January 21, 2015
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.
Figure 1. Title X Clients, by Age
What Is the Federal Funding Level? FY2015 funding is
$286.5 million, the same as the FY2014 level.
Clients Served (2013):
Number of Title X Clinics (2013):
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.
Source: U.S. Department of Health and Human Services (HHS), Title
X Family Planning Annual Report: 2013 National Summary,
Note: Sums may not total 100% due to rounding.
Figure 2. Title X Clients, by Race
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.
For unemancipated minors who request confidential
services, eligibility for discounts is based on the minor’s
Source: HHS, Title X Family Planning Annual Report: 2013 National
Notes: 30% of clients (all races) identified as Latino/Hispanic. Sums
may not total 100% due to rounding.
Who Are Title X Clients? In 2013, Title X-funded clinics
served 4.6 million clients, primarily low-income women
and adolescents. Of those clients, 92% were female, 8%
were male, 70% 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 2013, 63% of Title X clients were uninsured.
www.crs.gov | 7-5700
Title X Family Planning Program
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
federal, state, and local government spending). In
comparison, Title X accounted for 10%.
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.
Figure 3. 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 contend
that Title X confidentiality rules interfere with parents’
rights to know of and guide their children’s health care.
Services to Adolescents. Opponents argue that by
providing contraception to adolescents, the government is
implicitly sanctioning nonmarital sexual activity among
The Consolidated and Further Continuing Appropriations
Act, 2015 (P.L. 113-235) 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
Source: Guttmacher Institute.
Are Private Health Plans Required to Cover Family
Planning Services? Patient Protection and Affordable Care
Act (ACA; P.L. 111-148, as amended) regulations and
guidance require most non-grandfathered health plans to
cover contraceptive services without cost-sharing. There are
some exceptions and accommodations for religious
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
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 activity.
• Family planning providers are not exempt from state
notification and reporting laws on child abuse, child
molestation, sexual abuse, rape, or incest.
The above requirements are in addition to statutory
mandates in Title X of the Public Health Service Act,
which, 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
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 contend 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
Angela Napili, email@example.com, 7-0135
For more information, see CRS Report RL33644, Title X
(Public Health Service Act) Family Planning Program.
www.crs.gov | 7-5700