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-HHS) 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 grantees across the country.

Recent Fiscal 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 2021, 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 proposed eliminating the program six times between 2011 and 2018. The Senate continued to support Title X during that period, and the program was never 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 2022

The president released highlights of his FY 2022 discretionary budget proposal on April 9, 2021, and the full budget on May 28, 2021. He recommended $340 million for Title X, an increase of $53.5 million over current funding. Read NFPRHA's reaction to the proposal. The House Appropriations Committee released its proposal on July 11, which NFPRHA prasied for its history-making investment in Title X. The Senate's appropriations timeline is unclear.

	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. Title X funding dropped by $31 million from 2010 to 2018; over that same period, service sites saw 1.2 million fewer patients (a 25% decrease).

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.
Title X funding dropped by $31 million from 2010 to 2018; over that same period, service sites saw 1.2 million fewer patients (a 25% decrease).

	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 12 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-HHS.”

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 12 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-HHS.”

FY 2022 Title X Funding Chart (in millions)

FY 2022 Final	Change from Previous Year	FY 2021 President's Budget	FY 2021 House Labor-HHS Appropriations	FY 2021 Senate Labor-HHS Appropriations	FY 2022 Approved
$286.5	--	$340	$400	TBD	TBD

Resources:

Funding Overview

Fact sheet on President Biden's FY 2022 budget (PDF) - An analysis of the budget released in May 2021 (June 2021).
Fact sheet on the House of Representative's FY 2022 Labor-HHS Proposal (PDF) - An analysis of the draft bill released in July 2021 (July 2021).
Recent Federal Funding for Title X Public Health Program (PDF) - A funding history of Title X from FY 2010 - FY 2020 (September 2020).
Historical Funding of Title X (1971-2016) (PDF) - An infographic of Title X funding from 1971-2016 (May 2017).

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 2022

FY 2021

FY 2020

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

Title X

Budget & Appropriations

Recent Fiscal Challenges for Title X

Resources:

Issues

National Family Planning & Reproductive Health Association