The U.S. Department of Health and Human Services (HHS) shortened the funding period for the latest round of Title X family planning grants to just seven months, rather than the usual three-year cycle. The move has concerned reproductive health advocates, who said it could indicate that the Trump administration is rushing to implement its proposed anti-choice domestic gag rule.
Title X grantees typically go through the application process and compete for funding every three years. This time, however, grants have only been awarded to fund providers from September 1 of this year until the end of March 2019.
Sen. Patty Murray (D-WA), ranking member of the U.S. Senate Health, Education, Labor, and Pensions Committee, called the move “a gimmick, plain and simple” in a statement. “It’s all about moving as quickly as possible to undermine health care access for millions of people and to gag providers from discussing the full range of reproductive care options with patients.”
The move comes as the administration’s proposed Title X domestic gag rule, which could be finalized at some point this later month, looms. The rule would limit patients’ access to medically accurate family planning information and ban abortion providers from the Title X program. A September rollout for the new rule would dovetail with providers needing to restart the entire grant application process in November in order to have no gap in funding after April, when the current grants expire.
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An HHS spokesperson appeared to confirm that timing for Rewire.News: “We plan a new competition for any funds appropriated for FY2019. Since [the Office of Population Affairs] wishes to compete all Title X grants in the middle of the fiscal year, the fall release of the new funding announcement will enable it to do so.”
Despite the fact that the most recent solicitation for grant proposals called for details on funding for a full calendar year, an HHS spokesperson told Rewire.News that the decision to shorten the award period by several months was a matter of budgetary timing. “Several months’ worth of FY2018 funds were used to extend FY2017 projects, which left remaining funds for approximately 7 months to provide the same level of service in these new awards,” said the spokesperson in an email, before noting that the agency has the right to make shorter grant awards if they wished. “As noted in the Funding Opportunity Announcement: We are not obligated to make any Federal award as a result of this announcement. If awards are made, they may be issued for project periods shorter than indicated.”
However, according to Audrey Sandusky, director of advocacy and communications for National Family Planning and Reproductive Health Association, it’s not unusual for HHS to dig into funds for multiple fiscal years to provide the needed funding levels. “Because Title X funding isn’t tied to federal fiscal years (funding crosses over fiscal years), it’s quite typical that HHS has to ‘rely on’ future fiscal year funding to continue to fund programs,” she said in an email to Rewire.News, explaining that even though this is fairly usual, it hasn’t recently been used as a justification for changing the length of time that the grants fund. “I’d say it is certainly not customary to shorten for that reason.”
Without funding certainty, the sudden change in course has a real-world effect on the financial and operational planning for Title X providers who depend on the grants.
“In a competitive grant application, entities must prove they are best suited to meet the unique health needs of their communities and are poised to adhere to the strict quality standards Title X requires. It is a time and labor-intensive process that places an undue administrative burden on the network,” said Sandusky, who suggested HHS’ decision as an attempt to undermine providers. “To tax the network with effort semi-annually, rather than follow a customary three-year cycle, makes no sense. It should be viewed as an attempt to compromise the network and detract from providers’ daily work of ensuring high-quality family planning care to those in need.”
Providers say the Trump administration is undermining much-needed care for the people who need it most. “Each action taken by this administration not only undermines access to birth control but is having real-world effect and blocking access to health care to our most vulnerable people,” said Amanda Skinner, president and CEO of Planned Parenthood of Southern New England, a Title X provider servicing 75,000 patients in Connecticut and Rhode Island.
Joseph Wendelken, public information officer for the Rhode Island Department of Health—which recently received a notification that it would receive Title X funding—told Rewire.News that “shortened grant cycles could affect the accessibility of the comprehensive, high-quality, affordable, and confidential family planning services that are provided in Rhode Island. These services include a broad range of contraceptive methods, reproductive health counseling and education, pregnancy testing, preconception care, HIV/STI testing and referral services, as well as related preventive services.”
According to Wendelken, “Within the past year, the Title X project periods have already changed more than once, and with limited notice. Both the Rhode Island Department of Health and the community partners we work with are affected by the administrative burden of sudden, unanticipated changes to the Title X project cycle. These changes could impact the continuity of services with potential lapses in the availability of family planning services, as well as the ability to plan for long-term and ongoing project activities, including training, monitoring, and evaluation.”