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More than 10 days after the Trump administration froze roughly $66m of federal funds that had been earmarked for no- and low-cost family planning services, the providers that had been scheduled to receive that money are staring down the possibility of financial collapse.
Title X, the country’s largest federal family planning program, provides clinics across the country with more than $200m each year for services such as contraception, STI tests and cancer screenings. In 2023, more than 2 million people received healthcare through Title X, which helps people regardless of income, age or citizenship status. For many, Title X is their only source of healthcare.
But the future of the decades-old program is now in limbo.
On 31 March, the Trump administration notified 16 Title X providers that their funds would be temporarily withheld “pending a compliance review”, a US Department of Health and Human Services official told the Guardian. Title X programs had just 10 days – until Thursday 10 April – to turn over documentation for the review. Yet multiple Title X providers told the Guardian that they have not heard anything from the Trump administration since submitting their documentation.
Seven states currently have no Title X funding, while another 16 states have lost most or some Title X dollars, according to the National Family Planning and Reproductive Health Association, which represents the majority of Title X providers. In total, the funding freeze affects clinics that, in 2023, served about 846,000 people.
As Title X clinics often operate with razor-thin margins, this delay in funding could prove catastrophic, Title X providers said.
“If these funds are not released, many clinics are going to be facing the decision to either significantly reduce their staff and services or close their doors altogether,” said Michelle Trupiano, executive director of Missouri Family Health Council Inc, which handles Title X funding for 52 clinics scattered across Missouri.
“Once a clinic lays off staff or closes their doors, it’s almost impossible to open them again.”
If Title X funding is not restored by the end of the month, Trupiano said, clinics in Missouri may have to cut their staff, hours and services.
Some providers have just two weeks’ worth of reserve funding, said Clare Coleman, CEO of the National Family Planning and Reproductive Health Association. Among some providers, changes – such as charging for care that would previously have been free – may come as early as this week.
The Department of Health and Human Services did not respond to a request for comment on when Title X providers may expect to learn more about their withheld funding.
Many of the notices sent to the Title X providers with frozen funding accuse the providers of being potentially engaged “in widespread practices across hiring, operations, and patient treatment that ‘unavoidably employ race in a negative manner’” as well as possibly violating a Trump administration executive order prohibiting “taxpayer subsidization of open borders”.
Missouri Family Health Council, which handles funding for the 52 Title X clinics scattered across Missouri, was cited for a 2023 job posting that mentioned “diversity, equity, inclusion and belonging”, Trupiano said.
Converge, which deals with funding for 120 Title X clinics in Mississippi and Tennessee, was cited for a 2020 statement that, in the wake of George Floyd and Breonna Taylor’s deaths, affirmed that Converge’s leaders were “committed to having honest, on-going, challenging, and courageous conversations about how our work is addressing systemic racism in reproductive health care”, according to documents viewed by the Guardian.
Nine Planned Parenthood affiliates that receive Title X funding were cited for their mission statements as well as public documents that emphasize a “commitment to Black communities”, Politico reported.
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A spokesperson for Maine Family Planning, which handles Title X funding for Maine, declined to specify why the Trump administration cited the organization, but said it was “some of our public statements about health equity”.
“Our funding application adheres to the current requirements of the Title X program and regulations, which encompasses health equity,” said the spokesperson, Olivia Pennington.
“We’re going to do everything we can to fight back, and that may include litigation.”
If it continues, the freeze on Title X funding will probably hit women of color the hardest. In 2023, 85% of the 2.8 million people who sought care through Title X were women, and 48% identified as a race other than white.
The Trump administration should have at least given Title X providers time to amend their funding applications to come into compliance with the administration’s new policies, Coleman said.
“In no letter does it suggest that there’s something inside the application for funds itself that is problematic,” she said. “This is just not on the level.”
