Title X Family Planning: Proposed Rule on Statutory Compliance Requirements

Summary

The Title X Family Planning Program (Title X), enacted in 1970, is the only domestic federal program devoted solely to family planning and related preventive health services. All 50 states, the District of Columbia, and the U.S. territories and Freely Associated States (collectively referred to as states) are eligible to apply for Title X grants, as are other public agencies and nonprofit organizations. Title X grants enable grantees to establish and operate family planning projects. A family planning project refers to a set of activities that a Title X grantee undertakes under its grant agreement to provide a broad range of family planning methods and services to Title X clients. (In 2016, Title X-funded clinics served 4 million clients.) Examples of Title X activities include provider-to-patient counseling, dissemination of educational materials, and the delivery of clinical services. Clinical services provided through Title X projects include contraceptive services and supplies, sexually transmitted disease testing and treatment, and preconception health care services. All services are confidential.

Title X is administered through the Office of Population Affairs (OPA) in the Department of Health and Human Services (HHS). The program was appropriated $286.5 million for FY2018. Federal law (42 U.S.C. §300a-6) prohibits the use of Title X funds in projects “where abortion is a method of family planning.” According to OPA, family planning projects that receive Title X funds are closely monitored to ensure that federal funds are used appropriately and that funds are not used for prohibited activities such as for performing surgical abortion procedures. Under current program guidance, the abortion prohibition does not apply to all Title X grantees’ activities; instead, the prohibition applies only to activities that are part of the Title X project. A grantee’s abortion activities must be “separate and distinct” from the Title X project activities.

On June 1, 2018, OPA published a proposed rule in the Federal Register, “Compliance with Statutory Program Integrity Requirements,” that would make several changes to federal Title X family planning regulations, including the following:

Title X projects would no longer be required to offer pregnant clients the opportunity to receive abortion information, counseling, and referral upon request.

Title X projects would be prohibited from referring patients to abortion services.

Title X projects would be required to maintain physical and financial separation between their Title X projects and abortion-related activities.

Several terms, including “family planning” and “low-income family,” would have new definitions.

Criteria for awarding Title X Family Planning Services grants would be revised.

Title X grant applicants and grantees would be subject to new reporting requirements.

This proposed rule has sparked a congressional debate about the scope of Title X. The 115th Congress is debating the scope of Title X to determine whether providing an abortion-related service, such as referring a pregnant client to an abortion provider, should be a family planning service under Title X. In addition, Members of Congress are debating whether this proposed rule is a “gag rule”: an attempt to prevent some Title X clients from receiving adequate information that would permit them to make an informed decision about their health care treatment.

This report summarizes the proposed rule’s major elements and explains how the proposed rule differs from current Title X rules and guidance. In addition, CRS provides HHS’s rationale for the components of the proposed rule, as well as selected commentary from key stakeholders in reaction to the proposed rule.