.”

“Today’s decision is a win for reproductive rights, the power of federal agencies to do their jobs, and the text and history of the Constitution’s Spending Clause,” Constitutional Accountability Center Appellate Counsel Miriam Becker-Cohen said.

Oklahoma, however, has argued that HHS’s decision wrongly removes critical family planning funds for low-income and rural communities, something Judge Federico echoed in his dissent.

“Weighing against HHS’s interest is the reality that the termination of the grant to OSDH reduces access to health care for those who need it most: patients who visit OSDH clinics for health care because, by virtue of resources or geography, that is the only option available to them,” Federico wrote.