Federal Title X Funding Decimated for Many Providers
Long-time program received little money
In March, many Title X programs learned they would be unfunded or face major funding cuts due to funding cuts from Congress.
- Carson City Health and Human Services received zero federal funds after 20 years of Title X funding.
- Funding for Title X programs in California was cut by $8 million from the previous funding level.
- Reproductive health advocates and providers are urging Congress to find additional funding through the budget reconciliation process.
A shockwave rocked Title X programs on March 30, when the federal government’s latest round of funding left many facilities with huge budget shortfalls.
After dealing with years of flat funding, handling reproductive healthcare during the pandemic, and then seeing hundreds of their clinics leave the program under the Trump administration’s gag rule, Title X providers had high hopes for increased funding in 2022-23.
The Biden administration had reversed the gag rule and asked Congress for more Title X funds. Yet, when Title X funding was announced, many programs received the worst cut in their history with the program.
For example, Carson City (NV) Health and Human Services (CCHHS) had been a model Title X organization for two decades. But in March, the program was notified that it was approved for Title X but would receive no federal funds for the next year, says Katharyn Kurek, MHL, BSN, RN, CEN, clinical services manager.
“We have a very outstanding history with Title X,” Kurek says. “In 2018, our application was one of [the top] applications.” Despite the approval, the program was unfunded for the full five-year grant cycle.
Even as a small reproductive health provider, CCHHS provides critical reproductive health services to a large service area in which 30% of the patients served are Hispanic. The area also serves a Native American population.
Each previous funding cycle, the public health provider asked for, and largely received, $400,000 from Title X, which covers about half the facility’s costs. The other half comes from state grants and enough local government funding to cover one full-time employee.
“Up until this point, we always received a little under what we asked for, but it was nothing impactful, other than maybe having to cut back on office supplies,” Kurek says.
But the facility’s 20 years of Title X funding ended in 2022. Worse, if CCHHS is left unfunded again in March 2023, then it will be removed from Title X and will not be able to apply again until the next five-year funding cycle that begins in 2027.
Some reproductive health programs funded by Title X are experiencing funding shortfalls that may cause facilities to close or reduce serving all the patients who need affordable contraceptives and other services.
“We suffered a dramatic cut in funding,” says Amy Moy, chief external affairs officer of Essential Access Health in Berkeley, CA. “Our statewide Title X program received $13.2 million, which is a drastic reduction of $8 million from the previous funding level.”
It is the largest Title X cut Essential Access Health has ever received in its 50-plus-year history of administering the program.
“The Office of Population Affairs had to make extremely difficult decisions because Congress declined to increase Title X funding through the appropriations process, despite the increased need for family planning services nationwide,” Moy explains. “[The office] had to prioritize funding in areas with extreme abortion restrictions.”
Losing Title X funding also can mean the sites lose some of the legal and other advantages of the federal program. For example, even if CCHHS receives enough state and local government funds to cover the shortfall in federal funding, they will lose many services specific to funded Title X programs, Kurek says. These include the ability to provide confidential, free reproductive health services to minors. Nevada law requires healthcare providers to obtain guardian/parental approval before providing minors with contraceptive services and testing or treatment for sexually transmitted infections (STIs). Title X programs are exempt from these sorts of state requirements.
For the next year, CCHHS can continue as a Title X provider with about $50,000 left over from the Title X grants from the previous fiscal year they rolled over to the current fiscal year. “That’s the only thing that keeps us qualified as a Title X entity, which has to do with our seeing teens and minors with confidentiality,” Kurek adds. “But our accessibility has been hugely impacted.”
For instance, before Title X erased the facility’s funding, CCHHS was interviewing people for part-time positions, including a bilingual nurse to serve their Hispanic population. Since the defunding was announced, the facility stopped interviewing candidates and cut those potential new jobs.
Title X programs are important to the public health goal of preventing STIs, but these services also are curtailed because of inadequate funding. (See story in this issue on the effect of STI rates when funding and access are low.)
With recent extreme anti-abortion care restrictions in many states, and with the looming Supreme Court decision on access to safe and legal abortion care, people increasingly need access to affordable contraceptives. Title X programs have been the places that many uninsured and low-income women go for affordable reproductive healthcare.
“Because of years and years of stagnant funding appropriated by Congress, family planning providers across the country are grappling with some painful funding cuts,” says Audrey Sandusky, MPH, senior director of policy and communications at the National Family Planning & Reproductive Health Association (NFPRHA) in Washington, D.C. “Many entities received far below what they need to meet the healthcare needs in their community, and other entities didn’t receive any funding whatsoever. They received an approved grant without any funding.”
Essentially, some Title X programs were told they were approved for funding, but there was no money for them. “It’s not typical of what we’ve seen in the past with regard to grant-making,” Sandusky says. “It keeps them in the game to be potentially eligible for funding, if Congress can appropriate that.”
NFPRHA and other reproductive health advocates are asking Congress to secure emergency funding for Title X programs that are in a dire situation. “But right now, as it stands, there are entities that are not receiving Title X funding,” Sandusky adds.
Congress’ failure to increase Title X funding was a big disappointment, especially after the program suffered major losses of capacity in recent years because of the Trump-era gag rule that resulted in hundreds of healthcare facilities pulling out of the Title X program. (See story on gag rule and Title X in the November 2021 issue of Contraceptive Technology Update.)
Many Planned Parenthood affiliates that withdrew from Title X after their clinicians were banned from mentioning or answering questions about abortion have returned to the program since the Biden administration ended the ban. But their return to Title X is not the cause of the budget problems.
“The expectation was that Congress was going to significantly invest in the program to rebuild and restore and actively repair, and we’re seeing a nationwide fallout from a missed opportunity by Congress to invest in the Title X program and make it right,” Sandusky explains. “We’re pouring every ounce of energy into urging Congress to shore up additional funding through the budget reconciliation and the 50 votes needed for that. We are in the midst of our advocacy efforts to include it.”
Congress’ failure reflects how family planning and birth control access are a low priority among lawmakers, particularly in the increasingly partisan political climate.
“Although birth control is primary care for individuals of reproductive age — and it’s an essential part of our health and well-being — over the past two decades, family planning has become more partisan,” Moy says. “Despite the fact that the Senate and House appropriations committees that have jurisdiction over the Title X program called for significant increases, and the president’s blueprint also included a significant increase for the program, Congress failed to take actions to increase Title X funding in the last omnibus bill that passed. Title X has been on level-funding for nearly a decade. At this point, level funding is really a cut because current funding levels are unable to meet the need for funding resources, especially in the case of extreme abortion bans sweeping the nation.”A shockwave rocked Title X programs on March 30, when the federal government’s latest round of funding left many facilities with huge budget shortfalls. The Biden administration had reversed the gag rule and asked Congress for more Title X funds. Yet, when Title X funding was announced, many programs received the worst cut in their history with the program.
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