The Trump administration can implement a rule that could strip Planned Parenthood and other health care organizations of millions of dollars in federal funding, a panel of three judges from U.S. Courts for the Ninth Circuit ruled in a scathing opinion issued Thursday.

Under the rule, announced in February, health care providers that offer abortions or refer patients for the procedure will be cut off from Title X. The $286 million federal program currently caters to four million low-income people and offers them access to services like birth control, as well as cancer and STD screenings.

If they want to keep the money, providers must now maintain a “clear physical and financial separation” between abortion-related treatment and their other work — like building a completely separate facility to perform abortions in. They’re also generally forbidden from referring patients for abortions.

Several states and reproductive health groups sued the Department of Health and Human Services (HHS) over the Trump administration’s changes to Title X and argued they amounted to a “gag rule” on doctors that could decimate reproductive healthcare providers and force clinics to close.

It’s also already illegal to use federal funding to pay for most abortions, but Trump administration officials have said that the new rule is necessary to ensure taxpayer dollars are not involved in the procedure at all.

Two judges initially ruled to halt the rule from going into effect nationwide as the lawsuits unfolded. The Ninth Circuit’s decision Thursday effectively reverses those rulings and allows the Title X rule to be enacted in almost every state.

“To find that the Final Rule’s enactment was arbitrary and capricious, the district courts generally ignored HHS’ explanations, reasoning, and predictions whenever they disagreed with the policy conclusions that flowed therefrom,” the judges wrote. Without a stay, they continued, “HHS will be forced to allow taxpayer dollars to be spent in a manner that it has concluded violates the law.”

The rule was originally scheduled to take effect in May, though Title X beneficiaries would have had until March 2020 to comply with the physical separation requirement. Planned Parenthood has already vowed to seek emergency relief from the Court of Appeals.

“Planned Parenthood will not let the government censor our doctors and nurses from informing patients where and how they can access health care,” Leana Wen, President of Planned Parenthood Federation of America, said in a statement. “We will continue to fight the Trump administration in the courts and alongside champions in Congress to protect everyone’s fundamental right to health care.”