September 30, 2014
Title X Family Planning Program
Overview
For unemancipated minors who request confidential
services, eligibility for discounts is based on the minor’s
The Family Planning Program was enacted in 1970 as Title
own income.
X of the Public Health Service Act. It provides grants to
public and nonprofit agencies for family planning services,
Figure 1. Title X Clients (2012)
research, and training. Administered by the U.S.
Department of Health and Human Services (HHS), it is the
only domestic federal program devoted solely to family
planning and related preventive health services.
What Is the Federal Funding Level? FY2014 funding
was $286.5 million. The President’s budget requests the
same amount for FY2015. The Senate Appropriations
Labor-HHS-Education Subcommittee bill would provide
$300 million for FY2015. House minority bill H.R.5464
would also provide $300 million for FY2015. FY2015
continuing resolution P.L.113-164, signed by the President
on September 19, 2014, funds most discretionary programs
including Title X through December 11, 2014, at the rate
these programs were funded in FY2014, minus an across-
the-board 0.0554% reduction.
FY2014 Appropriations:
$286.5 million
Clients Served (2012):
4.8 million
Number of Title X Clinics (2012): 4,189
What Clinical Services Are Provided? Clinical services
provided through Title X include contraceptive services and
supplies, natural family planning methods, sexually
transmitted disease testing and treatment, HIV testing and
Source: HHS Family Planning Annual Report.
prevention, cervical and breast cancer screening,
Notes: 28% of clients (all races) identified as Latino/Hispanic.
Sums may not total due to rounding.
preconception health services, pregnancy testing and
counseling, condoms, sterilization services, basic infertility
services, and other patient education and referrals. All
Who Are Title X Clients? In 2012, Title X-funded clinics
services are confidential.
served 4.8 million clients, primarily low-income women
and adolescents. Of those clients, 92% were female and 8%
Does Title X Fund Abortions? By law, Title X funds may
were male; 71% had incomes at or below the FPL and 90%
not be used for abortions. A grantee’s abortion activities
had incomes at or below 200% FPL. For 61% of clients,
must be “separate and distinct” from its Title X project
Title X clinics are their “usual” or only regular source of
activities.
health care. In 2012, 64% of Title X clients were uninsured.
Other Family Planning Programs
What Do Clients Pay? Priority for services is given to
persons with family income at or below 100% of the federal
Do Other Federal Programs Fund Family Planning?
poverty guideline (FPL), who may not be charged for care.
Although Title X is the only federal domestic program
Clients from families with income between 100% and
primarily focused on family planning, other programs also
250% FPL are charged on a sliding scale based on their
finance family planning, among their other services. These
ability to pay. Clients from families with income higher
programs include Medicaid, the Health Center Program
than 250% FPL are charged fees designed to recover the
under Section 330 of the Public Health Service Act,
reasonable cost of providing services.
Maternal and Child Health Block Grants, and Social
Services Block Grants. In FY2010, Medicaid accounted for
75% of U.S. public family planning expenditures (including
www.crs.gov | 7-5700
Title X Family Planning Program
federal, state, and local government spending). In
Confidentiality for Minors. Opponents are concerned that
comparison, Title X accounted for 10%.
Title X projects do not require parental notification or
parental consent for services to minors. Opponents argue
Figure 2. Public Family Planning Expenditures by
that Title X confidentiality rules interfere with parents’
Funding Source, FY2010
rights to know of and guide their children’s health care.
Legislative Mandates
The FY2014 Consolidated Appropriations Act (P.L.113-76)
continues requirements for Title X funds included in
previous years’ appropriations laws:
• Title X funds may not be spent on abortions.
• All pregnancy counseling must be nondirective.
• Funds may not be spent on “any activity (including
the publication or distribution of literature) that in
Source: Guttmacher Institute.
any way tends to promote public support or
opposition to any legislative proposal or candidate
Are Private Health Plans Required to Cover Family
for public office.”
Planning Services? Patient Protection and Affordable Care
Act (ACA) regulations and guidance require most non-
• Grantees must certify that they encourage family
grandfathered health plans to cover contraceptive services
participation when minors decide to seek family
without cost-sharing. There are some exceptions and
planning services.
accommodations for religious objections.
• Grantees must certify that they counsel minors on
Health plans in the ACA exchanges (marketplaces) are
how to resist attempted coercion into sexual
required to have a sufficient number and geographic
activity.
distribution of “essential community providers,” which
include Title X projects.
• Family planning providers are not exempt from
state notification and reporting laws on child
Supporting Views
abuse, child molestation, sexual abuse, rape, or
incest.
Health Benefits. Supporters argue that Title X prevents
unintended and high-risk pregnancies, thereby preventing
FY2015 continuing resolution P.L.113-164 continues
abortions and reducing fetal, infant, and maternal mortality
funding through December 11, 2014, under the same
and morbidity.
conditions as in P.L.113-76.
Cost-Effectiveness. Supporters see public family planning
The above requirements are in addition to statutory
programs as cost-effective, saving money for public
mandates in Title X of the Public Health Service Act that,
programs (such as Medicaid dollars that otherwise would be
among other things, require family planning participation to
spent on prenatal, maternity, and newborn care).
be voluntary and prohibit the use of Title X funds in
programs in which abortion is a method of family planning.
Economic Benefits. Supporters argue that family planning,
by allowing women to plan whether and when to have
More Information
children, contributes to women’s educational attainment,
labor force participation, and financial independence.
For more information, see CRS Report RL33644, Title X
(Public Health Service Act) Family Planning Program.
Opposing Views
Angela Napili, anapili@crs.loc.gov, 7-0135
Funds to Abortion Providers. Opponents are concerned
IF00052
that some Title X funds go to abortion providers (such as
some Planned Parenthood clinics). Although Title X funds
may not be used for abortions, opponents argue that Title X
funding frees up Planned Parenthood’s other resources for
its abortion activities.
Services to Adolescents. Opponents argue that by
providing contraception to adolescents, the government is
implicitly sanctioning nonmarital sexual activity among
teens.
www.crs.gov | 7-5700
Document Outline