Updated June 3, 2020
Title X Family Planning Program
Introduction
and diseases which may threaten childbearing capability or
The Title X Family Planning Program (Title X) was
the health of the individual, sexual partners, and potential
enacted in 1970 as Title X of the Public Health Service Act
future children.” Title X does not fund prenatal care
(PHS Act). Title X provides grants to public and nonprofit
directly, but the 2019 rule requires Title X projects to
agencies for family planning services, research, and
provide prenatal care referrals for all pregnant clients.
training. The Office of Population Affairs (OPA) within the
Department of Health and Human Services (HHS)
Does Title X Fund Abortions? Since the program’s
administers Title X, which is the only domestic federal
establishment in 1970, the PHS Act has prohibited using
program devoted solely to family planning and related
Title X funds in projects where abortion is a method of
preventive health services. This In Focus answers questions
family planning (42 U.S.C. §300a-6). The 2019 rule
on Title X, legislative mandates, and other family planning
requires “physical and financial separation” between Title
programs, and it identifies resources for Title X projects
X projects and prohibited activities, replacing the prior
during the Coronavirus Disease 2019 (COVID-19)
requirement that they be “separate and distinct” from each
pandemic.
other. Prohibited activities include abortion, referral for
abortion as a method of family planning, and activities that
Overview of Title X
encourage, promote, or advocate for abortion.
What Is the Federal Funding Level? FY2020 funding is
$286.5 million, the same as FY2019.
Physicians and advanced practice providers may provide
nondirective abortion counseling. The 2019 rule’s preamble
FY2020 Appropriations:
$286.5 mil ion
provides guidance that nondirective counseling involves
presenting options “in a factual, objective, and unbiased
Clients Served (2018):
3.9 mil ion
manner.” Title X projects may also refer patients to
Number of Title X Clinics (2018):
3,954
abortion providers for emergency care and in certain cases
of rape and incest.
What Is the Status of the 2019 Final Rule? In March
2019, HHS published in the Federal Register a final rule
What Do Clients Pay? Persons with income at or below
that, among other things, prohibits Title X projects from
100% of the federal poverty guidelines do not pay for care.
referring clients for abortion as a method of family
Clients with income between 100% and 250% of the
planning, and it requires physical and financial separation
poverty guidelines are charged on a sliding scale based on
between Title X projects and certain abortion-related
their ability to pay. Clients with income higher than 250%
activities. (CRS In Focus IF11142, Title X Family Planning
of the poverty guidelines are charged fees designed to
Program: 2019 Final Rule.) Some Title X providers,
recover the reasonable cost of providing services. (In 2020,
including all Planned Parenthood-affiliated clinics, have
the poverty guidelines for an individual in the 48
announced that they are no longer using Title X funds or
contiguous states and the District of Columbia is an annual
have withdrawn from the program. On February 14, 2020,
income of $12,760; for families of two or more persons,
the U.S. District Court for the District of Maryland enjoined
$4,480 is added to the annual income figure for each
the rule’s implementation in Maryland (https://go.usa.gov/
additional person.)
xVX4t). Future court rulings could affect rule
implementation in that state and in others. The Kaiser
For unemancipated minors who request confidential
Family Foundation is tracking program participation at
services, eligibility for discounts is based on the minor’s
https://www.kff.org/interactive/the-status-of-participation-
own income. The 2019 rule allows Title X project directors
in-the-title-x-federal-family-planning-program/.
to offer discounted or free contraceptive services to certain
clients who cannot get job-based contraception coverage
What Clinical Services Are Provided? Title X clinical
due to their employer’s religious or moral objection.
guidelines are at https://go.usa.gov/xEdm6. The 2019 rule
requires Title X projects to provide “a broad range of
Are There Special Requirements for Services to
acceptable and effective family planning methods
Minors? All Title X services are confidential, including
(including contraceptives, natural family planning or other
services to minors. Title X projects do not require parental
fertility awareness-based methods) and services (including
notification or parental consent. However, Title X statute
infertility services, information about or referrals for
requires grantees, “[t]o the extent practical,” to encourage
adoption, and services for adolescents).” The 2019 rule also
family participation. By law, Title X providers must also
states that family planning methods and services include,
counsel minors on how to resist attempted coercion into
for example, choosing not to have sex, preconception
sexual activity. Under the 2019 rule, Title X projects must
counseling, general reproductive and fertility health care,
conduct a preliminary screening of any minor who presents
and “the prevention, diagnosis, and treatment of infections
with a sexually transmitted disease, pregnancy, or any
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Title X Family Planning Program
suspicion of abuse in order to rule out victimization. The
Grantees must certify that they counsel minors on how
2019 rule also has new documentation requirements (e.g.,
to resist attempted coercion into sexual activity.
certain minors’ medical records should indicate their sexual
Family planning providers are not exempt from state
partners’ ages).
notification and reporting laws on child abuse, child
molestation, sexual abuse, rape, or incest.
Who Are Title X Clients? In 2018, Title X served 3.9
million clients. Of those clients, 87% were female, 13%
These requirements are in addition to statutory mandates in
were male, 86% had incomes at or below 200% of the
Title X of the PHS Act, which, among other things, require
federal poverty guidelines, and 65% had incomes at or
family planning participation to be voluntary and prohibit
below the federal poverty guidelines. The Guttmacher
the use of Title X funds in programs in which abortion is a
Institute found that in 2016, 60% of clients said their Title
method of family planning.
X clinic was their only source of broader health care over
the past year. In 2018, 40% of Title X clients were
Other Family Planning Programs
uninsured. Figure 1 provides demographic data.
Do Other Federal Programs Fund Family Planning?
Although Title X is the only federal domestic program
Figure 1. Title X Clients by Age and by Race
primarily focused on family planning, other programs also
finance family planning, among their other services. These
programs include Medicaid, the Health Center Program
under Section 330 of the PHS Act, Maternal and Child
Health Block Grants, Social Services Block Grants, and
Temporary Assistance for Needy Families. In FY2015,
Medicaid accounted for 75% of U.S. public family planning
expenditures (including federal, state, and local government
spending), whereas Title X accounted for 10%
(https://www.guttmacher.org/report/public-funding-family-
planning-abortion-services-fy-1980-2015).
Are Private Health Plans Required to Cover Family
Planning Services? Most health insurance issuers and
employment-based health plans are required to cover
preventive care for women “as provided for” in certain
agency-supported guidelines. (42 U.S.C. § 300gg-13(a)(4)).
Those guidelines include FDA-approved contraceptives
among the covered services. (Health Res. & Servs. Admin.,
Women’s Preventive Services Guidelines, Dec. 2019,
https://www.hrsa.gov/womens-guidelines-2019). For
background on the federal contraceptive coverage
requirement, the regulations exempting certain entities from
that requirement, and related legal challenges, see CRS
Report R45928, The Federal Contraceptive Coverage
Source: CRS using data from HHS, Title X Family Planning Annual
Requirement: Past and Pending Legal Challenges.
Report: 2018 National Summary, pp. 9, 10, and 12, https://go.usa.gov/
COVID-19
xVyWK.
Notes: 33% of clients (al races) identified as Latino/Hispanic.
What Resources Are Available for Title X Projects? The
Percentages may not sum to 100% due to rounding.
Title X-funded Family Planning National Training Center
has released a toolkit on COVID-19 that provides resources
Legislative Mandates
on topics such as telehealth, curbside pickup and mail
delivery of medications, and the provision of 12-month
What Title X Provisions are in the Most Recent
supplies of family planning methods
Appropriations Law? The Further Consolidated
(https://www.fpntc.org/resources/what-family-planning-
Appropriations Act, 2020 (P.L. 116-94) includes
providers-can-do-meet-client-needs-during-covid-19). Title
requirements on the use of Title X funds that are similar to
X projects may apply for a 30-day waiver for nondirective
provisions included in previous years’ appropriations laws:
counseling to be provided by other trained staff if
physicians and advanced practice providers are unavailable.
Title X funds cannot be spent on abortions.
The toolkit quotes the HHS Deputy Assistant Secretary for
All pregnancy counseling must be nondirective.
Population Affairs: “The Office of Population Affairs
Funds cannot be spent on “any activity (including the
(OPA) fully supports Title X Grantees to consider creative
publication or distribution of literature) that in any way
solutions that will work in [their] communities to ensure
tends to promote public support or opposition to any
that clients continue to receive family planning services.”
legislative proposal or candidate for public office.”
Grantees must certify that they encourage family
Angela Napili, Senior Research Librarian
participation when minors decide to seek family
IF10051
planning services.
https://crsreports.congress.gov
Title X Family Planning Program
Disclaimer
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congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
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https://crsreports.congress.gov | IF10051 · VERSION 16 · UPDATED