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Title X Family Planning Program
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Updated June 3, 2020
The Title X Family Planning Program (Title X) was
enacted in 1970 as Title X of the Public Health Service Act
(PHS Act). Title X provides grants to public and nonprofit
agencies for family planning services, research, and
training. The Office of Population Affairs (OPA) within the
Department of Health and Human Services (HHS)
administers Title X, which is the only domestic federal
program devoted solely to family planning and related
preventive health services. This In Focus answers questions
on Title X, legislative mandates, and other family planning
programs, and it identifies resources for Title X projects
during the Coronavirus Disease 2019 (COVID-19)
pandemic.
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What Is the Federal Funding Level? FY2020 funding is
$286.5 million, the same as FY2019.
FY2020 Appropriations: $286.5 million
Clients Served (2018): 3.9 million
Number of Title X Clinics (2018): 3,954
What Is the Status of the 2019 Final Rule? In March
2019, HHS published in the Federal Register a final rule
that, among other things, prohibits Title X projects from
referring clients for abortion as a method of family
planning, and it requires physical and financial separation
between Title X projects and certain abortion-related
activities. (CRS In Focus IFi 1142, Title XFamily Planning
Program: 2019 Final Rule.) Some Title X providers,
including all Planned Parenthood-affiliated clinics, have
announced that they are no longer using Title X funds or
have withdrawn from the program. On February 14, 2020,
the U.S. District Court for the District of Maryland enjoined
the rule's implementation in Maryland (https://go.usa.gov/
xVX4t). Future court rulings could affect rule
implementation in that state and in others. The Kaiser
Family Foundation is tracking program participation at
https://www.kff.org/interactive/the-status-of-participation-
in-the-title-x-federal-family-planning-program/.
What Clinical Services Are Provided? Title X clinical
guidelines are at https://go.usa.gov/xEdm6. The 2019 rule
requires Title X projects to provide a broad range of
acceptable and effective family planning methods
(including contraceptives, natural family planning or other
fertility awareness-based methods) and services (including
infertility services, information about or referrals for
adoption, and services for adolescents). The 2019 rule also
states that family planning methods and services include,
for example, choosing not to have sex, preconception
counseling, general reproductive and fertility health care,
and the prevention, diagnosis, and treatment of infections
and diseases which may threaten childbearing capability or
the health of the individual, sexual partners, and potential
future children. Title X does not fund prenatal care
directly, but the 2019 rule requires Title X projects to
provide prenatal care referrals for all pregnant clients.
Does Title X Fund Abortions? Since the program's
establishment in 1970, the PHS Act has prohibited using
Title X funds in projects where abortion is a method of
family planning (42 U.S.C. §300a-6). The 2019 rule
requires physical and financial separation between Title
X projects and prohibited activities, replacing the prior
requirement that they be separate and distinct from each
other. Prohibited activities include abortion, referral for
abortion as a method of family planning, and activities that
encourage, promote, or advocate for abortion.
Physicians and advanced practice providers may provide
nondirective abortion counseling. The 2019 rule's preamble
provides guidance that nondirective counseling involves
presenting options in a factual, objective, and unbiased
manner. Title X projects may also refer patients to
abortion providers for emergency care and in certain cases
of rape and incest.
What Do Clients Pay? Persons with income at or below
100% of the federal poverty guidelines do not pay for care.
Clients with income between 100% and 250% of the
poverty guidelines are charged on a sliding scale based on
their ability to pay. Clients with income higher than 250%
of the poverty guidelines are charged fees designed to
recover the reasonable cost of providing services. (In 2020,
the poverty guidelines for an individual in the 48
contiguous states and the District of Columbia is an annual
income of $12,760; for families of two or more persons,
$4,480 is added to the annual income figure for each
additional person.)
For unemancipated minors who request confidential
services, eligibility for discounts is based on the minor's
own income. The 2019 rule allows Title X project directors
to offer discounted or free contraceptive services to certain
clients who cannot get job-based contraception coverage
due to their employer's religious or moral objection.
Are There Special Requirements for Services to
Minors? All Title X services are confidential, including
services to minors. Title X projects do not require parental
notification or parental consent. However, Title X statute
requires grantees, [t]o the extent practical, to encourage
family participation. By law, Title X providers must also
counsel minors on how to resist attempted coercion into
sexual activity. Under the 2019 rule, Title X projects must
conduct a preliminary screening of any minor who presents
with a sexually transmitted disease, pregnancy, or any
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