Updated November 5, 2019
Title X Family Planning Program
Overview
fertility awareness-based methods) and services (including
The Title X Family Planning Program (Title X) was
infertility services, information about or referrals for
enacted in 1970 as Title X of the Public Health Service Act
adoption, and services for adolescents).” The 2019 rule also
(PHS Act). It provides grants to public and nonprofit
states that family planning methods and services include,
agencies for family planning services, research, and
for example, choosing not to have sex, preconception
training. The U.S. Department of Health and Human
counseling, general reproductive and fertility health care,
Services (HHS) administers Title X, which is the only
and “the prevention, diagnosis, and treatment of infections
domestic federal program devoted solely to family planning
and diseases which may threaten childbearing capability or
and related preventive health services.
the health of the individual, sexual partners, and potential
future children.” Title X does not fund prenatal care
In March 2019, HHS published in the Federal Register a
directly, but the 2019 rule requires Title X projects to
final rule that prohibits Title X projects from referring
provide prenatal care referrals for all pregnant clients.
clients for abortion as a method of family planning, and it
requires physical and financial separation between Title X
Does Title X Fund Abortions? Since the program’s
projects and certain abortion-related activities, among other
establishment in 1970, the PHS Act has prohibited using
changes to Title X regulations. (CRS In Focus IF11142,
Title X funds in projects where abortion is a method of
Title X Family Planning Program: 2019 Final Rule.)
family planning (42 U.S.C. §300a-6; https://go.usa.gov/
xpgb8). The 2019 rule requires “physical and financial
As of July 15, 2019, HHS has required compliance with the
separation” between Title X projects and prohibited
final rule, except for the physical separation requirements,
activities, replacing the prior requirement that they be
for which compliance is required by March 4, 2020
“separate and distinct” from each other. Prohibited
(https://go.usa.gov/xVX4t). Some Title X providers,
activities include abortion, referral for abortion as a method
including all Planned Parenthood-affiliated clinics, have
of family planning, and activities that encourage, promote,
announced that they are no longer using Title X funds or
or advocate for abortion.
have withdrawn from the program. (The Kaiser Family
Foundation is tracking program participation at
Physicians and advanced practice providers may provide
https://www.kff.org/interactive/the-status-of-participation-
nondirective abortion counseling. The 2019 rule’s preamble
in-the-title-x-federal-family-planning-program/.) HHS
provides guidance that nondirective counseling involves
redistributed some of the relinquished funds among
presenting options “in a factual, objective, and unbiased
remaining grantees (https://go.usa.gov/xVMPF). Future
manner.” Title X projects may also refer patients to
court rulings could affect rule implementation.
abortion providers for emergency care and in certain cases
of rape and incest.
What Is the Federal Funding Level? FY2019 funding
was $286.5 million, the same as FY2018.
What Do Clients Pay? Persons with income at or below
100% of the federal poverty guidelines do not pay for care.
FY2019 Appropriations:
$286.5 mil ion
Clients with income between 100% and 250% of the
Clients Served (2018):
3.9 mil ion
poverty guidelines are charged on a sliding scale based on
Number of Title X Clients (2018):
3,954
their ability to pay. Clients with income higher than 250%
of the poverty guidelines are charged fees designed to
P.L. 116-59, Continuing Appropriations Act, 2020, and
recover the reasonable cost of providing services. (In 2019,
Health Extenders Act of 2019, continues funding for most
the poverty guidelines for an individual in the 48
discretionary HHS programs, including Title X, through
contiguous states and the District of Columbia is an annual
November 21, 2019 (or until full-year funding is
income of $12,490; for families of two or more persons,
appropriated), at the rate they were funded in P.L. 115-245,
$4,420 is added to the annual income figure for each
the Department of Defense and Labor, Health and Human
additional person.)
Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019. The temporary
For unemancipated minors who request confidential
funding is subject to the same authority and conditions as in
services, eligibility for discounts is based on the minor’s
FY2019.
own income. The 2019 rule allows Title X project directors
to offer discounted or free contraceptive services to certain
What Clinical Services Are Provided? Title X clinical
clients who cannot get job-based contraception coverage
guidelines are at https://go.usa.gov/xEdm6. The 2019 rule
due to their employer’s religious or moral objection.
requires Title X projects to provide “a broad range of
acceptable and effective family planning methods
Are There Special Requirements for Services to
(including contraceptives, natural family planning or other
Minors? All Title X services are confidential, including
https://crsreports.congress.gov
link to page 2 link to page 2 
Title X Family Planning Program
services to minors. Title X projects do not require parental
Medicaid accounted for 75% of U.S. public family planning
notification or parental consent. However, Title X statute
expenditures (including federal, state, and local government
requires grantees, “[t]o the extent practical,” to encourage
spending), whereas Title X accounted for 10% (Figure 2).
family participation. By law, Title X providers must also
counsel minors on how to resist attempted coercion into
Figure 2.Public Family Planning Expenditures
sexual activity. Under the 2019 rule, Title X projects must
by Funding Source
conduct a preliminary screening of any minor who presents
with a sexually transmitted disease, pregnancy, or any
suspicion of abuse in order to rule out victimization. The
2019 rule also has new documentation requirements (e.g.,
certain minors’ medical records should indicate their sexual
partners’ ages).
Who Are Title X Clients? In 2018, Title X served 3.9
million clients. Of those clients, 87% were female, 13%
were male, 86% had incomes at or below 200% of the
federal poverty guidelines, and 65% had incomes at or
below the federal poverty guidelines. The Guttmacher
Source: CRS using data from Guttmacher Institute,
Institute found that in 2016, 60% of clients said their Title
https://www.guttmacher.org/report/public-funding-family-planning-
X clinic was their only source of broader health care over
abortion-services-fy-1980-2015. Medicaid expenditures include
the past year. In 2018, 40% of Title X clients were
federal, state, and local government spending.
uninsured. Figure 1 provides demographic data.
Are Private Health Plans Required to Cover Family
Figure 1. Title X Clients by Age and by Race
Planning Services? Certain individual and group market
private health insurance plans are required to cover
contraception (among other preventive services) without
cost-sharing. Although these rules currently include
exemptions and accommodations for certain entities with
religious or moral objections, there is ongoing litigation
over the scope of those exemptions and the process for
obtaining an accommodation, including court orders
enjoining enforcement in certain contexts. (See CRS Report
R45928, The Contraceptive Coverage Requirement and
Legal Challenges Five Years After Hobby Lobby.)
Legislative Mandates
P.L. 115-245 includes requirements on the use of Title X
funds contained in previous years’ appropriations laws:
Title X funds cannot be spent on abortions.
All pregnancy counseling must be nondirective.
Funds cannot be spent on “any activity (including the
publication or distribution of literature) that in any way
tends to promote public support or opposition to any
legislative proposal or candidate for public office.”
Grantees must certify that they encourage family
participation when minors decide to seek family
planning services.
Source: CRS using data from HHS, Title X Family Planning Annual
Report: 2018 National Summary, pp. 9, 10, and 12, https://go.usa.gov/
Grantees must certify that they counsel minors on how
xVyWK.
to resist attempted coercion into sexual activity.
Notes: 33% of clients (al races) identified as Latino/Hispanic.
Family planning providers are not exempt from state
Percentages may not sum to 100% due to rounding.
notification and reporting laws on child abuse, child
molestation, sexual abuse, rape, or incest.
Other Family Planning Programs
Do Other Federal Programs Fund Family Planning?
These requirements are in addition to statutory mandates in
Although Title X is the only federal domestic program
Title X of the PHS Act, which, among other things, require
primarily focused on family planning, other programs also
family planning participation to be voluntary and prohibit
finance family planning, among their other services. These
the use of Title X funds in programs in which abortion is a
programs include Medicaid, the Health Center Program
method of family planning.
under Section 330 of the PHS Act, Maternal and Child
Health Block Grants, Social Services Block Grants, and
Angela Napili, Senior Research Librarian
Temporary Assistance for Needy Families. In FY2015,
https://crsreports.congress.gov
Title X Family Planning Program
IF10051
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https://crsreports.congress.gov | IF10051 · VERSION 14 · UPDATED