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1 1 (October 28, 2020)

handle is hein.crs/govdchr0001 and id is 1 raw text is: Title X Family Planning Program Updated October 28, 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. tOverview (& Titke X What Is the Federal Funding Level? FY2020 funding was $286.5 million, the same as for FY2019. Continuing resolution P.L. 116-159 continues funding for most discretionary HHS programs, including Title X, through December 11, 2020 (or until full-year funding is appropriated), at the rate they were funded in P.L. 116-94, Further Consolidated Appropriations Act, 2020. The temporary funding is subject to the same authority and conditions as in FY2020. 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. It also requires physical and financial separation between Title X projects and certain abortion-related activities. (CRS In Focus IF 1142, Title XFamily Planning Program: 2019 Final Rule.) The rule has been challenged in several lawsuits across the country, but is currently in effect in all states except Maryland, where it has been enjoined. Future court rulings could affect the rule's further implementation (https://go.usa.gov/xVX4t). According to the 2019 Family Planning Annual Report, the final rule has affected participation in the Title X program: As a result of the Final Rule, 18 agencies representing 19 grants and 231 subrecipients discontinued participation in the Title X program; the number of Title X service sites was reduced by 945 sites (https://go.usa.gov/xGQXE). HHS redistributed some of the relinquished funds among remaining grantees (https://go.usa.gov/xVMPF). In September 2020, HHS awarded new grants for unserved and underserved areas (https://go.usa.gov/xGQNN). The September 2020 Family Planning Directory lists no Title X sites in Hawaii, Maine, Oregon, Vermont, or Washington (https://go.usa.gov/x7qrT). 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, however, 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 higher than 100% and up to 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 also 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.

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