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![handle is hein.crs/goveivl0001 and id is 1 raw text is: Congressional Research Servic
Informing the legislitive debate sinco 1914
Title X Family Planning Progran
introduction
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 dedicated solely to family planning and related
preventive health services.
In 2019, HHS promulgated a final rule that, among other
things, prohibited Title X projects from referring clients for
abortion as a method of family planning. It also required
physical separation between Title X projects and certain
abortion-related activities. The 2019 rule took effect in all
states except Maryland, where it was enjoined. (CRS In
Focus IF 11142, Title X Family Planning Program: 2019
Final Rule.)
In 2021, HHS promulgated a new rule that, among other
things, revoked the 2019 rule in its entirety. For example, it
requires Title X projects to provide an abortion referral if
requested by the client and removes the physical separation
requirement. The 2021 rule has been in effect since
November 8, 2021. (CRS In Focus IF11986, Title X Family
Planning Program: 2021 Final Rule.)
Overview of T sie X
What Is the Federal Funding Level? The Consolidated
Appropriations Act, 2022 (P.L. 117-103) provided $286.5
million in FY2022 discretionary funding for Title X, the
same as the FY2021 amount.
Additionally, the American Rescue Plan Act (ARPA, P.L.
117-2) provided Title X with $50 million in mandatory
funding, with funds to remain available until expended.
HHS indicated it used some of the ARPA funding for
FY2022 grants for the following purposes: to address the
dire need for family planning services in certain states
with restrictive policies on reproductive health access and
in certain states that had no or limited Title X services
(https://go.usa.gov/xug5j); to improve and expand
telehealth infrastructure (https://go.usa.gov/xJgaN); and to
support training and technical assistance to address the
challenges that the recent Supreme Court decision may
have on Title X services (https://go.usa.gov/xSYyW).
What Clinical Services Are Provided? The 2021 rule
requires Title X projects to provide a broad range 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, preconception health
Updated September 15, 2022
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
family planning (42 U.S.C. §300a-6). In addition, annual
appropriations laws state that Title X funds shall not be
expended for abortions.
According to the 2021 rule's preamble, the program is
reinstating guidance published in the July 3, 2000 Federal
Register (https://go.usa.gov/xMfP5). This guidance requires
that a grantee's Title X project 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, so long as it is
possible to distinguish between the Title X supported
activities and non-Title X abortion-related activities, for
example, through allocating and prorating costs.
Must Title X projects provide abortion referrals upon
client request? The 2021 rule restores pre-2019
requirements that Title X projects offer pregnant clients
information and nondirective counseling on each of these
options: prenatal care and delivery; infant care, foster care,
or adoption; and abortion (unless a client indicates that they
do not want information or counseling about particular
options). Projects would also be required to provide
referrals upon client request, including abortion referrals.
Program guidance states that abortion referrals may include
providing relevant 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 abortion services for the
patient (see https://go.usa.gov/xhDns).
The 2021 rule's preamble states that objecting individuals
and grantees will not be required to counsel or refer for
abortions in the Title X program in accordance with
applicable federal law. A footnote in the rule notes that
[p]roviders may separately be covered by federal statutes
protecting conscience.
What Do Clients Pay? Persons with income at or below
100% of the federal poverty guidelines (FPL) do not pay for
care. Clients with income higher than 100% and up to
250% FPL are charged on a sliding scale based on their
ability to pay. Clients with income higher than 250% FPL
are charged fees designed to recover the reasonable cost of
providing services. (In 2022, in the 48 contiguous states and
the District of Columbia, the poverty guidelines for an
individual is an annual income of $13,590; for families of](ViewImageLocal?handle=hein.crs/goveivl0001&div=1&collection=&method=preview&ext=.png&size=3)