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![handle is hein.crs/govehls0001 and id is 1 raw text is: Title X Family Planning Prograr
Introduction
The Title X Family Planning Program (Title X) was
enactedin 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
programdedicatedsolelyto family planning andrelated
preventive health services.
In the March 4, 2019 Federal Register, HHS published a
final rule that, among other things, prohibited Title X
projects fromreferring clients for abortion as a methodof
family planning. It also required physical separation
between Title Xprojects and certain abortion-related
activities. (CRS In Focus 1i1142, Title XFamily Planning
Program: 2019 Final Rule.) The 2019 final rule tookeffect
in all states except Maryland, where it was enjoined.
In the October 7, 2021 Federal Register, HHS published a
final rule that, among other things, revokes the 2019 final
rule in its entirety. For example, it requires Title Xprojects
to provide an abortion referral if requested by the client and
removes the physical separationrequirement (see
https://go.usa.gov/xMfQy). The 2021 rule took effect
November 8, 2021.
Overvkew of T ite X
What Is the Federal Funding Lewl? The Consolidated
Appropriations Act, 2021 (P.L. 116-260) provided $286.5
million in FY2021 discretionary funding for Title X. The
Extending Government Funding and Delivering Emergency
Assistance Act (P.L. 117-43) continues funding for most
discretionary HHS programs, including Title X, through
December 3, 2021 (or until full-year funding is
appropriated), at the s ame rate, and under the s ame
authority and conditions, as P.L. 116-260. Additionally, the
American Rescue Plan Act(P.L. 117-2) provided Title X
with $50 million in mandatory funding for FY2021, with
funds to remain available until expended.
What Clinical Services Are Provided? The 2021 rule
requires Title Xprojects to provide abroadrange of
acceptable and effective medically approved family
planning methods (including natural family planning
methods) and services (including pregnancy testing and
counseling, assistance to achieve pregnancy, basic
infertility services, STI services, preconceptionhealth
services, and adolescent-friendly health services). Title X
clinical guidelines are at https://go.usa.gov/xEdm6.
Does Title X Fund Abortions? Since Title X's
establishment in 1970, the PHS Act has prohibited using
Title X funds in programs where abortion is a method of
Updated November 16,2021
[
family planning (42U.S.C. §300a-6). In addition, annual
appropriations laws s tate that Title X funds shallnot be
expended for abortions.
According to the 2021 final rule's preamble, the programis
reinstating guidance published in the July 3, 2000 Federal
Register (see https://go.usa.gov/xMfP5). This guidance
requires that a grantee's Title Xproject activities and its
non-Title X abortion activities be separate and distinct;
they may share a common facility, a common waiting
room, common staff, and a common records system, s o
long as it is po s s ible to dis tinguish between the Title X
supported activities and non-Title X abortion-related
activities, for eample, through allocating and prorating
costs.
Must Title X projects provide abortion referrals upon
client request? The 2021 rule restores pre-2019
requirements that Title Xprojects offerpregnant clients
information and nondirective counseling on each of these
options: prenatalcare and delivery; infant care, foster care,
or adoption; and abortion (unless a client indicates thatthey
do not want information or counseling about particular
options). Projects would also be required to provide
referrals upon client request, including abortionreferrals.
Programguidance states that abortionreferrals may include
providing relev ant factual information (such as the abortion
provider's phone number, address, and charges), but the
project may not take further affirmative action (such as
negotiating a fee reduction, making an appointment,
providing transportation) to secure abortionservices for the
patient (seehttps://go.usa.gov/xMGgv).
The 2021 rule's preamble states that objecting individuals
and grantees will not be required to counselor refer for
abortions in the Title Xprogramin accordance with
applicable federallaw. A footnote in the finalrule notes
that [p]roviders may separately becoveredby federal
statutes protecting conscience.
What Do Clients Pay? Persons with income at or below
100% of the federalpoverty guidelines (FPL) do not pay for
care. Clients with income higher than 100% and up to
250% FPL are charged on a sliding scale basedon their
ability to pay. Clients with income higher than 250% FPL
are charged fees designed to recover the reasonable cost of
providing services. (In 2021, in the 48 contiguous states and
the District of Columbia, the poverty guidelines for an
individualis an annual income of $12,880; for families of
two or more persons, $4,540 is added to the annual income
figure for each additionalperson.)](ViewImageLocal?handle=hein.crs/govehls0001&div=1&collection=&method=preview&ext=.png&size=3)