Title X
Key Facts About Title X
What is the Title X family planning program?
Title X is a federal grant program that makes high-quality family planning and sexual health services more accessible to people with low or no incomes. In fact, Title X is the only federal program dedicated to family planning.
Why is Title X important?
Title X makes it possible for a wide range of health centers to offer family planning care at no or discounted costs to patients. This care is desperately needed - in 2019, close to 10 million women of reproductive age in the United States lived below the federal poverty line. Indeed, in 2019, Title X supported services for more than 3 million people over nearly 4.7 million visits, and a 2016 study found that 60% of the women who received contraceptive care from Title X-funded health centers had seen no other medical provider in the previous year.
In addition, Title X offers benefits that no other health program delivers, from offering care at no cost to people living below the federal poverty line to providing unparalleled confidentiality protections that make sensitive health care services accessible for minors, individuals experiencing intimate partner violence, and anyone else in need of confidential care. Title X-supported health centers are more likely than other publicly funded health centers to offer a wide range of contraceptive methods and allow patients to begin a method the same day as their appointment.
Who receives Title X funding?
Title X is a competitive grant program awarded to public and private entities across the United States. The money is allocated to health centers to support their family planning programs for the following year; unlike with insurance programs, health centers do not need to wait to be reimbursed for a particular service for a particular patient.
Everyone who accesses family planning care at a Title X-funded health center is a Title X patient. Anyone can receive these services, regardless of age, sex, immigration status, race, sexual orientation, gender identity, income, insurance status, or any other characteristic. Importantly, people who live at or below 250% of the federal poverty level (FPL) receive no-cost or discounted services.
Title X patients come from all walks of life, with people of color and people with low incomes disproportionately represented. In 2019, 87% of patients were women; 88% of patients had incomes at or below 250% FPL; 41% of patients were uninsured and 38% were enrolled in public insurance programs like Medicaid; and 78% were between the ages of 18 and 39. That same year, sites reported that 54% of patients were white, 24% were Black, 4% were multiracial, 3% were Asian, and 1% each were Native Hawaiian/ Pacific Islander or indigenous (14% of patients’ race was unreported), while 33% were Latinx and 62% were not.
I heard Title X changed in 2019. What happened?
In March 2019, the Trump administration finalized a new regulation for Title X that imposed a variety of onerous and dangerous requirements on health centers that undermine the standards of care, such as barring all abortion referrals, even when a patient requests them; no longer mandating that health centers funded under the program offer pregnancy options counseling; and scaling back the strong confidentiality protections that made the program so important for adolescents. The rule also made it nearly impossible for health centers that offer abortion care to remain in the program and opened the door for organizations that oppose contraception to participate in the program.
Following the implementation of the rule, more than 1,000 service sites in 33 states withdrew from the program. In 2018, those sites made up a quarter of the program and had provided Title X-supported services to more than 1.5 million people. Data from 2019 show that, even with the rule only in effect for five months, 844,803 fewer patients received care than had the previous year.
To see the impact of the rule on your state, visit https://www.nationalfamilyplanning.org/pages/issues/nfprha-interactive-map. To learn more about the legal challenges to the rule, visit https://www.nationalfamilyplanning.org/pages/issues/title-x-cases.
I live in Maryland, and my Title X-funded health center still operates as it always has. Is something different here?
Yes. In 2019, many organizations, including NFPRHA and its member Cedar River Clinics, filed a total of eight lawsuits to block the rule across the country. As of October 2020, six court decisions had sided with the government, one case is pending, and the courts sided with the plaintiffs in Maryland that the Trump rule is illegal and have blocked the rule in Maryland. As a result, there are two operating rules: the Trump rules are in effect everywhere except for in Maryland, and Title X-funded grantees, subrecipients, and service sites in Maryland are operating under the 2000 Title X rules that had been in effect nationwide until July 2019.
What services are supported by Title X?
Title X clinical services include pregnancy testing; contraceptive counseling, services, and supplies; pelvic exams; screening for cervical cancer; screening for breast cancer; screening for high blood pressure, anemia, and diabetes; testing and treatment for sexually transmitted diseases (STDs); testing for HIV; and basic infertility services. If you are pregnant, some Title X-funded health centers can provide you with counseling on your options. In addition to these clinical services, Title X also support sexual health education, community outreach, and referrals for other health and social services. Under the Trump rule, patients have lost access to nondirective pregnancy options counseling, which includes providing information and referrals upon request for adoption, abortion, and parenting resources, despite the importance of such discussions for pregnant people.
Title X services are provided by a wide range of medical professionals, including nurse practitioners, physician assistants, nurse-midwives, registered nurses, physicians, and health educators. More than 75% of Title X-supported visits include a midlevel clinician or physician.
Where can I receive Title X-supported services?
As of October 2020, Title X-supported services are available in most states, the District of Columbia, and every US territory. These services are provided in thousands of health centers that are part of the 76 grantee networks across the country. To find a Title X-funded health center near you, visit www.hhs.gov/opa and look for the “Find a Family Planning Clinic” tool.
Sources
- "2019 Poverty Guidelines," U.S. Department of Health and Human Services (2019). https://aspe.hhs.gov/2019-poverty-guidelines.
- Office of the Assistant Secretary for Health, Office of Secretary, US Department of Health and Human Services, “Compliance with Statutory Program Integrity Requirements,” Federal Register 84 (March 4, 2019): 7714-7791.
- Christina Fowler et al, “Family Planning Annual Report: 2019 National Summary,” Office of Population Affairs (September 2020). https://opa.hhs.gov/sites/default/files/2020-09/title-x-fpar-2019-national-summary.pdf.
- Meghan Kavanaugh, "Use of Health Insurance Among Clients Seeking Contraceptive Services at Title X-Funded Facilities in 2016," Guttmacher Institute (June 2018). https://www.guttmacher.org/journals/psrh/2018/06/use-health-insurance-among-clients-seeking-contraceptive-services-title-x.