January 21, 2015
Title X Family Planning Program
Overview

Figure 1. Title X Clients, by Age
(2013)
The Family Planning Program was enacted in 1970 as Title
X of the Public Health Service Act. It provides grants to
public and nonprofit agencies for family planning services,
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? FY2015 funding is
$286.5 million, the same as the FY2014 level.

FY2015
Appropriations:

$286.5
million
Source: U.S. Department of Health and Human Services (HHS), Title
X Family Planning Annual Report: 2013 National Summary
,
Clients Served (2013):



4.6 million
http://www.hhs.gov/opa/pdfs/fpar-2013-national-summary.pdf.
Note: Sums may not total 100% due to rounding.
Number of Title X Clinics (2013):

4,168
Figure 2. Title X Clients, by Race
(2013)
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
prevention, cervical and breast cancer screening,
preconception health services, pregnancy testing and
counseling, condoms, sterilization services, basic infertility
services, and other patient education and referrals. All
services are confidential.
Does Title X Fund Abortions? By law, Title X funds may
not be used for abortions. A grantee’s abortion activities
must be “separate and distinct” from its Title X project
activities.

What Do Clients Pay? Priority for services is given to
Source: HHS, Title X Family Planning Annual Report: 2013 National
persons with family income at or below 100% of the federal
Summary, http://www.hhs.gov/opa/pdfs/fpar-2013-national-
poverty guideline (FPL), who may not be charged for care.
summary.pdf.
Clients from families with income between 100% and
Notes: 30% of clients (all races) identified as Latino/Hispanic. Sums
250% FPL are charged on a sliding scale based on their
may not total 100% due to rounding.
ability to pay. Clients from families with income higher
than 250% FPL are charged fees designed to recover the
Who Are Title X Clients? In 2013, Title X-funded clinics
reasonable cost of providing services.
served 4.6 million clients, primarily low-income women
and adolescents. Of those clients, 92% were female, 8%
For unemancipated minors who request confidential
were male, 70% had incomes at or below the FPL, and 90%
services, eligibility for discounts is based on the minor’s
had incomes at or below 200% FPL. For 61% of clients,
own income.
Title X clinics are their “usual” or only regular source of
health care. In 2013, 63% of Title X clients were uninsured.
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Title X Family Planning Program
Other Family Planning Programs
Opposing Views
Do Other Federal Programs Fund Family Planning?
Funds to Abortion Providers. Opponents are concerned
Although Title X is the only federal domestic program
that some Title X funds go to abortion providers (such as
primarily focused on family planning, other programs also
some Planned Parenthood clinics). Although Title X funds
finance family planning, among their other services. These
may not be used for abortions, opponents argue that Title X
programs include Medicaid, the Health Center Program
funding frees up Planned Parenthood’s other resources for
under Section 330 of the Public Health Service Act,
its abortion activities.
Maternal and Child Health Block Grants, and Social
Services Block Grants. In FY2010, Medicaid accounted for
Services to Adolescents. Opponents argue that by
75% of U.S. public family planning expenditures (including
providing contraception to adolescents, the government is
federal, state, and local government spending). In
implicitly sanctioning nonmarital sexual activity among
comparison, Title X accounted for 10%.
teens.
Figure 3. Public Family Planning Expenditures
Confidentiality for Minors. Opponents are concerned that
by Funding Source, FY2010
Title X projects do not require parental notification or
parental consent for services to minors. Opponents contend
that Title X confidentiality rules interfere with parents’
rights to know of and guide their children’s health care.
Legislative Mandates
The Consolidated and Further Continuing Appropriations
Act, 2015 (P.L. 113-235) 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.
Source: Guttmacher Institute.
• Funds may not be spent on “any activity (including the
publication or distribution of literature) that in any way
Are Private Health Plans Required to Cover Family
tends to promote public support or opposition to any
Planning Services? Patient Protection and Affordable Care
legislative proposal or candidate for public office.”
Act (ACA; P.L. 111-148, as amended) regulations and
guidance require most non-grandfathered health plans to
• Grantees must certify that they encourage family
cover contraceptive services without cost-sharing. There are
participation when minors decide to seek family
some exceptions and accommodations for religious
planning services.
objections.
• Grantees must certify that they counsel minors on how
to resist attempted coercion into sexual activity.
Health plans in the ACA exchanges (marketplaces) are
required to have a sufficient number and geographic
• Family planning providers are not exempt from state
distribution of “essential community providers,” which
notification and reporting laws on child abuse, child
include Title X projects.
molestation, sexual abuse, rape, or incest.
Supporting Views
The above requirements are in addition to statutory
mandates in Title X of the Public Health Service Act,
Health Benefits. Supporters argue that Title X prevents
which, among other things, require family planning
unintended and high-risk pregnancies, thereby preventing
participation to be voluntary and prohibit the use of Title X
abortions and reducing fetal, infant, and maternal mortality
funds in programs in which abortion is a method of family
and morbidity.
planning.
Cost-Effectiveness. Supporters see public family planning
More Information
programs as cost-effective, saving money for public
programs (such as Medicaid dollars that otherwise would be
For more information, see CRS Report RL33644, Title X
spent on prenatal, maternity, and newborn care).
(Public Health Service Act) Family Planning Program.
Economic Benefits. Supporters contend that family
Angela Napili, anapili@crs.loc.gov, 7-0135
planning, by allowing women to plan whether and when to

have children, contributes to women’s educational
IF10051
attainment, labor force participation, and financial
independence.
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