Title X is a federal statute, administered by the Department of Health and Human Services (HHS), that provides grants for reproductive healthcare for low-income patients. For the majority of the forty-plus years that Oklahoma has received Title X funding for its state-run healthcare centers, HHS regulations have required the state’s clinics to provide abortion counseling and referral upon request. Oklahoma unilaterally stopped complying with that requirement in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization—despite receiving clear guidance from HHS that the Title X funding requirements had not changed. As a result, HHS terminated Oklahoma’s Title X funding.

Oklahoma responded by filing suit against HHS in federal district court and requesting a preliminary injunction ordering the federal government to reinstate its funding of the state clinics. After the district court denied Oklahoma’s request, the state appealed to the United States Court of Appeals for the Tenth Circuit, where CAC filed an amicus brief in support of the federal government.

CAC’s brief focused on refuting Oklahoma’s sweeping Spending Clause claim: namely, that it was never obligated to comply with the counseling and referral requirement in the first place because the requirement was set forth in a regulation, as opposed to a statute. Our brief made two main points.

First, Oklahoma’s argument was at odds with binding Supreme Court precedent. The Court has plainly held that federal regulations can provide sufficient notice of grant conditions. That conclusion follows from two principles in constitutional law. First, the Court has made clear time and again that Congress may delegate broad authority, including the authority to establish funding conditions, so long as those conditions are consistent with an “intelligible principle” set forth by statute—a highly deferential and permissive standard. Second, the Spending Clause is satisfied so long as the relevant statute and regulations considered together provide sufficient notice of the conditions with which the grantee must comply.

Our brief explained that those standards were clearly met in this case: under binding Supreme Court precedent, the counseling and referral rule is consistent with the principles set forth by Congress in Title X. And Oklahoma did not assert—nor could it—that it was unaware of the counseling and referral requirement when it accepted Title X funds. The counseling and referral rule, promulgated via notice and comment rulemaking, was in place when the state accepted Title X funding, and the regulation itself is unambiguous. Moreover, Title X expressly delegates authority to HHS to issue funding conditions. Oklahoma thus knew to look to regulations for the terms of its grant, just like states do in countless other areas of law in which agencies are empowered to impose funding conditions.

Second, our brief explained that Oklahoma’s construction of Congress’s limited authority to delegate the power to impose funding conditions is at odds with constitutional history. At the Founding, Congress delegated broad swaths of its taxing and spending power without constitutional objection. Our brief provided three examples of these broad delegations: (1) the creation of the nation’s first veterans’ benefits program administered by the executive branch, (2) the refinancing of the national debt in the wake of the Revolutionary War, run by the President and a commission of high-ranking officials, and (3) the imposition of a direct tax on all property-holders in the nation administered by a massive group of tax commissioners. Indeed, these examples illustrate that as compared to early American practice, Congress’s delegation of authority to HHS to establish funding conditions under Title X is actually quite modest.

In sum, there is simply nothing in precedent or constitutional text, structure, or history that prevents Congress from unambiguously delegating its power to impose funding conditions to executive officials—so long as those officials, in turn, comply with the Spending Clause’s clear-statement requirement, and their regulations are consistent with a statutory “intelligible principle.”  Those conditions were plainly met here, so the Tenth Circuit needed to reject Oklahoma’s assertion that it is exempt from compliance with a lawfully promulgated regulation on Spending Clause or separation-of-powers grounds.

In July 2024, the Tenth Circuit ruled in favor of HHS, holding that HHS does not need to award federal funding to state-run reproductive healthcare clinics that refuse to comply with the funding condition requiring clinics to offer non-directive counseling and referral upon request for abortion care.

The Court rejected Oklahoma’s argument that, as a matter of law under the Spending Clause, the state lacked sufficient notice of the counseling and referral requirement. Echoing our brief’s articulation of the requirements for fair notice under the Spending Clause, the Court held that Oklahoma was able to make “an informed decision” whether to accept Title X funding “based on the combination of Title X’s language and HHS’s conditions” considered together. And looking to the same history we presented in our brief demonstrating the frequent Founding-era delegations of the authority to impose conditions on federal funding, the court concluded that Title X lawfully delegates authority to HHS to impose the counseling and referral requirement.

In addition to rejecting Oklahoma’s arguments premised on the Spending Clause, the majority also rejected the state’s other arguments regarding why it should have been awarded Title X funding. Judge Federico dissented with respect to one of those other arguments, stating that he would have held that termination of Oklahoma’s Title X grant constituted unlawful discrimination under the Weldon Amendment.