Title X

Budget & Appropriations

NFPRHA advocates to sustain and increase federal funding resources for the Title X family planning program. Similar to other federal safety-net health care programs, Congress annually appropriates Title X family planning program grant funds within the Labor, Health and Human Services, Education, and Related Agencies (Labor-H) appropriations bill. After Congress appropriates the funds, they are provided to the Health Resources Services Administration (HRSA), which then transfers the Title X portion to the Office of Population Affairs (OPA). OPA administers the grant program and distributes the funds to 91 grantees across the country. 

Recent Challenges for Title X

Beginning in fiscal year (FY) 2011, many federal programs, including Title X, saw their annual appropriations decrease markedly as a result of pressure to reduce the federal deficit. For FY 2016, the most recent year for which the appropriations process was completed, Title X received $286.5 million, down from the program’s peak of $317.5 million (in FY 2010). 

On top of those cuts, in 2011, for the first time in the history of the Title X program, the House voted to defund the program (H.R. 1). The Senate’s proposal included $300 million, and $299.4 million was ultimately adopted in the final negotiation for annual funding. That fight served as a catalyst for a number of subsequent attempts at the federal and state levels to restrict individuals' access to affordable family planning and other preventive reproductive and sexual health care, contrary to strong public support for such services. Indeed, the House has proposed eliminating the program in five of the last seven years, and in the other two years, there was not a Labor-H bill introduced for congressional consideration. The Senate has continued to support Title X and the program has never been defunded in a final appropriations bill signed by the president. 

Additionally, the Budget Control Act (BCA) of 2011 put into place a set of spending caps on federal programs and triggered automatic across-the-board spending cuts (sequestration) that went into effect on March 1, 2013. As a result, in FY 2013, the Title X program took a $15.6 million cut, $14.9 million of which was due to sequestration. While sequestration was soon halted by a temporary agreement, Title X never regained the lost funds. 

FY 2017 and FY 2018

The federal government is currently operating under a continuing resolution (CR) for FY2017 that expires on April 28, 2017. By that day the president must sign another CR, an omnibus bill, or a combination of the two, or the government will shut down. NFPRHA expects a deal to be reached to avoid a shutdown. 
FY 2018 begins on October 1, 2018. House appropriations subcommittees are currently working on their bills for FY 2018. The Senate appropriations subcommittees will begin their work in April or May.

 Key Facts
 
  • Current funding levels are less than 40% of what is needed to meet the need for publicly funded family planning in this country, according to analyses published in the American Journal of Public Health, which found that Title X would need $737 million annually to meet the need for its services.
  • The Guttmacher Institute found that only 7.8 million women were able to access publicly funded services in 2014, despite there being 20 million women who could benefit from such care.
  • Title X-funded programs saw more than 1.2 million fewer patients in 2015 than they did in 2010 as the funding for the program dropped by $31 million. 
 The Budget & Appropriations Processes 
 
  • The federal fiscal year is October 1 – September 30. The year is noted as FY followed by the calendar year in which the fiscal year ends. For example, October 1, 2017 – September 30, 2018 is referred to as FY 2018.
  • The budget is different than appropriations. The budget is the top-level funding for the government, while appropriations are the amounts allocated to specific programs.
  • Appropriations can be made through stand-alone bills; omnibus bills, in which multiple appropriations categories are handled in one bill; or a continuing resolution (CR), in which the previous year’s funding levels are carried forward for a set amount of time. CRs are often used by Congress to provide more time for negotiations to draft and pass stand-alone or omnibus bills while avoiding a government shutdown.
  • The House and Senate each have 13 subcommittees to divide up the work of appropriations. Each subcommittee produces its own appropriations bill for its programs. Title X is covered in the Labor, Health and Human Services, Education and Related Agencies subcommittee/bill. This bill is often referred to as “Labor-H.” 

There remain substantial disagreements on how to fund the government in FY 2018 and how to handle the sequestration requirements under the BCA, which will come back into effect for that fiscal year. The president’s initial budget request in March 2017 asked for a $54 billion reduction to non-defense discretionary programs, which include Title X, in order to increase defense spending and pay for a border wall. The president has not thus far specifically discussed Title X spending; however, more detailed information is expected in May 2017 when the administration provides agency-level budget requests for FY 2018.

FY 2017 Title X Funding Chart (in millions)

FY2016 Final 

FY2017 Enacted 

Change from Previous Year (+/-)

FY2017 President's Budget (Obama)

FY2017 House Labor-HHS Appropriations

FY2017 Senate Labor-HHS Appropriations

$286.5

TBD

TBD

$300

Complete program elimination

$286.5


Resources:

Funding Chart

Funding Request Letters
Every year, NFPRHA and its national partners prepare letters to Congress making the case for sustained and increased funding for Title X. NFPRHA’s congressional champions also lead and join letters to their colleagues urging their support.

FY 2018

FY 2017

FY 2016

 FY 2015

For additional resources & information, access NFPRHA fact sheets and federal comments by issue or read NFPRHA's publications.  

 

 

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National Family Planning & Reproductive Health Association

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Phone: 202-293-3114  |  info@nfprha.org

© 2011 National Family Planning & Reproductive Health Association