Starting now, abortion providers in all states but Maryland will lose federal money if they refer patients for abortion.

In response to a lawsuit filed by Planned Parenthood Federation of America, the American Medical Association (AMA), 21 state attorneys general and California, the United States Court of Appeals for the Ninth Circuit in San Francisco is considering the legality of a proposed rule from the Trump administration. Thursday (June 20), the court dismissed injunctions that sought to block implementation of the rule pending its decision.

Reports The New York Times:

A three-judge panel called the rule a “reasonable interpretation” of the federal family planning law known as Title X, and said the administration was likely to successfully show it should be upheld.

The panel also said the public interest supported the rule, given the government’s “important policy interest” in ensuring that taxpayer dollars not fund or subsidize abortions.

The regulation—which reproductive rights advocates call a domestic “gag rule”—changes the requirements health care providers must meet to receive federal money via Title X, the federal family planning program established in 1970. It provides $286 million in funding for programs that provide services like birth control and mammograms, and screenings for breast cancer and cervical cancer. Title X serves people with low incomes; according to Planned Parenthood, the people most impacted by the funding are people of color.

Under the rule, health care providers will be able to discuss abortion with patients, but will be barred from saying where one can be obtained. Clinics will also be able to omit abortion from conversations with pregnant women who are weighing their options, whereas previously, a clinic could not receive federal funding unless all options were discussed.

The rule also stipulates that every pregnant patient must get a referral for prenatal care, that clinics licensed to perform abortions will have to do so in a separate facility from where they provide other services and that they must keep separate financial records for abortion-related expenses, per The Washington Post.

Planned Parenthood serves 41 percent of all patients receiving care under Title X. According to The New York Times, it gets approximately one-fifth of all Title X funds. In response to the court’s decision, the organization’s president, Leana Wen, released a statement that reads, in part:

The Trump-Pence administration’s gag rule is unethical, illegal and harmful to public health. The news out of the Ninth Circuit this morning is devastating for the millions of people who rely on Title X health centers for cancer screenings, HIV tests, affordable birth control and other critical primary and preventive care.

Maryland is exempt from yesterday’s decision because, as Colorlines previously reported, in March, it passed a law that ended the state’s inclusion in the Title X program. The law requires the governor to use state money to fund the family planning program. Maryland’s population is nearly one half people of color, with Black residents making up 30.8 percent of the state and Latinx residents accounting for 10.1 percent.

study released Thursday supports reproductive rights activists’ belief that lower income-earning pregnant people will be disproportionately affected by the gag rule. The study, by researchers at Advancing New Standards in Reproductive Health at the University of California, San Francisco, found that about one in four lower-income earning people who want an abortion give birth instead because their insurance will not cover the procedure. “Denying public funding of abortion creates an insurmountable barrier for patients with lower incomes, putting abortion out of reach for thousands of people,” Sarah Roberts, senior author of the study, said in an emailed statement.

“The Ninth Circuit Court has joined the war on young people, people of color, low-income families and all those who need quality reproductive health care with Thursday’s decision to allow the Trump administration’s Title X Gag Rule to take effect,” said Deb Hauser, president, and Diana Thu-Thao Rhodes, director of public policy, at Advocates for Youth, said in an emailed statement.

Although the rule is now in effect, its legality is still being decided in response to the lawsuit. The New York Times reports that the Ninth Circuit is considering its merit “on an expedited basis.”