SACRAMENTO, Calif. — Christine Ruiz sits in an exam room for aesthetic skin treatments, nervous but familiar with injectables like Botox. It’s her first time getting them at a Planned Parenthood clinic.
“So, I usually do the elevens and then across the forehead. I really like the little lip flip,” Ruiz tells her clinician, describing the look she wants.
The Sacramento location is part of Planned Parenthood Mar Monte, the largest Planned Parenthood affiliate in the country, which covers Northern California and parts of Nevada. It has added services such as Botox injections, IV hydration for skin rejuvenation or post-night-out recovery, and sedation for some procedures like IUD placement. Patients pay cash for these services.
The shift comes as Planned Parenthood confronts financial uncertainty after President Donald Trump and Congress removed Medicaid reimbursement for non-abortion services at organizations that provide abortions as part of last year’s tax and spending package. The rule is set to expire this summer, though Congress could extend it for another year.
About 75 to 80% of Planned Parenthood Mar Monte’s patients are on Medi-Cal, California’s Medicaid program. Leaders say revenue from cosmetic and cash-pay services could help the affiliate continue offering reproductive care while it works to replace lost funding.
“I’m really excited by the idea of patients coming to us because it’s a way they can support us financially. I think that’s exciting and we get to hear their stories,” says Dr. Laura Dalton, the affiliate’s chief medical operating officer.
The affiliate has closed five clinics since the cuts. Ruiz, who relied on Planned Parenthood for birth control and reproductive care in younger years and now is in her early 50s, decided to try the new services partly to support the organization. “I felt respected. I felt supported. I felt like the care that I got was without judgment,” she says. “So, when the opportunity came up, I was like, ‘Sure, why not support that?'”
Planned Parenthood charges $9 per unit of Botox — in many places 25% to 50% cheaper than other providers. California’s governor and lawmakers have provided emergency state funding to Planned Parenthood and similar organizations since the federal cuts, including $90 million in February, though leaders say it’s unclear whether that will cover core services like cancer screenings, STI testing and contraceptive care if the federal restrictions persist.
The move to offer aesthetic treatments has drawn criticism from anti-abortion politicians and groups. Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called state support a “Botox bailout” for a major Democratic backer. The expansion has also prompted unease among some supporters of the organization’s mission. Jessica DeFino, a beauty critic, says she worries about linking anti-aging procedures like Botox to feminism, arguing that aesthetic uses don’t align with efforts to free people from gender-based discrimination.
Planned Parenthood leaders counter that aesthetic services can have medical uses — for example, treating migraines or serving gender-affirming care — and that they help patients exercise bodily autonomy. Dalton says the affiliate is seeing heightened interest in aesthetic procedures, often for cosmetic reasons, and is exploring additional offerings such as cosmetic fillers and GLP-1 weight-loss drugs. She suggests the new services could serve as a model for other clinics trying to stay open amid funding challenges.