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Victoria Knight
By Victoria Knight November 8, 2021

Biden administration rule paves the way for Planned Parenthood clinics to rejoin Title X network

In October, the Biden administration issued a final rule to overturn a 2019 directive issued by then-President Donald Trump that forbade health clinics from receiving federal funding if they provided abortion referral services or were located on the same property as an abortion provider. 

The funding in question is delivered through the Title X program, which provides federal funds for family planning services to clinics that serve low-income and uninsured people. These types of services can include contraceptive care, sexually-transmitted infection and cancer screenings, and pregnancy counseling. 

In response to the Trump-era 2019 rule, more than a 1,000 clinics, including 400 Planned Parenthood clinics, chose to withdraw from the Title X network, which meant they no longer received federal funding. This circumstance, coupled with the chilling effect the covid-19 pandemic had on people seeking care, triggered a drop in the number of patients served by Title X clinics of almost 2.5 million from 2018 to 2020, according to the Department of Health and Human Services 2021 Office of Population report.

"Patients have been lost to Title X care at historic rates, and providers are struggling to keep their doors open with limited funds," said Audrey Sandusky, senior director for policy and communications at the National Family Planning and Reproductive Health Association, a non-partisan group that represents family planning clinics across the U.S. "That's cut off access to reproductive health services, from contraception to cervical cancer screenings." 

The American Civil Liberties Union filed a lawsuit against the Trump administration on behalf of the National Family Planning and Reproductive Health Association challenging the changes to the Title X program in 2018. 

President Joe Biden is now paving the way to restore that federal funding to Planned Parenthood clinics, which was a promise he made during the 2020 presidential election. 

The Biden administration's final rule, which took effect on Nov. 8, returns the Title X program mostly back to how it functioned before the Trump administration. Clinics that receive Title X funding can provide abortion counseling and referrals, or the clinics can have abortion services co-located on the same property, but federal funds cannot be used to pay directly for abortions. 

The rule also reverses the 2019 rule's requirement that pregnant patients be referred for prenatal services, regardless of their preference for care. Under the Biden rule, pregnancy counseling must again be non-directive, meaning the patient decides what their path forward with the pregnancy will be and is not directed by the provider. That can include referral for an abortion, if the patient asks for such a service. 

The Biden rule has just a few small differences from previous versions of the rule, in that telehealth is allowed to be used for family planning services and requires clinics to provide health care that is equitable and inclusive. 

But, the issuing of the final rule is just one of several more steps that need to be taken before Planned Parenthood and other health clinics start to receive federal Title X funding again. They must also reapply for funding and rejoin their state networks. 

In late October, HHS posted the first notice of a funding opportunity for entities to apply for Title X family planning funding. Applications close in January, and it seems likely clinics will receive the assistance starting in spring 2022, said Dee Srivastava, a policy analyst with Planned Parenthood Federation of America. 

Srivastava said she is not yet sure how many Planned Parenthood clinics will return to the Title X network. 

"We are still developing how we are supporting affiliates through the application process," said Srivastava. "They have a lot to do operationally and it turns out getting back in [to the Title X network] is harder than getting out." 

Other funding opportunities are also slated to open up next year for clinics to receive funding under Title X, said Sandusky, which could help even more join the network. But much is still unknown. 

"We don't have a forecast of what the network will look like when new grant making is done," said Sandusky. "I think what our hope is that this funding will make it possible for longstanding expert providers to return to the program." 

There is also a lawsuit that could potentially threaten this restoration of federal funding. On Oct. 25, 12 states, led by Ohio, filed a lawsuit against HHS stating that the Biden administration's rule violates the federal statute which says funds under Title X can't be "used in programs where abortion is a method of family planning."

So, while Biden appears poised to achieve this campaign promise of restoring federal funding to Planned Parenthood, the clinics have not gotten the money yet, and it seems it will be several more months before they do. There is also a pending lawsuit. And it's still to be determined how many clinics will rejoin the Title X network and if it can return to its original size and build back up the number of low-income and uninsured patients served.  

We rate this promise In the Works.

Our Sources

American Civil Liberties Union, National Family Planning & Reproductive Health Association V. Azar, Updated May 2, 2018

Associated Press, "Biden sued over reversal of Trump-era abortion referral ban," Oct. 25, 2021

Department of Health and Human Services - Final Rule, Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services, Oct. 7, 2021

Department of Health and Human Services - Title X Family Planning Services Grants, Oct. 27, 2021

Department of Health and Human Services - Office of Population Affairs - Title X Family Planning Annual Report 2020 National Summary, Sept. 2021

KFF, Rebuilding Title X: New Regulations for the Federal Family Planning Program, Nov. 3, 2021

Phone interview with Dee Srivastava, a policy analyst with Planned Parenthood Federation of America, Nov. 2, 2021 

Phone interview with Audrey Sandusky, senior director for policy and communications at the National Family Planning and Reproductive Health Association, Nov. 2, 2021 

Politico Pulse Newsletter, "NIH Director Francis Collins to step down," Oct. 5, 2021

Politifact, "Biden administration starts the process of restoring federal funding for Planned Parenthood," Jan. 28, 2021

USA Today, "Biden administration lifts Trump-era abortion referral ban on family planning clinics," Oct. 4, 2021

The Washington Post, "Trump administration will pull funds from groups that perform abortions or provide referrals," May 18, 2018

Victoria Knight
By Victoria Knight January 28, 2021

Biden administration starts the process of restoring federal funding for Planned Parenthood

On Jan. 28, President Joe Biden signed a memorandum that marks the first step towards restoring federal funding for Planned Parenthood clinics. 

The memo directs the Department of Health and Human Services to look at the current regulations in place for the Title X family planning program and decide whether to suspend, revise or rescind those regulations. The Title X program provides federal funds to clinics that serve low income and uninsured people. 

There is a section within the Title X statute that states funds cannot be "used in programs where abortion is a method of family planning." Before Trump took office, that was interpreted to mean federal funds could not be used to directly pay for abortion services. Money could still go to clinics where abortion services were provided or which referred patients for such services. The Title X funding had to be kept financially separate from abortion-related activities and funding. 

The Trump administration issued a new regulation in 2019 that said federal funds could not be distributed to any clinic that provided referrals for abortions. It also required any pregnant patients to be counseled for prenatal services regardless of their pregnancy intention. In response, Planned Parenthood withdrew from the Title X program in August 2019. 

As a result of Biden's memorandum, HHS will now evaluate the Trump administration regulation and issue their own rule, which will then be subject to a period of public comment. That could take months. 

The Supreme Court is also reviewing three cases challenging the Trump administration's Title X rule, which could complicate things. 

If HHS does issue a new rule that allows Title X funding to be given to clinics who provide abortion referral services, that doesn't mean those clinics will receive the funds right away.  Clinics will then have to reapply to the Title X program and rejoin their state's networks. 

"It won't just be like flipping a switch to get all the providers of the Title X program back in," Planned Parenthood President Alexis McGill Johnson said to reporters on Jan. 26.

Still, it appears to be the first step toward bringing Planned Parenthood back into the Title X program. 

 We rate this promise In the Works. 

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