HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.
![handle is hein.crs/govelxg0001 and id is 1 raw text is:
Congressional Research Servic
Informing the legislitive debate since 1914
Title X Family Planning Program
Updated June 8, 2023
Introduction
The Title X Family Planning Program (Title X) was
enacted in 1970 as Title X of the Public Health Service Act
(PHS Act, codified at 42 U.S.C. §§300 to 300a-6). 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.
Most Title X regulations are at 42 C.F.R. Part 59.
Overview of Tie X
What Is the Federal Funding Level? The Consolidated
Appropriations Act, 2023 (P.L. 117-328) provided $286.5
million in FY2023 discretionary funding for Title X. The
program has had the same enacted annual discretionary
funding level since FY2014.
The American Rescue Plan Act (ARPA; P.L. 117-2, §2605)
also provided Title X with $50 million in one-time
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
[Dobbs v. Jackson Women's Health Organization] may
have on Title X services (https://go.usa.gov/xSYyW). P.L.
118-5, Fiscal Responsibility Act of 2023, Division B §2(24)
rescinded unobligated balances of this ARPA funding as of
the date of enactment, June 3, 2023. As of this writing,
USAspending.gov showed an unobligated balance of $4
million, reflecting data through April 30, 2023.
What Clinical Services Are Provided? Regulations
require 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 [sexually transmitted infection]
services, preconception health services, and adolescent-
friendly health services). Title X clinical guidelines are at
https://go.usa.gov/xEdm6. The Kaiser Family Foundation
reports that there are 4,108 Title X clinics as of 2023.
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. Additionally, annual appropriations laws
have stated that Title X funds shall not be expended for
abortions.
Program 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 (https://go.usa.gov/xMfP5).
Must Title X projects provide abortion referrals upon
client request? Regulations require Title X projects to offer
pregnant clients information and nondirective counseling on
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 are also 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 (https://go.usa.gov/xhDns).
HHS has stated 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 (86
Fed. Reg. 56153) and that providers may separately be
covered by federal statutes protecting conscience. (42
C.F.R. 59.5, footnote 2)
What Do Clients Pay? Persons with income at or below
100% of the federal poverty level 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 2023, in the 48 contiguous states and
the District of Columbia, the poverty guideline for an
individual is an annual income of $14,580; for families of
two or more persons, $5,140 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.
Are There Special Requirements for Services to
Minors? Annual appropriations laws have stated that Title
X providers are not exempt from state notification and
reporting laws on child abuse, child molestation, sexual
abuse, rape, or incest. Title X providers must counsel](ViewImageLocal?handle=hein.crs/govelxg0001&div=1&collection=&method=preview&ext=.png&size=3)