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 2017, 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 2018

FY 2018 begins on October 1, 2018. House and Senate appropriations subcommittees are currently working on their bills for FY 2018. Title X could face substantial challenges in this budget cycle, given that sequestration returns then (meaning a high likelihood of large cuts across the board) and the program continues to face criticism from Congressional leadership. The president recommended that the program be flat-funded in FY18 at $286.5 million, though his budget as a whole makes substantial cuts to health and human services programs and would threaten public health across the country. 

 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 6.2 million women were able to access publicly funded services in 2015, 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-HHS.” 

FY 2017 Title X Funding Chart (in millions)

FY2017 Final 

FY2018 Enacted 

Change from Previous Year (+/-)

FY2018 President's Budget (Trump)

FY2018 House Labor-HHS Appropriations

FY2018 Senate Labor-HHS Appropriations

$286.5

TBD

TBD

$286.5 million

$0 (program elimination)

TBD


Resources:

Funding Overview

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