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Congressional Research Service
Inforrning the legislative debate since 1914
Updated May 16, 2025
Title X Family Planning Program
Introduction f
The Title X Family Planning Program (Title X) was
enacted in 1970 as Title X of the Public Health Service Act
(PHSA, codified at 42 U.S.C. §§300 to 300a-6). Title X
provides grants to public and nonprofit agencies for family P
planning services, research, and training. The Office of p
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 P
family planning and related preventive health services. g
Most Title X regulations are at 42 C.F.R. Part 59. OPA a
reports there were 3,853 Title X clinics as of 2023. On a
March 27, 2025, HHS announced an agency restructuring, c
including reducing the number of HHS employees and
eliminating a number of offices and agencies, while b
consolidating others. It is unclear how these changes may a
affect the administration of Title X.
Overview of Title X
What Is the Federal Funding Level? Funding for Title X
is discretionary and subject to the annual appropriations c
process. The Continuing Appropriations and Extensions
Act, 2025 (P.L. 119-4) provided $286.5 million for Title X c
in FY2025, continuing funding at the same level, and under c
the same authority and conditions, as the Further t
Consolidated Appropriations Act, 2024 (P.L. 118-47). The o
program has had the same enacted annual discretionary c
funding level since FY2014. President Trump's FY2026
Budget Request would eliminate funding for the program. P
The American Rescue Plan Act of 2021 (ARPA; P.L. 117- p
2, §2605) also provided Title X with $50 million in one- n
time mandatory funding. HHS indicated it used some ofte r
ARPA funding for FY2022 grants to address the increased t
need for Title X 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; c
to improve and expand telehealth infrastructure; and to
support training and technical assistance.
What Clinical Services Are Provided? Title X federal p
regulations require projects to provide a broad range of
acceptable and effective medically approved family
planning methods (including natural family planning 1
methods) and services (including pregnancy testing and p
counseling, assistance to achieve pregnancy, basic
infertility services, STI [sexually transmitted infection] a
services, preconception health services, and adolescent- a
friendly health services). The Title X Program Handbook p
provides additional clinical and programmatic guidance. t
Although Title X is the only federal domestic program
focused primarily on family planning, other programs also f
provide or finance family planning services among their
other services (see CRS Report R46785, Federal Support
or Reproductive Health Services: Frequently Asked
Questions).
Does Title X Fund Abortions? Since Title X's enactment,
HSA Section 1008 has prohibited using Title X funds in
rograms where abortion is a method of family planning.
Additionally, annual appropriations laws have stated that
Title X funds shall not be expended for abortions.
rogram guidance and federal regulations require that a
rantee's Title X project activities and its non-Title X
bortion activities, should they engage in both, be separate
nd distinct. They may share a common facility, a
ommon waiting room, common staff, and a common
ecords system, so long as it is possible to distinguish
etween the Title X supported activities and non-Title X
bortion-related activities. For example, grantees must
learly delineate clinic staff time spent on project activities
and paid for by Title X from non-Title X activities.
Must Title X projects provide abortion referrals upon
lient request? Current regulations require Title X projects
o offer pregnant clients with information and nondirective
ounseling on prenatal care and delivery; infant care, foster
are, or adoption; and abortion (unless a client indicates that
hey do not want information or counseling about particular
ptions). Projects are also required to provide referrals upon
lient request, including abortion referrals.
rogram guidance states abortion referrals may include
providing relevant information (such as the abortion
rovider's phone number and address), but the project may
ot take further affirmative action (such as negotiating a fee
eduction, making an appointment, or providing
ransportation) to secure abortion services for the patient.
Title X providers and grantees with religious or
onscientious objections to abortion counseling and
eferrals are not required to provide such services according
o federal regulations (86 Fed. Reg. 56153). Providers with
objections may separately be covered by federal statutes
rotecting conscience (42 C.F.R. 59.5, footnote 2).
What Do Clients Pay? Persons with income at or below
00% of the federal poverty level guidelines (FPL) do not
ay for care. Clients with income higher than 100% and up
o 250% FPL are charged on a sliding scale based on their
bility to pay. Clients with income higher than 250% FPL
re charged fees designed to recover the reasonable cost of
roviding services. (In 2025, in the 48 contiguous states and
he District of Columbia, the poverty guideline for an
individual is an annual income of $15,650; for families of
wo or more persons, $5,500 is added to the annual income
igure for each additional person.) For unemancipated
minors who request confidential services, eligibility for
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