September 30, 2014
Title X Family Planning Program
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.
For unemancipated minors who request confidential
services, eligibility for discounts is based on the minor’s
Figure 1. Title X Clients (2012)
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 acrossthe-board 0.0554% reduction.
Clients Served (2012):
Number of Title X Clinics (2012):
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
What Do Clients Pay? Priority for services is given to
persons with family income at or below 100% of the federal
poverty guideline (FPL), who may not be charged for care.
Clients from families with income between 100% and
250% FPL are charged on a sliding scale based on their
ability to pay. Clients from families with income higher
than 250% FPL are charged fees designed to recover the
reasonable cost of providing services.
Source: HHS Family Planning Annual Report.
Notes: 28% of clients (all races) identified as Latino/Hispanic.
Sums may not total due to rounding.
Who Are Title X Clients? In 2012, Title X-funded clinics
served 4.8 million clients, primarily low-income women
and adolescents. Of those clients, 92% were female and 8%
were male; 71% had incomes at or below the FPL and 90%
had incomes at or below 200% FPL. For 61% of clients,
Title X clinics are their “usual” or only regular source of
health care. In 2012, 64% of Title X clients were uninsured.
Other Family Planning Programs
Do Other Federal Programs Fund Family Planning?
Although Title X is the only federal domestic program
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 Public Health Service Act,
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
comparison, Title X accounted for 10%.
Figure 2. Public Family Planning Expenditures by
Funding Source, FY2010
Confidentiality for Minors. Opponents are concerned that
Title X projects do not require parental notification or
parental consent for services to minors. Opponents argue
that Title X confidentiality rules interfere with parents’
rights to know of and guide their children’s health care.
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
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
Grantees must certify that they counsel minors on
how to resist attempted coercion into sexual
Family planning providers are not exempt from
state notification and reporting laws on child
abuse, child molestation, sexual abuse, rape, or
Source: Guttmacher Institute.
Are Private Health Plans Required to Cover Family
Planning Services? Patient Protection and Affordable Care
Act (ACA) regulations and guidance require most nongrandfathered health plans to cover contraceptive services
without cost-sharing. There are some exceptions and
accommodations for religious objections.
Health plans in the ACA exchanges (marketplaces) are
required to have a sufficient number and geographic
distribution of “essential community providers,” which
include Title X projects.
Health Benefits. Supporters argue that Title X prevents
unintended and high-risk pregnancies, thereby preventing
abortions and reducing fetal, infant, and maternal mortality
Cost-Effectiveness. Supporters see public family planning
programs as cost-effective, saving money for public
programs (such as Medicaid dollars that otherwise would be
spent on prenatal, maternity, and newborn care).
Economic Benefits. Supporters argue that family planning,
by allowing women to plan whether and when to have
children, contributes to women’s educational attainment,
labor force participation, and financial independence.
FY2015 continuing resolution P.L.113-164 continues
funding through December 11, 2014, under the same
conditions as in P.L.113-76.
The above requirements are in addition to statutory
mandates in Title X of the Public Health Service Act that,
among other things, require family planning participation to
be voluntary and prohibit the use of Title X funds in
programs in which abortion is a method of family planning.
For more information, see CRS Report RL33644, Title X
(Public Health Service Act) Family Planning Program.
Angela Napili, firstname.lastname@example.org, 7-0135
Funds to Abortion Providers. Opponents are concerned
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
www.crs.gov | 7-5700