The Trump administration has told California that it will lose federal money unless it stops requiring health insurance plans to provide abortion coverage, marking the latest attack on abortion access amid an ongoing and heated national debate.
The threat marks the latest clash between Donald Trump's White House and the Democratic west coast state, which has emerged as a key counterweight to some of the president's most contentious positions on issues ranging from immigration to climate change, and including abortion.
In making the threat, the Trump administration is seeking to restrict Californians' access to abortion services, which the state requires individual and small business insurance plans to cover. Those rules do not apply to federally funded insurance plans like Medicare or Medicaid, and do not apply to larger employer plans.
"If California wants to provide abortion services, it can do so," Roger Severino, the director of the Office for Civil Rights in the Department of Health and Human Services(HHS), told the Los Angeles Times. "What the state is not free to do is force people to pay for other people's abortions."
The "notice of violation" issued by HHS will give California 30 days to comply with a federal law known as the Weldon amendment, which bars federal health care funding to states that practice "discrimination" against an organisation because it "does not provide, pay for, provide coverage of, or refer for abortions."
According to Mr Severino, California is violating those restrictions, and said that 28,000 Californians had abortion-free plans before state imposed requirements for abortion coverage, and that the option is now lost. The California law has resulted in federal complaints filed by an order of nuns known as the Missionary Guadalupanas of the Holy Spirit, and a church.
"If states receive federal funds ... they cannot discriminate against a health plan that declines to cover abortions," Mr Severino said, according to the Associated Press.
Access to abortion has been considered an important facet of California's healthcare policies, leading some to complain that the rights have led to discrimination against religious individuals and organisations that believe the procedure is amoral.
The HHS civil rights office has historically focused complaints about privacy violations, but a new division was added after Mr Severino took over that looks into complaints of alleged discrimination based on religious beliefs or moral scruples, according to the Associated Press.
Mr Severino has referred to religious freedom in public as "the first freedom", and has received considerable attention for his efforts to enforce a rule allowing employers to refuse birth control as a part of employee health insurance plans, if that refusal is made on religious or moral objection to contraception.