The case now before him in America’s biggest red state does not surround abortion, which has been banned in Texas since the U.S. Supreme Court overturned Roe v. Wade last year. But Planned Parenthood argues the attempt to recoup at least $17 million in Medicaid payments for health services, including cancer screenings, is a new effort to weaken the organization after years of Republican-led laws that stripped funding and imposed restrictions on how its clinics operate.

At issue is money Planned Parenthood received for health services before Texas removed the organization from the state’s Medicaid program in 2021. Texas had begun trying to oust Planned Parenthood four years earlier and is seeking repayment for services billed during that time.