The Obama administration has proposed barring states and other recipients of federal family planning grants from placing their own eligibility restrictions on where the money can go, which would undermine the efforts of Indiana and 12 other Republican-led states to prevent such money from going to Planned Parenthood.
The Department of Health and Human Services is accepting public comments about the proposed changes to the Title X grant program until Oct. 7. It contends that these state restrictions have hurt the quality and geographic availability of family planning services to the poor families that Title X is intended to reach. It also says the program is cost-effective, noting that every grant dollar spent on family planning saves an average $7.09 in Medicaid-related costs.
The proposed rule change was welcomed by Planned Parenthood, which relies on Title X to provide reproductive health care services to 1.5 million patients across the country, making it the medical provider for about a third of the patients served by the grant program.
"This is critically important and I am grateful that the Obama administration is taking these efforts to make sure nobody stands in the way of the care that people need. These proposed regulations make it clear that politicians can't stop women from getting services," said Dr. Raegan McDonald-Mosley, chief medical officer for the Planned Parenthood Federation of America.
Title X is designed to provide contraception services, pregnancy tests, screening and treatment for sexually transmitted diseases and cancer screenings at little or no cost to low-income patients. It doesn't pay for abortions, except in cases of rape, incest or when the mother's life is endangered. Title X grants account for 10 percent of the public funding clinics receive for family planning services, with Medicaid picking up 75 percent, according to the Guttmacher Institute, a research group that supports abortion rights.
Federal law prohibits blocking a qualified provider from getting Medicaid, and no court so far has upheld a single attempt by a state to block Medicaid funding to Planned Parenthood, said Kinsey Hasstedt, a Guttmacher Institute policy expert. But because Title X is a grant program, some states have been more successful in restricting the disbursement of those funds, she said.
In 2011, Kansas established a tiered system for dispersing its Title X funding that favors county health departments and other providers that offer more comprehensive medical services, rather than those that specialize in reproductive health, such as Planned Parenthood.
The tiered system, which took effect in 2014 after an appeals court upheld its legality, made it harder for families to access medical services, particularly in the rural western part of the state, where Planned Parenthood closed a clinic in Hays and an unaffiliated family planning clinic shut down in Dodge City. The number of Kansans who received Title X services fell from 38,461 in 2011 to 24,047 in 2015 — a decrease of more than 37 percent, according to HHS.
Other Republican-led states have passed similar restrictions, including Arkansas, Arizona, Florida, Indiana, New Hampshire, North Carolina, Ohio, Oklahoma, Tennessee, Texas, Utah and Wisconsin.
If states don't scrap their restrictions, they stand to lose all their Title X funding. For 2015, that ranged from $785,000 in New Hampshire to $13.67 million in Texas, according to figures compiled by the National Family Planning & Reproduction Health Foundation. HHS said the Texas State Department of Health did not receive a 2016 Title X grant, while Kansas received $2.52 million that year.
Abortion opponents, who have tried various ways of trying to defund Planned Parenthood because it provides abortions at some of its clinics, are outraged by the proposed Title X rule change.
"This is intended to undermine the state authority in Kansas — to undo tiering — and is intended to be a gift for Planned Parenthood," said Kathy Ostrowski, legislative director for the anti-abortion group Kansans for Life.