Pennsylvania has joined 21 states that are challenging the legality of the Trump administration’s changes to the Title X family planning program, including a rule barring funding to clinics that make abortion referrals.

Pa. Attorney General Josh Shapiro on Tuesday announced the state’s participation in the national lawsuit, filed in the U.S. District Court in Eugene, Ore.

“Women depend on Title X clinics for essential health-care services like contraception, preventive care, and cancer screenings,” Shapiro said in a statement. “Today we are taking action to prevent the federal government from jeopardizing the health care of Pennsylvania women.”

The $260 million federal program gives priority to low-income families, who receive care free or on a sliding scale. Pennsylvania, with 200,000 Title X patients, has the third highest number in the nation, behind California and New York.

Federal funds are already prohibited by law from being used for abortion. But the eagerly-awaited Title X rules, which were published in the Federal Register on Monday, go further, banning abortion referrals and requiring clinics to physically and financially separate their abortion services from their Title X services.

Planned Parenthood Federation of America and the American Medical Association also filed suit Tuesday in federal court in Oregon to block the new policy. Planned Parenthood is by far the biggest Title X recipient, getting more than $50 million a year.

The new requirements are similar to those that were put in place but never enforced under President Ronald Reagan. Opponents challenged the Reagan rules all the way to the U.S. Supreme Court, which upheld them in 1991. The policy was rescinded under President Bill Clinton.

Despite the Supreme Court precedent, those who oppose the Trump rules say renewed legal action is needed because they believe the administration has violated protections enacted in the 2010 Affordable Care Act, as well as changes made by Congress to Title X funding provisions.