A federal appeals court refused Thursday to block the Trump administration’s Title X family-planning rules from taking effect, keeping in place newly instated requirements preventing grant recipients from referring clients for abortions.

The 9th Circuit Court of Appeals rejected a plea from 20 states and the District of Columbia, as well as abortion providers like Planned Parenthood, to impose an emergency stay after lifting June 20 preliminary injunctions ordered by lower courts in California, Oregon and Washington.

In February, the Department of Health and Human Services overhauled rules governing Title X grants for family-planning services to low-income patients, prohibiting recipients from using the funds to “perform, promote, refer to, or support abortion as a method of family planning.”

The rule change could cost Planned Parenthood, the nation’s largest abortion provider, as much as $60 million per year, although the Title X grants represent only a small percentage of the organization’s half-billion in annual federal funding.

Pro-life groups cheered the court for standing by its earlier ruling. All seven of the judges who voted to deny the emergency stay were appointed by Republicans—including two chosen by President Trump—while the four who voted in the minority were named by Democrats.

“This is a victory for commonsense, life-affirming policy,” said Kristan Hawkins, president of Students for Life of America. “The Protect Life rule ensures that the people helping women plan for families are not misusing appointments to market abortions at taxpayer expense.”

She added that “Title X had become a marketing slush fund for Planned Parenthood, and the Trump Administration and the American people won today.”

The Title X overhaul opened the door for pro-life pregnancy centers to receive funds by removing the requirement for “nondirective counseling on abortion.” In March, the Obria Group of California became the first such center to receive a Title X grant.

The rule also requires a “clear financial and physical separation” between abortion procedures and other family-planning services, a mandate scheduled to take effect in March 2020.

Planned Parenthood blasted the court’s refusal to block “the Title X gag rule,” calling it “devastating.”

“This is devastating news,” said Planned Parenthood president Leana Wen. “While we are incredibly concerned the panel did not recognize the harm of the Trump-Pence administration’s gag rule, we will not stop fighting for the millions across the country in need for care.”

Jeanne Mancini, president of the March for Life, said that abortion “is neither health care nor family planning and therefore should not be funded by the Title X program.”

“This regulation helps to get taxpayers out of the abortion business, without cutting resources for those in need, and is a victory for all Americans,” she said.

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