President-elect Donald Trump's first administration barred them from receiving federal Title X grants, but Planned Parenthood clinics have been able to rejoin the program under President Joe Biden.

Keeping a promise he made in 2020 to restore Planned Parenthood's federal funding, Biden issued a final rule that overturned Trump's directive in October 2021. Since then, hundreds of Planned Parenthood clinics that left the network have rejoined.

Title X grants provide federal dollars for family planning services to clinics that serve low-income and uninsured people. These services include contraception; pregnancy tests and counseling; sexually-transmitted infection and cancer screenings; and some infertility care.

Organizations receiving these grants cannot use the money to pay for abortion services because of the Hyde Amendment, a 1977 federal provision prohibiting the use of federal money for abortions except in cases of rape, incest or threats to the pregnant woman's life. But in 2019, the Trump administration issued a rule that barred clinics from receiving the money if they provided abortion referrals, or were on the same property as an abortion provider.

The rule spurred almost a third of the participants to withdraw from the Title X network, including more than 400 Planned Parenthood clinics and about 900 other clinics according to health news organization KFF. Now, more clinics are participating in the program than did before Trump's rule, KFF found. 

Of the roughly 400 Planned Parenthood sites that left the program, 286, or about 70% have rejoined as of 2023. More than 800 clinics in total that left have rejoined the network, and more than 700 new clinics have been added.

The Biden administration rule, which took effect Nov. 8, 2021, returned the program mostly to its pre-Trump administration condition. Clinics that receive Title X grants can provide abortion counseling and referrals, or can have abortion services on the same property.

The new rule also reversed the 2019 rule requiring pregnant patients to be referred for prenatal services, whether they wanted the services or not. Because of Biden's move, pregnancy counseling must again be nondirective, meaning patients decide their path forward undirected by providers. If the patients choose, the path can include abortion referral.

The Biden rule also added that telehealth be permitted for family planning services.

In fiscal year 2022, the U.S. Department of Health and Human Services disbursed $256 million in Title X grants, including $16 million to Planned Parenthood regional groups.

The agency awarded more than $263 million in Title X funds in fiscal year 2023, with about $15.5 million going to Planned Parenthood groups, and $261 million in fiscal year 2024, with $21 million to Planned Parenthood groups.

Planned Parenthood also received other Title X grants through the Biden administration.

The administration, as part of the 2022 American Rescue Plan, gave $6.6 million to eight grantees, which included Planned Parenthood clinics, to address "dire family planning needs." This was part of a series of actions HHS took in response to S.B. 8, a Texas law banning abortions in the state after six weeks of pregnancy. HHS also awarded $16.3 million in supplemental funds to 31 grantees to enhance and expand telehealth infrastructure and capacity.

The incoming Trump administration will likely reverse Biden's changes, health policy experts said.

"This may likely be the reality that Planned Parenthood and other clinics will face with the changing of each administration," said Brittni Frederiksen, an associate director for Women's Health Policy at KFF who has focused on Title X.

Title X funding accounts for a small portion of the total funding clinics receive. A bigger source of funding comes from Medicaid, Frederiksen said.

In 2016, Trump campaigned on defunding Planned Parenthood. Vice President-elect JD Vance has said the incoming Trump administration will stand by that goal.

Nevertheless, Biden achieved his campaign promise of restoring federal funding to Planned Parenthood. At least 70% of the Planned Parenthood sites that left the program under Trump rejoined the network as of 2023.

We rate this Promise Kept.

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.

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.