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Congressional Research Service
~~Info rmig the legishtive debate since 1914
Updated May 20, 2019
Title X Family Planning Program: 2019 Final Rule
Introduction
The Family Planning Services and Population Research Act
of 1970 (P.L. 91-572, as amended) established the Title X
Family Planning Program (Title X) under Title X of the
Public Health Service Act. Administered by HHS, Title X
provides grants to public and nonprofit agencies to establish
and maintain family planning projects (Title X projects).
Title X is the only domestic federal program devoted solely
to family planning and related preventive health services. In
2017, the program served 4 million clients through 3,858
Title X clinics. Congress appropriated $286.5 million to the
program for FY2019.
On March 4, 2019, the Department of Health and Human
Services (HHS) published a final rule on Title X in the
Federal Register, at https://go.usa.gov/xEdTp. The rule
changes, among other things, how Title X projects provide
family planning methods and services to clients.
Courts have preliminarily enjoined the final rule from being
implemented (see https://go.usa.gov/xmNRh and
https://go.usa.gov/xmNn3). Future court rulings may
determine whether and when the rule is implemented.
Overview of the 2019 Final Rule
This section summarizes selected regulatory changes made
by the final rule.
Family Planning Definition
Prior regulation. Prior regulations did not define family
planning.
2019 rule. The rule introduces a new definition of family
planning, referring to it as the voluntary process of
identifying goals and developing a plan for the number and
spacing of children and the means by which those goals
may be achieved. Family planning can include, among
other things, a range of acceptable and effective choices,
which may range from choosing not to have sex to the use
of other family planning methods and services to limit or
enhance the likelihood of conception (including
contraceptive methods and natural family planning or other
fertility awareness-based methods) and the management of
infertility (including adoption).
Scope of Family Planning Services
A Title X grantee can undertake a Title X project that has
several participating entities, organizations, and/or clinics.
A grantee that is a state agency, for example, can have a
Title X project that supports local entities, organizations,
and clinics throughout the state.
Prior regulation. Prior regulations required Title X
projects to[p]rovide a broad range of acceptable and
effective medically approved family planning methods
(including natural family planning methods) and services
(including infertility services and services for adolescents).
If a health care entity offers only a single method of family
planning, it may participate as part of a project as long as
the entire project offers a broad range of family planning
services.
2019 rule. The rule does not require family planning
methods and services to be medically approved. The rule
also does not require Title X projects to provide every
acceptable and effective family planning method or service.
It states that [a] participating entity may offer only a single
method or a limited number of methods of family planning
as long as the entire project offers a broad range of such
family planning methods and services.According to the
rule's preamble, the rule allows participation by clinics that,
for reasons of conscience, limit the services they offer.
Physical and Financial Separation
Prior guidance. By law, Title X funds may not be used for
abortion. Prior program guidance interpreted the law as
requiring that a grantee's abortion activities be separate
and distinct from its Title X project activities. Under prior
guidance, a grantee's abortion activities and its Title X
project activities could 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 (see https://go.usa.gov/xEdtA).
2019 rule. The rule requires Title X projects to be
physically and financially separate from prohibited
activities, including providing, referring, encouraging,
promoting, or advocating for abortion. The rule requires,
for example, separate facilities (including exam and waiting
rooms, entrances and exits, and websites), separate staff,
separate accounting and medical records, and separate
workstations. Title X funds cannot be used to build
infrastructure for prohibited abortion-related activities.
The preamble to the rule states that abortion-providing
organizations may still apply for and receive Title X grants,
provided they comply with the physical and financial
separation requirements, and other Title X requirements.
Referrals to Primary Care
Prior regulation. Prior regulations required Title X
projects to provide for coordination and use of referral
arrangements with other health care providers.
2019 rule. The rule encourages Title X projects to offer
either comprehensive primary health services onsite or have
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