Title X

Key Facts About Title X

How is the Program Administered?

  • Similar to other federal safety-net health care programs, the Title X grant program funds are appropriated to the Health Resources Services Administration (HRSA) through the annual, discretionary appropriations process by Congress. However, the program is unique in that while it is funded through HRSA, it has been administered by the Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health in the Department of Health and Human Services (HHS) since 1983.
  • OPA provides Title X funding to public and private nonprofit grantees across the country. Grantees are awarded funds through a competitive process. 
  • In 2018, state, county, and local health departments made up just over half (51%) of Title X grantees. Family planning councils, Planned Parenthoods, and other private non-profit organizations made up the rest (49%) of the network. Services are provided by the grantees directly and by a network of 1,128 subrecipients, which include free-standing family planning centers, federally qualified health centers, hospitals, school- and university-based health centers, tribal health centers, correctional facilities, and other private nonprofits. In summer 2019, the network began shrinking as entities withdrew from the program rather than comply with the Trump administration's Title X final rule. 

What Does the Provider Network Look Like?

  • In 2018, 3,595 full-time equivalent health care professionals provided Title X services including nurse practitioners, physicians, physician assistants, certified nurse-midwives, registered nurses, counselors, and health educators. 
  • By law, Title X funds are not the sole source of income for providers. Rather, Title X funding is leveraged throughout the health centers in its network. In 2018, Title X grantees reported their major sources of revenue to include 39% Medicaid/CHIP, 19% Title X, 13% state and local funding, 4% patient fees, 11% private third-party reimbursement and 14% other funding streams. 

What Clinical Services Health Centers Provide? 

  • Title X health centers provide access to contraceptive services, supplies, and information to all who want and need them. By law, however, priority is given to persons from low-income families.
  • Since its inception, Title X has statutorily required that its providers preserve patients’ confidentiality for the array of services delivered, despite Title X funds not covering the full costs of services provided. 
  • Title X clinical services include pregnancy testing; contraceptive counseling and services; pelvic exams; screening for cervical and breast cancer; screening for high blood pressure, anemia, and diabetes; screening for sexually transmitted diseases (STDs) and HIV/AIDS; infertility services; health education; and referrals for other health and social services.
  • In 2018, Title X-funded centers provided more than 650,000 Pap smears, more than 800,000 clinical breast exams, more than 4 million STD tests, and 1.2 million HIV tests.  

Who Does Title X Serve?

  • In 2016, Title X-funded providers were the sole source of medical care for 60% of their contraceptive clients. 
  • In 2018, Title X-funded providers served close to 4 million people, 87% of whom were women. 
  • Sixty-five percent of Title X patients have incomes at or below the federal poverty level—meaning they earn less than $12,140 per year if they have a 1-person household. These patients receive services at no cost to them.  
  • Forty percent of Title X patients are uninsured, 38% have Medicaid or other public health insurance, and 20% have private insurance. 
  • Title X patients are disproportionately Black and Hispanic or Latino, with 22% of Title X patients self-identifying as Black and 33% as Hispanic or Latino, as compared to 18% and 12% of the nation, respectively. Thirty-one percent of Title X patients identify as people of color. 

What are the Benefits of Publicly Funded Family Planning Health Centers?

  • Title X funding has been proven effective while simultaneously saving millions in taxpayer funds. 
  • In 2015 publicly funded health centers services helped prevent 1.9 million unintended pregnancies, which would have resulted in 876,100 unplanned births and 628,600 abortions. Services provided by Title X centers helped women avert 43% (822,300) of these unintended pregnancies, which would have resulted in 387,200 unplanned births and 277,800 abortions.
  • Title X provides significant cost savings to the federal and state governments. The Guttmacher Institute estimates that for every dollar invested in family planning, the taxpayer saves $7.09 - or a net $13.6 billion in 2010. 

Key Budget Facts

  • In total, between FY 2010-FY 2019, funding for Title X was cut by $31 million - a 10% reduction.
  • The Title X program took a $14.9 million cut in FY 2013 due to sequestration alone, and only $8.2 million of that cut was restored to the program in FY 2014.

For a PDF version of the information above and sources, see the Introduction to Title X factsheet and the Title X Budget & Appropriations page. 

Sources 

National Family Planning & Reproductive Health Association

1025 Vermont Ave. NW, Suite 800, Washington, DC 20005
Phone: 202-293-3114  |  info@nfprha.org

© 2019 National Family Planning & Reproductive Health Association