Updated September 15, 2022
Title X Family Planning Program
Introduction
services, and adolescent-friendly health services).” Title X
The Title X Family Planning Program (Title X) was
clinical guidelines are at https://go.usa.gov/xEdm6.
enacted in 1970 as Title X of the Public Health Service Act
(PHS Act). Title X provides grants to public and nonprofit
Does Title X Fund Abortions? Since Title X’s
agencies for family planning services, research, and
establishment in 1970, the PHS Act has prohibited using
training. The Office of Population Affairs (OPA) within the
Title X funds in programs where abortion is a method of
Department of Health and Human Services (HHS)
family planning (42 U.S.C. §300a-6). In addition, annual
administers Title X, which is the only domestic federal
appropriations laws state that Title X funds “shall not be
program dedicated solely to family planning and related
expended for abortions.”
preventive health services.
According to the 2021 rule’s preamble, the program is
In 2019, HHS promulgated a final rule that, among other
reinstating guidance published in the July 3, 2000 Federal
things, prohibited Title X projects from referring clients for
Register (https://go.usa.gov/xMfP5). This guidance requires
abortion as a method of family planning. It also required
that a grantee’s Title X project activities and its non-Title X
physical separation between Title X projects and certain
abortion activities be “separate and distinct”; they may
abortion-related activities. The 2019 rule took effect in all
share a common facility, a common waiting room, common
states except Maryland, where it was enjoined. (CRS In
staff, and a common records system, “so long as it is
Focus IF11142, Title X Family Planning Program: 2019
possible to distinguish between the Title X supported
Final Rule.)
activities and non-Title X abortion-related activities,” for
example, through allocating and prorating costs.
In 2021, HHS promulgated a new rule that, among other
things, revoked the 2019 rule in its entirety. For example, it
Must Title X projects provide abortion referrals upon
requires Title X projects to provide an abortion referral if
client request? The 2021 rule restores pre-2019
requested by the client and removes the physical separation
requirements that Title X projects offer pregnant clients
requirement. The 2021 rule has been in effect since
information and nondirective counseling on each of these
November 8, 2021. (CRS In Focus IF11986, Title X Family
options: prenatal care and delivery; infant care, foster care,
Planning Program: 2021 Final Rule.)
or adoption; and abortion (unless a client indicates that they
do not want information or counseling about particular
Overview of Title X
options). Projects would also be required to provide
What Is the Federal Funding Level? The Consolidated
referrals upon client request, including abortion referrals.
Appropriations Act, 2022 (P.L. 117-103) provided $286.5
million in FY2022 discretionary funding for Title X, the
Program guidance states that abortion referrals may include
same as the FY2021 amount.
providing relevant factual information (such as the abortion
provider’s phone number, address, and charges), but “the
Additionally, the American Rescue Plan Act (ARPA, P.L.
project may not take further affirmative action (such as
117-2) provided Title X with $50 million in mandatory
negotiating a fee reduction, making an appointment,
funding, with funds to remain available until expended.
providing transportation) to secure abortion services for the
HHS indicated it used some of the ARPA funding for
patient” (see https://go.usa.gov/xhDns).
FY2022 grants for the following purposes: to address the
“dire need” for family planning services in certain states
The 2021 rule’s preamble states that “objecting individuals
with “restrictive” policies on reproductive health access and
and grantees will not be required to counsel or refer for
in certain states that had no or limited Title X services
abortions in the Title X program in accordance with
(https://go.usa.gov/xug5j); to improve and expand
applicable federal law.” A footnote in the rule notes that
telehealth infrastructure (https://go.usa.gov/xJgaN); and to
“[p]roviders may separately be covered by federal statutes
support “training and technical assistance to address the
protecting conscience.”
challenges that the recent Supreme Court decision may
have” on Title X services (https://go.usa.gov/xSYyW).
What Do Clients Pay? Persons with income at or below
100% of the federal poverty guidelines (FPL) do not pay for
What Clinical Services Are Provided? The 2021 rule
care. Clients with income higher than 100% and up to
requires Title X projects to provide “a broad range of
250% FPL are charged on a sliding scale based on their
acceptable and effective medically approved family
ability to pay. Clients with income higher than 250% FPL
planning methods (including natural family planning
are charged fees designed to recover the reasonable cost of
methods) and services (including pregnancy testing and
providing services. (In 2022, in the 48 contiguous states and
counseling, assistance to achieve pregnancy, basic
the District of Columbia, the poverty guidelines for an
infertility services, STI services, preconception health
individual is an annual income of $13,590; for families of
https://crsreports.congress.gov
link to page 2 
Title X Family Planning Program
two or more persons, $4,720 is added to the annual income
of Title X funds that are similar to provisions included in
figure for each additional person.) For unemancipated
previous years’ appropriations laws:
minors who request confidential services, eligibility for
discounts is based on the minor’s own income.
Title X funds cannot be spent on abortions.
All pregnancy counseling must be nondirective.
Are There Special Requirements for Services to
Minors? The Title X statute requires grantees, “[t]o the
Funds cannot be spent on “any activity (including the
extent practical,” to encourage family participation.
publication or distribution of literature) that in any way
However, all Title X services are confidential, including
tends to promote public support or opposition to any
services to minors. The 2021 rule states that Title X
legislative proposal or candidate for public office.”
projects may not require parental consent and may not
Grantees must certify that they encourage family
notify a parent or guardian that a minor has requested or
participation when minors seek services.
received Title X family planning services.
Grantees must certify that they counsel minors on how
to resist attempted coercion into sexual activity.
Annual appropriations laws state that Title X providers are
not exempt from state notification and reporting laws on
Family planning providers are not exempt from state
child abuse, child molestation, sexual abuse, rape, or incest.
notification and reporting laws on child abuse, child
Title X providers must counsel minors on how to resist
molestation, sexual abuse, rape, or incest.
attempted coercion into sexual activity.
These requirements are in addition to statutory mandates in
Title X of the PHS Act, which, among other things, require
Who Are Title X Clients? In 2020, Title X served 1.5
family planning participation to be voluntary and prohibit
million clients (50% fewer than in 2019 and 61% fewer
the use of Title X funds in programs where abortion is a
than in 2018). Of those clients, 86% were female, 66% had
method of family planning.
incomes at or below FPL, 84% had incomes at or below
200% FPL, and 39% were uninsured. The Guttmacher
Other Family Planning Programs
Institute found that in 2015-2019, 60% of contraceptive
Do Other Federal Programs Support Family Planning?
clients said their Title X clinic was their usual source of
Although Title X is the only federal domestic program
broader health care over the past year. Figure 1 provides
primarily focused on family planning, other programs also
demographic data.
finance family planning and contraception, among their
other services. For details, see CRS Report R46785,
Figure 1. Title X Clients by Age and by Race
Federal Support for Reproductive Health Services:
Frequently Asked Questions
Are Private Health Plans Required to Cover Family
Planning Services? Federal law generally requires health
insurance issuers and employment-based health plans to
cover FDA-approved contraceptives for women (See
https://go.usa.gov/xhDRq and https://go.usa.gov/xhDR3).
Regulations issued in 2018 exempt employers that have
religious or moral objections to providing contraceptive
coverage. See CRS Report R45928, The Federal
Contraceptive Coverage Requirement: Past and Pending
Legal Challenges. In 2020, following legal challenges by a
number of states, the Supreme Court upheld the 2018 rules
as authorized by the Affordable Care Act (Little Sisters of
the Poor Saints Peter & Paul Home v. Pennsylvania, 140 S.
Ct. 2367 (2020)). On July 8, 2022, HHS submitted a draft
rule proposing amendments to the 2018 rules for regulatory
review (https://go.usa.gov/xhDRC).
COVID-19
How Has the COVID-19 Pandemic Affected Title X?
Title X clinics continue to operate during the pandemic,
Source: CRS using data from HHS, Title X Family Planning Annual Report:
incorporating strategies such as telehealth, curbside
2020 National Summary, pp. 14, 17, https://go.usa.gov/xMNPJ.
services, and providing a one-year supply of oral
Notes: 35% of clients (all races) identified as Latino/Hispanic.
contraceptives. According to the Family Planning Annual
Percentages may not sum to 100% due to rounding.
Report (FPAR), Title X served 1.5 million clients in 2020,
Legislative Mandates
compared to 3.1 million in 2019 and 3.9 million in 2018.
FPAR estimated that 37% of the decrease since 2018 was
What Title X Provisions Are in the Most Recent
due to the pandemic, whereas 63% was due to providers
Appropriations Law? The Consolidated Appropriations
leaving the program after the 2019 rule’s implementation.
Act, 2022 (P.L. 117-103) included requirements on the use
Angela Napili, Senior Research Librarian
https://crsreports.congress.gov
Title X Family Planning Program
IF10051
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