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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 http://opa.osophs.dhhs.gov/titlex/ofp.html (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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