The US Court of Appeals for the Fifth Circuit ruled on Monday that Texas and Louisiana are allowed to exclude Planned Parenthood from Medicaid programs. The decision overturned a lower court ruling that prevented states from banning Medicaid coverage for Planned Parenthood patients.

The case to disqualify Planned Parenthood was first brought in 2015 when a secretly recorded video appeared to show a Houston clinic worker discussing the sale of fetal tissue for medical research. Since then, 13 states have conducted investigations into these allegations and none of them has resulted in criminal charges.

Nevertheless, Texas state officials argued that Planned Parenthood clinics should be excluded from Medicaid because they violated the laws, leaning on these unfounded allegations. Several clinics and seven individual plaintiffs sued to block the state from banning Planned Parenthood from Medicaid plans. The lower court granted the preliminary injunction in 2017 because the state did not produce enough evidence to justify termination of the clinics’ Medicaid provider agreements.

Monday’s decision overturned this ruling. The Fifth Circuit judges followed the precedent set in O’Bannon v. Town Court Nursing Center, which held that Medicaid users do not have a right to contest a state’s determination as to whether a provider should be covered by Medicaid. Judges James Dennis and James Graves, dissenting, said that the decision subjects millions of Medicaid recipients to “unlawful state interference with their choice of health care providers.”

The Fifth Circuit’s decision will affect Planned Parenthood clinics in Texas, Louisiana and Mississippi. Abortion rights advocates have said this ruling will not only harm people seeking abortions but will also limit access to essential services such as birth control and cancer screenings for people who use Medicaid.