SACRAMENTO — Christine Ruiz sat in an exam room at a Planned Parenthood clinic, nervous but familiar with cosmetic injectables. It was her first time getting Botox at the Sacramento site, part of Planned Parenthood Mar Monte, and she described the look she wanted — “the elevens and then across the forehead” and a “little lip flip.”
Planned Parenthood Mar Monte, the nation’s largest affiliate, has begun offering cash-pay aesthetic services at some locations, including Botox injections, IV hydration touted for skin rejuvenation or hangover recovery, and sedation for procedures such as IUD insertion. The affiliate covers Northern California and parts of Nevada.
The shift comes after a federal change in a tax and spending package last year removed Medicaid reimbursement for non-abortion services provided by organizations that also offer abortions. That restriction, put in place under President Donald Trump and Congress, is scheduled to expire this summer unless lawmakers extend it.
About 75 to 80% of Mar Monte’s patients rely on Medi-Cal, California’s Medicaid program. Leaders say revenue from lower-cost, cash-pay cosmetic treatments could help make up some lost income and allow the affiliate to keep offering reproductive services while it seeks other funding sources. Dr. Laura Dalton, the affiliate’s chief medical operating officer, said she’s excited that patients can support the organization this way and that staff get to hear their stories.
The affiliate has closed five clinics since the federal cuts took effect. Ruiz, now in her early 50s and a longtime patient who used Planned Parenthood for birth control and reproductive care, said she returned for 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 said.
Planned Parenthood charges about $9 per unit of Botox at some sites — in many areas 25% to 50% cheaper than competing providers. California’s governor and lawmakers have provided emergency state aid to Planned Parenthood and similar clinics after the federal restriction, including $90 million allocated in February. Leaders warn, however, that it’s unclear whether emergency funding will cover core services such as cancer screenings, STI testing and contraceptives if federal limits persist.
The move into aesthetics has drawn criticism. Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, derided state support as a “Botox bailout.” Some supporters of Planned Parenthood’s mission have also expressed unease; beauty critic Jessica DeFino said she worries about linking anti-aging procedures to feminism.
Planned Parenthood leaders counter that aesthetic treatments can have legitimate medical uses — for example, Botox for migraines or as part of gender-affirming care — and that offering paid services preserves patients’ bodily autonomy and access to reproductive care. Dalton said the affiliate is seeing increased interest and is exploring other offerings such as cosmetic fillers and GLP-1 weight-loss drugs. She suggested this mix of services could be a model for other clinics navigating funding challenges.