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Planned Parenthood said Monday that it is withdrawing from the federal family planning program known as Title X to avoid following a new Trump administration rule barring clinics from referring women for abortions.

The move will have a disproportionate impact in Minnesota, where 90% of Title X patients are served by Planned Parenthood; that figure is 40% nationwide.

Planned Parenthood’s network of health centers will remain open, including operations in Minnesota. But backing out of the program means Planned Parenthood would lose $2.7 million to cover birth control, cancer screenings, and testing and treatment for sexually transmitted diseases for Minnesota patients.

Alexis McGill Johnson, Planned Parenthood’s acting president and CEO, predicted that many low-income women who rely on the organization’s services would delay or forgo care. “We will not be bullied into withholding abortion information from our patients,” McGill Johnson said. “Our patients deserve to make their own health care decisions, not to be forced to have Donald Trump or Mike Pence make those decisions for them.”

Responding with its own statement, the federal Department of Health and Human Services said that Planned Parenthood affiliates knew months ago about the new restrictions and suggested the group could have chosen at that point to exit the program.

“Some grantees are now blaming the government for their own actions — having chosen to accept the grant while failing to comply with the regulations that accompany it — and they are abandoning their obligations to serve patients under the program,” the department said.

The Title X program doles out $260 million in grants to clinics around the country to cover reproductive health services. The money cannot be used to cover abortions; Planned Parenthood does not use it for that purpose.

Under the new rules, grantees would still be permitted to talk to patients about abortion while not making actual referrals for the procedure. Planned Parenthood has called the ban on abortion referrals a “gag rule,” while the administration insists that’s not the case.

“We will do everything in our power to fight this rule for one simple reason: It is a direct attack on the health of our state and our country,” said Sarah Stoesz, president and CEO of Planned Parenthood North Central States, which serves Minnesota, the Dakotas, and after a 2018 merger, Iowa and Nebraska.

When the organization covered just Minnesota and the Dakotas in fiscal year 2018, it took in $54 million in revenue, according to its most recent available annual report.

A federal appeals court in San Francisco is weighing a lawsuit to overturn the rules, with oral arguments set for the week of Sept. 23. Several states are among the plaintiffs, including Minnesota, where Planned Parenthood serves 72,000 patients. Activists are also pressing Congress to overturn the rule.

Minnesota Citizens Concerned for Life (MCCL), which opposes abortion, applauded the new rule and said in a statement that taxpayer dollars should not be used to directly or indirectly support abortion.

“Planned Parenthood has chosen not to follow the Title X requirements,” said the statement provided by MCCL communications director Paul Stark. “That money is better spent elsewhere.

U.S. Sen. Tina Smith, a Democratic member of the Senate Health Committee and former Planned Parenthood executive, criticized the rule.

“Family planning is basic health care for people, and key to economic opportunity and people having the freedom to build their own lives,” Smith said in a statement.

Planned Parenthood North Central States has already trained health center managers and front desk staff to help patients navigate the changes. Uninsured and underinsured patients who had previously seen their care covered by Title X funds could start paying more for their medical care out of pocket. A sliding fee scale based on income will be offered to patients.

“We do anticipate that patients who haven’t received bills in the past will have bills to pay following their care [now],” said Shannon Bakshian, senior director of health care practice and nurse practitioner at Planned Parenthood North Central States. “We also are concerned that patients may just not come in for the care that they would have needed in the past over fears of the costs they would endure.”

Nicole Chaisson noted that the federal program has paid for access to birth control. Without that funding, “STD rates could go up and unintended pregnancy rates could go up because people aren’t accessing their birth control of choice,” said Chaisson, associate medical director of family planning and gender affirming care at Planned Parenthood North Central States. “Cancer screening rates are going to go down.”

Monday was the deadline set by the government for program participants to submit statements that they intended to comply with the new rules, along with a plan. Enforcement will start Sept. 18.

Along with the ban on abortion referrals by clinics, the rule’s requirements include financial separation from facilities that provide abortion, designating abortion counseling as optional instead of standard practice, and limiting which staff members can discuss abortion with patients. Clinics would have until next March to separate their office space and examination rooms from the physical facilities of providers that offer abortions.

The family planning rule is part of a series of efforts to remake government policy on reproductive health to please conservatives who are a key part of President Donald Trump’s political base. Religious conservatives see the program as providing an indirect subsidy to Planned Parenthood, which runs family planning clinics and is also a major abortion provider.

The Associated Press contributed to this report.