A federal appeals court on Thursday greenlit President Donald Trump’s mission to defund Planned Parenthood health centers.

The 1st Circuit Court of Appeals ruled that the Trump administration can enforce a provision in the reconciliation bill, passed in July, to block Planned Parenthood from receiving Medicaid funds because the organization offers abortion care services. This means that more than 1.1 million patients currently using Medicaid will no longer be covered for basic reproductive health care, including STI testing and cancer screenings, at Planned Parenthood clinics around the country.

Half of Planned Parenthood patients use Medicaid for their health care insurance, according to the organization. Without that Medicaid reimbursement, nearly 200 of Planned Parenthood’s 600 health centers are at risk of closing, and more than 90% of those closures would occur in states where abortion is legal.

The decision is “a devastating blow for patients across the country,” Alexis McGill Johnson, president of Planned Parenthood Federation of America, said during a Friday morning press call.

The Supreme Court ruled in June that the spending bill’s provision could take effect, denying hundreds of thousands of low-income patients their only health care option. In July, a judge temporarily stopped the provision from going into effect after Planned Parenthood sued. The Thursday night ruling granted a stay of that injunction.

Peyton Humphreville, a senior staff attorney at Planned Parenthood, told reporters that the organization is evaluating all its options, but legal challenges will continue in November when oral arguments are scheduled to begin on the preliminary injunction appeal.

“It’s not just abortion that’s going to be impacted,” McGill Johnson said. “Cancers will go undetected, STIs will go untreated, and patients won’t get the birth control that they need to plan their families and futures. Patients will have to travel further to get care and wait longer to get it. As demand surges at health centers, Black, brown and rural communities will be hit the hardest.”

Around 60% of health care centers at risk of closing are located in medically underserved or rural areas, meaning patients who are already marginalized will feel the effects the most.

Planned Parenthood is offering the option to affiliates to opt out of providing abortion care so that health centers can continue receiving Medicaid reimbursement, McGill Johnson confirmed in the Friday press call. Autonomy News first reported in June that Planned Parenthood was looking into providing waivers for certain affiliates to drop abortion care to avoid federal funding loss.

“It is true that our Planned Parenthood committees have created an option for affiliates to stop providing abortion in the event that abortion is able to be provided in that community,” McGill Johnson told reporters.

“That is not an attempt to walk away from abortion,” she added. “Planned Parenthood strongly stands behind our need and ability to provide abortion care wherever it is legal in this country. It is simply an opportunity for us to engage our federation to be able to provide the care and also preserve, again, as much Medicaid funding for reimbursement for the services, just like any other health care provider should be able to do.”

Medicaid generally cannot be used for abortion care. The Hyde Amendment bans the use of federal funds, including Medicaid, from covering abortion unless it’s in cases of rape, incest or where the pregnant person’s life is in danger. The right-wing argument that federal dollars are going toward abortion care is inaccurate and used as a backdoor way to defund Planned Parenthood.

Dominique Lee, president and CEO of Planned Parenthood League of Massachusetts, told reporters that they’ve already heard from patients who are shocked and confused that their Medicaid coverage won’t work at Planned Parenthood. Planned Parenthood Massachusetts cares for over 30,000 patients annually, with 40% of them relying on Medicaid.

“It is not a hypothetical; it is actually happening now. And if Planned Parenthood health centers close their doors, people will suffer, people will die,” Lee said. “Here’s the truth: there is no backup plan. There’s no one waiting in the wings to take care of our patients. Planned Parenthood is the safety net.”

Lee said they’ve already heard from patients who are crushed when they learn their new provider doesn’t have any availability for another six months.

Medicaid is the largest payer of reproductive health care in the U.S., subsidizing 75% of all publicly funded family planning services ranging from Pap smears to high blood pressure treatment and screenings for anxiety and depression. Medicaid reimbursements for providers are extremely low, disincentivizing clinics from accepting Medicaid patients and making it really hard for patients to find a provider that accepts their insurance coverage.

More than 20 Planned Parenthood health centers have closed or announced their closing since Trump took office. All have closed due to federal funding losses, including Trump’s decision to cut $65.8 million in family planning grants under Title X, a federal program dedicated to providing free or discounted family-planning services to approximately 4 million low-income Americans each year.