The money once funded some 4,000 U.S. clinics offering services like STI testing, cancer screenings, and birth control.

The Trump administration’s attempt to carve abortion-related services out of the only federal program dedicated to funding family planning has driven entire states to leave it.

At least six states no longer have access to the money provided by the Title X program, which once funded some 4,000 U.S. clinics offering services like STI testing, cancer screenings, and birth control. Rather than comply with the administration’s decree that these providers no longer refer patients for abortions — which reproductive health advocates say amount to an unethical “gag rule” — state health departments and individual organizations across the country have decided to leave the program entirely.

Not having access to that money could cripple states’ ability to provide services to the 4-million low-income people, largely women of color, served by Title X.

“They may have to have longer waiting periods for appointments because they’ve had to cut back on clinic hours,” said Alina Salganicoff, senior vice president and director of women’s health policy for the Kaiser Family Foundation. “The clinics may cut back on education and outreach services. You may have to be referred to another site if you want an IUD or an implant because they no longer stock them or offer those services, because it’s too costly.”

In Oregon, Illinois, Vermont, and Washington state, state health departments have all announced that they will no longer operate on Title X dollars. There are zero clinics in those states now using Title X. In two other states, Utah and Maine, the only proprietors of Title X money have also chosen to pull out of the program, effectively cutting the state off from the funding, too.

State health departments in Massachusetts and Maryland are also leaving Title X, but other program recipients remain, according to a Kaiser analysis.

At least four of those states have pledged to try to use their own budgets to cover the loss.

In total, more than one in five of all Title X-funded clinics in the United States will no longer take money from the program, Kaiser found.

The Trump administration first announced in mid-July that Title X clinics were officially barred from referring patients for abortions, and that they needed to financially separate any abortion-related services from their other offerings. As of next year, clinics will also need to physically separate out those services.

“We’re gonna see women driving hundreds of miles just to access birth control, like an IUD.”

Though 21 state attorneys general had sued to stop the changes from going into effect, some of their home states have since decided to stay in the program, for now. The governor of Hawaii also announced that the state would leave Title X rather than comply with the changes. But the state is currently in limbo.

“At this time, Hawaii has not withdrawn from the program, and the administration will not draw funding from Title X, at least pending the outcome of the current lawsuit challenging the new rules and concurrent efforts to consider procurement options,” Cindy McMillan, communications director for Gov. David Ige’s office, told VICE News in an email.

To further complicate the state of play in the Title X network, not every state has an government-run agency that serves as a Title X “grantee.” Grantees are the funnel of the Title X network: They receives money directly from the federal government, then often disperse those dollars to their own clinics and, often, to other organizations. Some states also have more than one grantee.

In Maine, the sole grantee is the nonprofit Maine Family Planning, which announced its departure from Title X hours after the Trump administration’s announcement. Sarah Nelson, a patient at a rural, northern Maine Family Planning clinic, told VICE News last month that she hadn’t had insurance in years. Around early July, Nelson started feeling a vicious pain in her abdomen.

Without Maine Family Planning, she would have had no choice but to make an expensive visit to the emergency room. Instead, Nelson got an appointment at her local clinic, where she found out she only had a cyst.

“So I only ended up having to pay $40, thanks to Maine Family Planning. If it wasn’t for that, like I said, I’d be in debt probably a grand or two,” Nelson said. “My income varies, because I wait tables. I never know what I’m gonna make from one day to the next.”

Similarly, the only grantee in Utah is Planned Parenthood — or rather, it was. Last week, Planned Parenthood announced that it would also leave Title X. The organization, which is also the largest Title X grantee in Alaska, Connecticut, and Minnesota, is surrendering a reported $60 million in funding.

It’s a devastating blow to the people who participate in Title X, as the reproductive health care giant serves about 40% of all Title X patients across the country.

“We are committed to doing some emergency funds to help our patients get through, but it will have an impact. It really does vary state by state,” Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, told reporters on a press call last week. While Planned Parenthood might do some fundraising to offset their funding losses, “It’s like holding an umbrella during a tsunami.”

“We’ve already seen the impact of women having to drive these impossible distances just to access abortions,” McGill Johnson went on. “We’re gonna see women driving hundreds of miles just to access birth control, like an IUD.”

Cover image: FILE – In this, Feb. 25, 2019, file photo, Dr. Erin Berry, Washington State Medical Director for Planned Parenthood of the Great Northwest and the Hawaiian Islands, holds a folder as she listens at a news conference announcing a lawsuit challenging the Trump administration’s Title X “gag rule” in Seattle. (AP Photo/Elaine Thompson, File)