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Federal Government

Low-Income Women's Access to Family Planning

Title X of the Public Health Service Act provides federal grant money to family-planning clinics that provide comprehensive reproductive-health services to low-income women, uninsured women, and women who fail to qualify for Medicaid.  For many women, Title X clinics provide the only basic health care that they receive.

Each year, approximately 5 million young and low-income women and men receive basic health care through the 4,500 clinics nationwide receiving Title X funds.  Grants are administrated through state health departments or regional umbrella agencies which subcontract to local agencies.

Besides providing contraceptive methods, counseling, and education, family-planning clinics offer many other reproductive-health services.  They provide screening for breast cancer, cervical cancer, and sexually transmitted diseases; Pap tests; breast and pelvic exams; hypertension and blood-pressure measurement; as well as prenatal, postpartum and well-baby care.

The Title X program also sponsors continuing-education programs for family-planning clinicians each year. In addition, the program maintains a clearinghouse for information and educational materials on family planning and reproductive health, and supports a research program which focuses on family-planning service delivery improvements.   Office of Population Affairs (OPA), U.S. Department of Health and Human Services (HHS), Office of Family Planning, at (last visited June 17, 2011).

Women with incomes at or below the poverty level receive fully subsidized services; women with incomes between 100-250 percent of the poverty level are charged on a sliding scale; and women with incomes over 250 percent of poverty must be charged full fees.  AGI, Issues in Brief:  Title X ad the U.S. Family Planning Effort, at 2 & 4; see also 45 Fed. Reg. 108 (1980) (codified at 42 C.F.R. § 59.5(7), (8), § 59.2).

Moreover, under the Affordable Care Act (ACA), states, at their own option, may extend Medicaid family-planning coverage to more women through a State Plan Amendment (SPA). A SPA, which does not require prior federal approval, allows states to improve access to family-planning care by amending their state Medicaid plans to create a new eligibility group of low-income individuals.  As a result, women who otherwise would not qualify for the Medicaid program are eligible for Medicaid family-planning services. P.L. 111-148, 111th Cong. (2010) § 2303.  States may also apply for and obtain waivers from the federal government to expand eligibility for Medicaid-funded family-planning care. 42 U.S.C. 1315.

Additionally, the ACA, through a provision known as the Women's Health Amendment, requires all newly issued insurance plans to cover women's family-planning care, including all Food and Drug Administration-approved contraceptive methods, without copayments or deductibles.  This recently adopted policy eliminates financial barriers to contraception for insured low- and middle-income women. 45 CFR Part 147.

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