Title X Family Planning Program

Title X Family Planning Program

Updated June 8, 2023
Title X Family Planning Program
Introduction
have stated that Title X funds “shall not be expended for
The Title X Family Planning Program (Title X) was
abortions.”
enacted in 1970 as Title X of the Public Health Service Act
(PHS Act, codified at 42 U.S.C. §§300 to 300a-6). Title X
Program guidance requires that a grantee’s Title X project
provides grants to public and nonprofit agencies for family
activities and its non-Title X abortion activities be “separate
planning services, research, and training. The Office of
and distinct”; they may share a common facility, a common
Population Affairs (OPA) within the Department of Health
waiting room, common staff, and a common records
and Human Services (HHS) administers Title X, which is
system, “so long as it is possible to distinguish between the
the only domestic federal program dedicated solely to
Title X supported activities and non-Title X abortion-
family planning and related preventive health services.
related activities,” for example, through allocating and
Most Title X regulations are at 42 C.F.R. Part 59.
prorating costs (https://go.usa.gov/xMfP5).
Overview of Title X
Must Title X projects provide abortion referrals upon
What Is the Federal Funding Level? The Consolidated
client request? Regulations require Title X projects to offer
Appropriations Act, 2023 (P.L. 117-328) provided $286.5
pregnant clients information and nondirective counseling on
million in FY2023 discretionary funding for Title X. The
prenatal care and delivery; infant care, foster care, or
program has had the same enacted annual discretionary
adoption; and abortion (unless a client indicates that they do
funding level since FY2014.
not want information or counseling about particular
options). Projects are also required to provide referrals upon
The American Rescue Plan Act (ARPA; P.L. 117-2, §2605)
client request, including abortion referrals.
also provided Title X with $50 million in one-time
mandatory funding, with funds to remain available until
Program guidance states that abortion referrals may include
expended. HHS indicated it used some of the ARPA
providing relevant factual information (such as the abortion
funding for FY2022 grants for the following purposes: to
provider’s phone number, address, and charges), but “the
address the “dire need” for family planning services in
project may not take further affirmative action (such as
certain states with “restrictive” policies on reproductive
negotiating a fee reduction, making an appointment,
health access and in certain states that had no or limited
providing transportation) to secure abortion services for the
Title X services (https://go.usa.gov/xug5j); to improve and
patient” (https://go.usa.gov/xhDns).
expand telehealth infrastructure (https://go.usa.gov/xJgaN);
and to support “training and technical assistance to address
HHS has stated that “objecting individuals and grantees will
the challenges that the recent Supreme Court decision
not be required to counsel or refer for abortions in the Title
[Dobbs v. Jackson Women's Health Organization] may
X program in accordance with applicable federal law” (86
have” on Title X services (https://go.usa.gov/xSYyW). P.L.
Fed. Reg. 56153) and that “providers may separately be
118-5, Fiscal Responsibility Act of 2023, Division B §2(24)
covered by federal statutes protecting conscience.” (42
rescinded unobligated balances of this ARPA funding as of
C.F.R. 59.5, footnote 2)
the date of enactment, June 3, 2023. As of this writing,
USAspending.gov showed an unobligated balance of $4
What Do Clients Pay? Persons with income at or below
million, reflecting data through April 30, 2023.
100% of the federal poverty level guidelines (FPL) do not
pay for care. Clients with income higher than 100% and up
What Clinical Services Are Provided? Regulations
to 250% FPL are charged on a sliding scale based on their
require Title X projects to provide “a broad range of
ability to pay. Clients with income higher than 250% FPL
acceptable and effective medically approved family
are charged fees designed to recover the reasonable cost of
planning methods (including natural family planning
providing services. (In 2023, in the 48 contiguous states and
methods) and services (including pregnancy testing and
the District of Columbia, the poverty guideline for an
counseling, assistance to achieve pregnancy, basic
individual is an annual income of $14,580; for families of
infertility services, STI [sexually transmitted infection]
two or more persons, $5,140 is added to the annual income
services, preconception health services, and adolescent-
figure for each additional person.) For unemancipated
friendly health services).” Title X clinical guidelines are at
minors who request confidential services, eligibility for
https://go.usa.gov/xEdm6. The Kaiser Family Foundation
discounts is based on the minor’s own income.
reports that there are 4,108 Title X clinics as of 2023.
Are There Special Requirements for Services to
Does Title X Fund Abortions? Since Title X’s
Minors? Annual appropriations laws have stated that Title
establishment in 1970, the PHS Act has prohibited using
X providers are not exempt from state notification and
Title X funds in programs where abortion is a method of
reporting laws on child abuse, child molestation, sexual
family planning. Additionally, annual appropriations laws
abuse, rape, or incest. Title X providers must counsel
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link to page 2 Title X Family Planning Program
minors on how to resist attempted coercion into sexual
• Title X funds cannot be spent on abortions.
activity. The Title X statute also requires grantees, “to the
• All pregnancy counseling must be nondirective.
extent practical,” to encourage family participation.
• Funds cannot be spent on “any activity (including the
publication or distribution of literature) that in any way
Regulations state that Title X projects may not require
tends to promote public support or opposition to any
parental consent and may not notify a parent or guardian
legislative proposal or candidate for public office.”
that a minor has requested or received Title X family
planning services. On December 20, 2022, a federal district
• Grantees must certify that they encourage family
court in Texas, in a case filed by a parent who objected to
participation when minors seek services.
these regulations on religious grounds, ruled that these
• Grantees must certify that they counsel minors on how
regulations violated the plaintiff’s constitutional right to
to resist attempted coercion into sexual activity.
direct the upbringing of his children and set aside these
• Family planning providers are not exempt from state
regulations. See CRS Legal Sidebar LSB10916, Title X
notification and reporting laws on child abuse, child
Parental Consent for Contraceptive Services Litigation:
molestation, sexual abuse, rape, or incest.
Overview and Initial Observations (Part 1 of 2) and CRS
Legal Sidebar LSB10917, Title X Parental Consent for
These requirements are in addition to statutory mandates in
Contraceptive Services Litigation: Overview and Initial
Title X of the PHS Act, which, among other things, require
Observations (Part 2 of 2). The government has filed an
family planning participation to be voluntary and prohibit
appeal; litigation is ongoing.
the use of Title X funds in programs where abortion is a
method of family planning.
Who Are Title X Clients? In 2021, Title X served 1.7
million clients. Of those clients, 85% were female, 65% had
Dobbs v. Jackson Women's Health
incomes at or below FPL, 83% had incomes at or below
Organization
200% FPL, and 36% were uninsured. The Guttmacher
How has the Title X program responded to the Dobbs
Institute found that in 2015-2019, of clients receiving
decision? The U.S. Supreme Court’s June 2022 ruling in
contraceptive services, 60% said their Title X clinic was
Dobbs v. Jackson Women's Health Organization provided
their usual source of broader health care over the past year.
states with increased discretion to restrict abortions. As
Figure 1 provides demographic data.
mentioned, the Title X program does not fund abortions,
but Title X projects are required to provide pregnant clients
Figure 1. Title X Clients by Age and Race, 2021
with nondirective counseling and referrals upon client

request, including abortion referrals.
Age

8%
In June 2022, OPA sent Title X providers Dobbs v. Jackson
17 or younger
Women's Health Organization U.S. Supreme Court

26%
18 through 24
Decision: Impact on Title X Program, a guidance document

on topics such as protecting client confidentiality, providing
33%
25 through 34
clients with referrals to out-of-state providers, serving
35 and older
32%
clients who live out-of-state, and pregnancy counseling via

telehealth (https://bit.ly/455arrE).
0%
20%
40%
60%
Race

In January 2023, the Title X-funded Reproductive Health
White
58%

National Training Center released a Nondirective
Black/African

25%
Counseling and Referral Sample Policy Template. It
American
suggests that providers may want to include in their referral
Race not reported
11%
procedures a description of abortion’s legal status in their

state and a process for out-of-state referrals, if necessary
Multiracial
3%
(https://bit.ly/3M8dHKl). In April 2023, HHS announced a
Asian
2%
forecasted funding opportunity to establish a national Title

X Nondirective Options Information, Counseling, and
American Indian/

1%
Alaska Native
Referrals Hotline and accompanying website for pregnant
Native Hawaiian/
clients (https://bit.ly/3MvFo1g).
1%
Pacific Islander
Source: CRS using data from HHS, Title X Family Planning Annual Report:
Other Family Planning Programs
2021 National Summary, pp. 12, 14, 15, https://go.usa.gov/xMNPJ.
Do Other Federal Programs Support Family Planning?
Notes: 38% of clients (al races) identified as Latino/Hispanic.
Although Title X is the only federal domestic program
Percentages may not sum to 100% due to rounding.
primarily focused on family planning, other programs also
finance family planning and contraception, among their
Legislative Mandates
other services. For details, see CRS Report R46785,
What Title X Provisions Are in the Most Recent
Federal Support for Reproductive Health Services:
Appropriations Law? The Consolidated Appropriations
Frequently Asked Questions.
Act, 2023 (P.L. 117-328) included requirements on the use
of Title X funds that are similar to provisions included in
Angela Napili, Senior Research Librarian
previous years’ appropriations laws:
IF10051
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Title X Family Planning Program

Disclaimer
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