Today, the Biden Administration’s new rule bolstering the Title X family planning program went into effect. The new rule includes an increased emphasis on health equity and undoes a harmful Trump-era policy that forced a large number of providers and grantees to leave the Title X provider network.
The Title X program is the nation’s only dedicated family planning safety net program and provides no- or low-cost family planning services to nearly four million people who are under- or uninsured. The Title X program serves many people that face significant barriers to accessing health care, including people with low incomes, Black, Indigenous, and other people of color, people living in rural areas, and members of the LGBTQ community.
The Administration proposed the rule change in April 2021, opening a 30-day public comment period in which the Center for Reproductive Rights submitted a detailed comment in favor of the rule change.
New Policy Aims to Restore the Title X Provider Network
The new Title X rule revokes several extremely harmful Trump-era provisions, including a requirement that prohibited providers in the Title X network from referring patients for abortion care and a burdensome requirement that Title X providers had to physically separate abortion care from all Title X services provided.
In response, more than 1,000 health centers across 33 states left the program during the Trump administration, nearly halving the network’s capacity to serve patients. Six states—Hawaii, Maine, Oregon, Utah, Vermont, and Washington—are currently without a single provider with Title X funding. The final rule will help restore the Title X provider network by allowing qualified providers and grantees who were forced out of the Title X program to apply to re-enter the program in the upcoming grant cycle.
Final Title X Rule Renews Focus on Health Equity, Improves Confidentiality and Other Provisions
Title X providers are essential in the fight to achieve health equity. Publicly funded family planning clinics are critically important resources for the 24% of U.S. residents living in rural areas, including 19 million women. Title X clinics are also a critical source of care for low-income communities of color. Decades of racism, sexism and other social and economic barriers have contributed to stark health disparities for women of color, who are more than half of the patients in the Title X program. Title X clinics are also an important source of care for LGBTQ+ people, who are disproportionately represented in the number of Americans living in poverty and homelessness.
With this context, it is so critical that the Final Rule includes a new focus on health equity. The rule calls for the evaluation of Title X grant applicants on their commitment to providing equitable care, while also finalizing related proposed definitions such as “client-centered care,” “culturally and linguistically appropriate services,” and “health equity.”
“The Title X program provides essential health care services that would otherwise be out of reach for many people,” said Freya Riedlin, Federal Policy Counsel at the Center. “We are delighted that the Administration is not only restoring the Title X program but is doing so with a strong commitment to health equity. This rule will go far in strengthening the program and ensuring increased access to affordable, essential reproductive health care services.”
The Final Rule also strengthens the confidentiality requirement under Title X for young people. It clarifies that while Title X requires providers to encourage family participation, they may not require parental consent for services for minors, nor may they notify parents or guardians before or after a minor has requested or received services.