Planned Parenthood of Northern New England officials said Thursday that a combination of declining revenue and increased demand is causing alarming budget shortfalls that need to be addressed by an increase in state funding.

A bill that would have allocated $3.4 million in state money to Planned Parenthood and Maine Family Planning failed to get funded in the most recent legislative session – and last year’s, too – despite passing both the Maine House and Senate. The funding would not have gone for abortion services but to other reproductive health services.

The bill died on the special appropriations table, one of the many lost in the shuffle at the end of a chaotic legislative session.

But the need for extra funding still exists, Planned Parenthood officials said.

Nicole Clegg, interim chief executive officer of Planned Parenthood of Northern New England, said the nonprofit faces an $8.6 million deficit over the next three years. The budget for the New England branch, which includes locations in Maine, New Hampshire and Vermont, is about $30 million per year.

“We could be forced to make some tough choices in our delivery of care,” Clegg said. “This is the most serious situation we’ve found ourselves in.”

Ben Goodman, a spokesperson for the Mills administration, said in a statement that “the governor strongly supports family planning services for Maine people, and she is very interested in working closely with lawmakers during the next legislative session to ensure the continued delivery of these crucial services.”

Mills administration officials did not answer a follow-up question asking specifically if she is in favor of the extra funding for Planned Parenthood and Maine Family Planning.

Jackie Farwell, a spokesperson for the Maine Department of Health and Human Services, said that the state, through changes to the Medicaid program, has increased family planning funding by $5 million since 2020. Medicaid, referred to as MaineCare here, is a federal health insurance program for lower-income and disabled people that is funded with a blend of federal and state dollars, and states have some flexibility in how services are delivered.

Since 2020, Maine has provided state dollars for Medicaid recipients who receive abortion services, spent extra money for reproductive health services and increased reimbursement rates for family planning services.

Mills has been broadly supportive of access to abortion and signed a bill into law in 2023 that removed all legal barriers to abortion access in Maine. The state previously outlawed abortions after fetal viability, when a prematurely born baby could live outside the womb – typically considered to be 22 to 24 weeks. There were exceptions for the life and health of the mother, but it was a legal gray area.

But Clegg said the lack of funding is threatening overall access to abortion and reproductive health services.

She said a number of overriding trends have caused the budget shortfall, including low reimbursement rates for services, an increase in charity care and a large increase in out-of-state patients from states that no longer have abortion services since the Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization upended its 1973 Roe v. Wade decision guaranteeing the right to abortion nationwide.

Planned Parenthood said that its clinics in Maine, New Hampshire and Vermont have seen a 46% increase in out-of-state abortion patients, from 217 to 316, since July 2022.

Also, more patients need behavioral health care, which Planned Parenthood provides at a loss, she said. And even patients who have insurance are more likely to have a high-deductible plan, so rather than using their insurance, they sign up for charity care, Clegg said. Other needed services also have expanded recently, including more access for medication abortion at clinics in Maine and telehealth appointments.

If the status quo continues, Planned Parenthood will be able to maintain services for the next year, Clegg said, but after that some services or clinics could be shuttered. Planned Parenthood’s Maine locations include Portland, Biddeford, Sanford and Topsham.

Clegg said Planned Parenthood officials also are worried that if Republican Donald Trump defeats Democrat Kamala Harris in the November election, that could be a threat to their operations. A national abortion ban would be possible if Trump wins, and Republicans have been hostile to any funding for abortion providers.

Without Planned Parenthood services, though, Clegg said, “the most vulnerable people in our communities could face catastrophic health outcomes, including unplanned pregnancies and worsening pregnancy outcomes, higher rates of sexually transmitted infections and HIV, and increased rates of cervical and breast cancers.”