RALEIGH, N.C. — The Trump administration is pressuring North Carolina and other states to strip all references to “gender ideology” from federally funded sex education programs, giving them two months to comply or risk losing millions in funding.

The Trump administration on Tuesday demanded in a letter that several states and U.S. territories remove all references to gender ideology in their federally funded Personal Responsibility Education Program (PREP) educational materials within 60 days.

Gender ideology is not defined in the letter. Instead, examples of “unauthorized gender ideology content” are laid out.

Through the program, the Administration for Children and Families, which is a division of the U.S Department of Health and Human Services, awards grants to state agencies to educate young people on both abstinence and contraception, according to the agency’s website.

The PREP program targets young people who are homeless, in foster care, living in rural areas or areas with high teen birth rates, or from minority groups.

The state’s Department of Health and Human Services confirmed to The News & Observer through spokesperson James Werner, said it was working to comply by the required deadline. DHHS also shared a letter dated Tuesday from HHS.

Werner said DHHS partners with five North Carolina agencies to implement PREP programming in 10 counties: Beaufort, Craven, Caldwell, Lee, Montgomery, Cumberland, Lenoir, Scotland, Pamlico and Brunswick.

In that letter, the federal government addressed Mandy Cohen, who served as North Carolina’s DHHS secretary and later as director of the U.S. Centers for Disease Control and Prevention. The current DHHS secretary is Devdutta Sangvai.

In the letter, HHS says it began a review of the state’s PREP materials but halted it after finding curricula and program materials not allowed under the program.

Examples cited by HHS include a middle school teacher guide that it says recommends teachers refer students to teen- and LGBT-friendly, culturally competent clinics and agencies that are supportive of all pregnancy options; and curricula that address sexual orientation, gender identity, gender-neutral names, homophobia, and other topics.

The letter says that PREP grant award laws don’t mention “gender ideology,” calling it “irrelevant to teaching abstinence and contraception and unrelated to any of the adult preparation subjects” allowed.

HHS said that the curricula and other materials had been approved under the prior administration — that of President Joe Biden — but said that approval exceeded the agency’s authority. HHS also said the examples cited are not exhaustive and that the state’s revisions should “remove these and all similar language throughout their curricula and program materials.”

The grant money is important for use in training sex education instructors and groups that teach sex education lessons, a spokesperson for the group SIECUS: Sex Ed for Social Change told The Associated Press.

“They build critical life skills for young people,” Alison Macklin of SIECUS told the AP.

How much could NC lose?

HHS gave the state until Oct. 27 to provide the modified curricula and materials.

Werner said that in fiscal year 2025 the department received $1.56 million in funding for PREP programming. He said an additional $3.3 million in funding for fiscal 2026 and 2027 is at risk if the state does not comply with directives issued by HHS.

Last week, HHS terminated California’s PREP grant after it said the state failed to remove gender ideology from its educational materials, according to a news release from the federal government.

In that release, the federal government calculated North Carolina could lose $3.9 million if it failed to comply.

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