The Title X Network is in Crisis

Title X, under the Public Health Services Act, allows for a family planning and reproductive health-based pool of funding that government agencies and nonprofits can apply for and use to support patients. Providers who receive Title X funding see all patients regardless of insurance status and income level. Clare Coleman, President and CEO of the National Family Planning and Reproductive Health Association (NFPRHA), sits down to talk with us about the recent and extremely harmful changes to Title X announced by the new administration.

At the beginning of April 2025, the government announced the withholding of 22 Title X awards. These awards, given consistently to projects who are years into their research, were rescinded with one day’s notice. On an annual basis, this impacts about $66 million in Title X funds-- about a quarter of all Title X grants. As of today, there are no Title X funded services in eight states, and 15 other states have lost either some or most of their Title X funding. About 842,000 people were served under these grants, and the number of health centers that are affected totals 865. These changes will impact access to care (particularly for young people and those with low incomes), affordability, and contraceptive choice.

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hi rePROs, how's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So y'all, it is, like, lovely ideal spring in DC and it's, like, have-windows-open-all-the-time weather and going out for walks and enjoying the low humidity and just perfect temperature weather. It never lasts for very long in DC. It always, like, immediately turns to unbearably humid and gross and don't-want-to-go-outside weather. But I am definitely enjoying this like short reprieve of really delightful spring weather, and I don't know if it was, like, the spring weather or what, it made me think of making zucchini bread which is something I couldn't tell you the last time I made it, like, it has been years and years. It just never occurs to me to make it. And so, I made some this weekend, and it was so good, but my brain immediately took me back to my Grandma Kind. And now, she's not actually my grandma—back in the day, before I remember it, she was my mom's secretary. And their grandchildren didn't live in the area. So, Ruth and Elmer, they had adopted me as their honorary grandchild. Since all of my grandparents were a little bit further away, they were close, but not right in town. So, Ruth and Elmer were very much my honorary grandparents. And I made this zucchini bread and just... it was just like this immediate memory of sitting at their kitchen table while grandma was cooking and having zucchini bread. I don't know. It's weird how your brain does that with foods and smells and things like that. Like I know... my grandma Wetter used to have a lot of, like, rose scented potpourri or soaps or lotions and stuff. And so, as soon as I smell that, like, I just immediately think of my grandma Wetter and being in their house. It's just wild that your brain does that and smells and foods and stuff are all connected to all of these memories. So, it was really nice. I hadn't thought about my Grandma and Grandpa Kind in a while. They've been gone for quite a long time. So, it was just a really nice memory to think of her. And now it just makes me think that I need to make zucchini bread a little more often in her honor. I have a couple things of hers that I make quite frequently, but that's one that has really fallen off my radar. I wonder if my mom has her recipe somewhere. Mom, if you're listening to this, send me Grandma Kind's recipe. I use the King Arthur one. I bet you she has a good one lying around somewhere in a recipe box that we might have. Anyway, with that, there's a little bit of bad news we need to talk about. Last week, the Supreme Court allowed the transgender military ban to go into effect. That's just absolutely devastating. It is still working through the court system, but they decided that it could go into effect while it is working through the court system. So, in just absolutely devastating news, it is going to be going into effect. And my heart goes out to trans service members who are just trying to serve their country and they are being demonized and being treated as dishonorable. That is unacceptable. And we need to just remember that trans rights are human rights, and we need to stand with the trans community right now in so many ways, as the administration continues to attack their rights on so many levels. So, I'm sure we'll be doing another episode soon with another slew of ways that the administration is going after transgender rights because it does really seem to be unending. Yeah, sorry y'all that's a little bit of a bummer to end the intro on but that's really something I've been thinking about recently is just how much this administration is going after the trans community. And it's really hurting my heart. Okay. Moving on to another area where they are attacking, we are going to talk about the administration's attacks on Title X that have been happening recently. And there could be no better person to talk to about what the administration is doing surrounding Title X than Clare Coleman, who is the executive director of NFPRHA, the National Family Planning and Reproductive Health Association. I'm so excited to have Clare on. We had her on way back in the day on the podcast, and I am so excited to have her on again to talk about Title X, to let you all know exactly what it is and get familiar with all of the providers and what they do, and then to talk about the ways that Title X is currently under attack. Okay, with that, let's go to my interview with Clare.

Jennie: Hi, Clare. Thank you so much for being here today.

Clare: Nice to be back, Jennie. Great to see you.

Jennie: I'm so excited to talk to you about all things related to Title X. Before we get started, though, would you like to take a second and introduce yourself and include your pronouns?

Clare: My name is Clare Coleman, she/her/hers. I am the President and CEO of the National Family Planning and Reproductive Health Association, often referred to as NFPRHA. The organization was founded in 1971 to represent providers and administrators of contraception and sexual health care all across the country. And today we represent upwards of 970 government agencies, private not-for-profits, and individuals working in contraception and sexual health care programs all across the country.

Jennie: I'm so excited to talk to you today about Title X. It has been way too long since we have talked. So, maybe before we get started into what is currently happening, let's just take a minute and talk about: what is Title X?

Clare: Title X refers to a section of federal law called the Public Health Services Act. And that's an umbrella law that includes a lot of really important federally funded programs, such as the Federal Community Health Center Program, also known as the Federally Qualified Health Center Program, Rural Health Care, Migrant Health Care, and Family Planning. Public Health Service Act programs are unique in that the government offers significant federal subsidy to underwrite care but also underwrite infrastructure. So, Public Health Service Act programs are not like an insurance program, even Medicaid insurance or commercial insurance. It's a program of subsidy. So, in the Title X Family Planning Program under the Public Health Services Act, government agencies and private not-for-profits can apply in a competition to get a certain share of the federal Title X funds. And when they apply, they apply with a detailed work plan about the area of the country they intend to serve down to how many people they think they'll be able to see in a year. They'll talk about the number and range of contraceptive methods that will be offered. They'll talk about the education programs that they'll offer both inside health centers and out in the community. And they'll also detail how they'll use funds to support everything that makes a health center system run. So, you can use Title X to subsidize clinician salaries and benefits. You can use Title X to pay rent and utilities. You can use Title X funds to develop educational materials and have them reviewed by folks who are living in your community. So again, the Title X program is invisible in a lot of ways, right? If you walk into Unity Healthcare here, or in D.C., there's not going to be a Title X label on the door or in the exam rooms, but it essentially is a pool of funding that is used to open those doors every day. Most of the money goes directly to patient health care, but as I mentioned, there are all these other things that can be supported under a Title X grant that the government approves.

Jennie: That's so important, one that it covers both services, but also the buildings and the providers, because that is a huge expense. So, making sure that those programs can keep running and put as much of the funding as they can towards patients, it seems like a really great way to ensure as many people as possible are getting access to these services.

Clare: I think the government understood in the Public Health Services Act that if you want services in medically underserved communities, in places in the country that are either underserved or population sparse, population dense—it works both ways—you need to give some support to just the costs of doing business in those areas of the country. You know, lots of local health departments participate in Title X. As I mentioned, all the other providers are private not-for-profits. So, a lot of them are working on very, very thin margins. They are serving very low-income people. And under the Public Health Service Act, we have to see everybody. So, you can't ask people if they can pay their bill. You know, those of us with the privilege of commercial insurance may have had the experience of calling a clinical office to make an appointment, and the first question they ask you, even before they ask you your name, is they ask you what insurance that you have. Because that can end a conversation in a doctor's office if you don't have the right insurance. Under the Public Health Service Act, Title X providers don't ask that question. They have to see everybody, regardless of their ability to pay, regardless of where they live, regardless of any other factor. They come through the door. We have to see them and serve them.

Jennie: Man, I feel that hard. I was in grad school and for a short time worked at an OBGYN's office and was in reception. And yes, that was absolutely the first question that I was required to ask. And then also thinking of who these programs target, like growing up in a rural area, there weren't a lot of options for where I could go to get care. Luckily, I didn't live too far from a city where I could go get care. But thinking of a lot of people who lived a lot more rural than I did, that can be a real problem, getting access to quality healthcare.

Clare: Yeah, having access points where people are living is incredibly important. Now, in many cases, those sites might not be open five days a week, right? They might have more limited hours, but to give people a place to go where they're not traveling far is a really important thing. Now, there are lots of towns in this country where there isn't a grocery store. So, people are traveling all the time, but they may not have access to public transportation, ready ability to get a ride. So, keeping the services as local as possible is one of the real benefits of Title X funding being in every state.

Jennie: Okay, so now that we know how amazing Title X is, and I've been lucky enough to meet lots of providers by attending your conferences and so can talk about how wonderful the provider community is. I also know the flip side that there have been a lot of threats to Title X recently. I mean, the most recent one was when I was at your conference and the new administration announced some changes. Can you talk a little bit about what is happening right now?

Clare: So, our Title X network is in crisis at this moment, and we are 38 days in to an extraordinary situation. On April 1st, which is the beginning of the Title X year— new federal spending arrives every year on the 1st of April—the day before, March 31st, the government announced that it was going to withhold 22 Title X awards. These awards were made competitively through a very clear and articulated process back in the spring of 2022. And so, these grants and the organizations that run these grants were about to start year four. So, well-established in their project period working to improve. And they were notified the day before that they would not get their year four awards. This impacts on an annual basis about $66 million in Title X funds. That is about a quarter of all Title X grants. There are 16 agencies that hold those 22 grants because you can have more than one Title X grant. All of the agencies are private not-for-profits. Nine of them are Planned Parenthood affiliates. The other seven are members of the Family Planning Councils of America. So, as of today, there are no Title X funded services in eight states. And in another 15 states, the states have lost either most of their Title X or some of their Title X. We estimate that under these grants in the last year for which there are data, about 840 42,000 people were served and the number of health centers that are affected is about 865. So, it's having an immediate negative impact. The grantees that were affected, as I said, had less than a business day of notice. about the government's decision to withhold these dollars. Nothing like this has ever happened before. It's, as I mentioned, unprecedented and it's incredibly reckless.

Jennie: Yeah, I can't imagine, like, you were expecting the money for the grant that you have already signed and are in year four of to arrive the next day and then to find out you're not getting it. There's no ability to have tried for other funding or any number of things. It's just all of a sudden you don't have the money to serve this community who relies on you.

Clare: I really can't say enough about the staff and the leaders in these affected agencies. Many of them were on site with NFPRHA at our national conference when they received these notices. The just remarkable composure and focus that they showed under extraordinary pressure. You know, all of these folks have staffs. They have volunteer boards. They have a network of health providers that they sub grant funds to in order to get services out into that network in the community. They had so much thinking to do and so much communicating. And the, you know, just emotional weight of sharing this kind of devastating news, you know, continue to be knocked out by these leaders. It's a tragedy that they're put in this situation. And I think they're doing their very, very best to make the next right decision at a very complicated time.

Jennie: Yeah, this makes me think of, you know, I work on the global side, so we often see some of these same things playing out around like the global gag rule. And, you know, I think so many people think that the money stops but restarts at another time and everything's fine. All the services are back, all the people come back, and that's not really... how this works. If patients go to a provider and the provider can't help them, the patient may not come back, even if the funding comes back, because some of that trust is broken that that's a service that's a provider they can rely on. So, it has such broader impacts than just that immediate impact of not being able to access the service.

Clare: Absolutely. I mean, you might be in a situation where you come into a health center where you've gotten free care or subsidized care in the past, and now there might be a minimum fee. You might have to cover the entire cost of your services. That's prohibitive for many, many, many of the folks who seek care in Title X funded settings. That's why they come to those settings. They know they can get good quality care, a provider they can trust, someone who's going to meet them where they are, address their needs and their values, and they're gonna do it in a way that doesn't make cost a prohibitive factor. But these agencies cannot sustain operating like that without federal support. And as I said, we're in day 38 of this emergency. Some of the agencies have shared that staff has begun to be furloughed. We have some health center closures that have been announced. I think we're just seeing the beginning of what I think will be a catastrophic impact on access. Healthcare in general is not terribly elastic, meaning when you close down an access point, it's very, very difficult to reopen it again. Staff find other roles; they may move out of sexual and reproductive health because it's not a steady place to be. There's a huge healthcare shortage in almost all of the countries. So, these providers are very heavily recruited and sought after. So, if you lose your staff and you close that access point, it's not gonna reopen. And Jennie, I wanna say, that's not a hypothetical to me. Before I came to NFPRHA, I ran a Title X funded health agency in my home state of New York, where we saw roughly 35,000 people a year in 13 health centers. And in my time in the job, and I wasn't there all that long, we closed four health centers, we laid off three rounds of staff. And I will never forget sitting across from somebody- I laid them off from a good job and with benefits, and they had to go get two jobs to make up for what they had lost in our organization. The impact here, not only on patient access, but on the communities, it is so devastating. I mean, the folks who work in these health centers and these grantee organizations—these are their hometowns. They grew up in these places. They're absolutely committed to serving people in their home states, in their communities. They may have come through as patients or educators in the systems as well. So, there's such a fierce commitment to keeping care local, keeping it high quality, keeping it trusted. This is such a violation of all the things that folks who work in these systems have built over many, many years.

Jennie: I think it's also really important to make the connections, right? This isn't happening in a silo. We are also hearing about proposed massive cuts to Medicaid, which will also further restrict people's ability to access broader healthcare, but also family planning services. And you're also seeing all of the attacks on abortion care. So, people may not then be able to get family planning services, that they were getting a Title X clinic. They may have an unintended pregnancy. Abortion could be banned in their state. All of these things are interacting and putting pressure on people's lives and the decisions they're able to make.

Clare: Absolutely. And another thing to add to that is the government's now proposing significant cuts in STI screening and treatment. So, the follow-on impacts on sexual and reproductive health, on women's health, on LGBTQ health, on transgender people's health, on adolescent health. I mean, the impacts are incredible. You mentioned Medicaid, and I'd love to stay there for a moment because the cuts that are being debated in Congress right now are absolutely catastrophic. You know, 70 million Americans rely on the Medicaid program. It's grown substantially in the last decade and a half. And it has been, since the 80s, the largest payer of family planning care in the country. And on average, it's paying for about half the births in the United States. So, millions and millions of people of reproductive health age rely on Medicaid for their health insurance. And those health centers have a very big Medicaid population they are serving. Again, just referring to my own experience when my time in New York, about 30% of our patients had Medicaid coverage. 50% of our patients had no insurance at all. So, they were on a sliding fee scale or getting free care subsidized by Title X. And then just about 20% of our folks had insurance. So, if you think about the situation that some of these affected grantees are in right now, if you lose your Title X money and Congress moves ahead with these massive Medicaid cuts and the president signs them into law, you can't stay in business. There is no business plan. There is no contingency. There's cash on hand. There's cash in the bank. And when you're out of cash, you're done. And that is why I'm so, so concerned about closure, about losing access points in the country. Because what we'll see, I think very quickly, is something like what we're seeing for folks seeking abortion care. So, contraception will technically be legal, but it will not be available. And you know you'll see people, in my judgement, doing one of two things. The first is they're going to slide down the ladder of contraceptive preference. There are methods that work for people in different points of their lives. That tends to change. Sometimes the more effective methods are the most expensive methods, and they can only be accessed in a health care setting. So, if you don’t have a place to go or a provider to rely on, or they’re there but you can’t pay the fees, then you're gonna slide down to the cheaper methods, right? And again, those methods may be quite effective for you with good consistent use, but that may not work as well. So, people aren't actually getting what they need, what works best for them. So, I think that's one thing that will happen. The other thing that I think is very likely, and this seems incredible, just three years after the Dobbs decision leaked, I think people are going to start traveling for contraception. And the idea that that's where we are in the United States in 2025, that people are going to cross state lines to access contraceptive care. We always said that it wasn't going to end with criminalizing and banning abortion. I think a lot of folks didn't think it would move this quickly. And I think we are facing a very rapid collapse in access to all sexual and reproductive health care, contraceptive care, STI care, and it's incredibly scary.

Jennie: Yeah, it makes me think of what we've talked about in other scenarios of like when they like worries about requiring mifepristone in person where we talk about like there is just not the ability to absorb that and ensure that people are getting the care if they have to travel in person to access care. Now if we add in having to travel for contraception to that, there's no way the system can support that at this time. And I think the other point I really always try to make is a lot of people, you may think that Medicaid is not your fight, like, that you don't get Medicaid, you're not on Medicaid, but it is paying for so many things that are important to you. Just to give an example, not to give too many details, but my mom is the chair of the board of the only public hospital in Southern Wisconsin. I know it is shocking the conversations they are having if they lose the majority of their Medicaid funding. Hospitals near you may close because of losses of Medicaid. And so, you may not be on Medicaid, but the health services you are relying on... they may have to cut providers. They may have to close a hospital. This is everybody's fight because it is going to impact how everybody is accessing healthcare.

Clare: Yeah, the federal investment in healthcare leads to access, right? If you want a local hospital, if you want a hospital with an emergency department, if you want to be able to deliver locally instead of having to drive three hours to the nearest maternity hospital, you need the public money coming in. The way we do healthcare financing in America is a mess. It's a mess. But when you pull on one string, you unravel the whole system because all the sources of financing are interdependent and very complex, but interdependent. So, when you pull out one source of financing, there's, you know, the stool tips over right away. And I think you're so right to encourage people to think about not just their individual insurance status but think about the infrastructure of health resources that are available to them. And, you know, none of us know when we might need emergency care, something urgent comes up. And that's why you need this network of, you know, local providers, community-based organizations, hospitals, right? That there's a reasonable This is a nested community. And what they're, you know, what they're considering in Congress is just catastrophic.

Jennie: Okay, so I'm sure you can't talk details, but what are you all doing to push back on what the administration is doing?

Clare: So, we've been pushing along on three tracks, I would say. The first for me is showing up in every way we can for these affected grantees. I want to say flatly that there's nothing that these grantees did that was inappropriate or out of compliance with Title X statute regulations and program guidance. They are not different from other grantees. There's really no rhyme or reason to why these 16 organizations and these particular grants. I think it's really important to underscore that. We have been working with them as a group and one-on-one because they're all in really different circumstances. They're all in an emergency because they can't access federal funds. But the initial step that they each had to take was when the government suspended and withheld their year four payment, they also demanded a significant amount of information. There were 10 or 11 elements that each agency was asked to respond to the government on. And they were only given 10 calendar days to respond to that. And not only did they have to respond to the government's requests, for their own organization, but they had to respond for their entire subrecipient network. So, many of these organizations run health centers themselves. They are direct service providers, but they also give money to a number of community partners to make a broader network have more access points. They had to go to each one of those agencies and say, the government's asking us for this information. Will you give us this information? You know, most notably, one of the affected grantees is the Title X grantee for the state of California. They have upwards of like 300 service sites. Like, they have dozens and dozens and dozens of subrecipients. So, this was an almost impossible job. Any request to the government for more time or more clarification was rejected flatly. So, the initial thing these affected grantees had to do was respond. So, and then I would say we're in the second stage now, and I would call this communication and fundraising. That's where the focus is. So, as I mentioned, these are all community-based organizations with volunteer boards and community support, big staffs, and then, you know, these tentacles out into the community of subrecipient agencies and then the local health center sites. Everybody's got to hear this story, right? They've got to understand what the government has done, the degree of uncertainty and ambiguity and threat that this conveys. And that's the job of the grantee to be sharing that information and trying to set some expectation for this network about what's gonna happen. Unfortunately, none of these grantees have heard a single thing from the federal government. Again, we're on day 38 of this crisis. There has been no reach back out to these grantees about the material that they submitted. They don't know who's doing this investigation. They don't know the timeline for this investigation. They don't know if there's a way to pass this investigation, right? So, having to tell people that you have no information for them, there's no end in sight, and then expect them to continue to provide care is just a really, really difficult, sensitive situation to find yourself in. So, lots of time spent on communication. And then equally so: fundraising, looking for community support, government support, if it's feasible. And a lot of these agencies are in states where government money is not gonna be made available to them. If you're in Missouri or you're in Montana or you're in Mississippi or you're working in Tennessee, the government is not likely to step in and provide family planning support, even in strongly supportive environments. State budgets are in very serious crisis right now. Lots of states running, you know, looking at big deficits. They have to run at even. They have to balance. Unlike the federal government, state governments can't run at a deficit. So, coming in at this stage in state budget cycles, typically state budget cycles are for July 1. Come in April and say, for example, in Missouri, we lost the equivalent of more than $8 million in Title X support. Missouri's not going to consider something like that. But even again, a strongly supportive policy environment, that's a very tall order to go in and say we're looking for one-to-one replacement dollars or our access points are going to close. So that's point one. Support these affected grantees. answer their questions, show up for them. The second thing we did is we sued the federal government. So, on April 27th, we filed a lawsuit in federal court because the government has violated the law in these withholdings. There is a process that the government has very clearly mapped out in statute and in regulation for bringing entities that are out of compliance with federal law into compliance. There are a series of steps that have to be taken including notifying the grantee, giving them a chance to correct any compliance issues voluntarily. There's a notice period, et cetera. The government didn't do any of those things. They said they had a suspicion and an allegation, and they withheld the money. That's against the law. You've got to make a finding of a violation. Finding. You have to come to a conclusion. And then, as I said, you've got to give that grantee an opportunity to respond and cure before you can move to withhold money or terminate grants. Government didn't do that in any of these cases. So, we are pending in the federal system. I do want to say that unlike a lot of lawsuits that have been filed in the past and have been filed in the early days of this administration, we are not seeking emergency relief. And that is because in early April, the Supreme Court came down with a ruling case related to education, Department of Education grant making, where they allowed the government to terminate grants while the litigation was going forward. And in the ruling that was issued, it became clear that if we were to seek emergency relief, meaning force the government to put these Title X funds out to the affected grantee organizations, if at a later stage in the litigation, we were to fail, lose at any later stage in the litigation, the grantee organizations would be responsible for paying the government back millions of dollars of grants. So again, let's be clear. Title X grants primarily go to provide healthcare to poor and low-income people. There's no way that those grantees could collectively be responsible for $66 million in repayment to the government. It was just too big a risk to those affected agencies for us to take such a step. So, what we did is we're filing on the violation of the law. We've said, you've done this wrong. You violated federal statutes and regulations. There's a process that is clear and the government didn't take any of the steps in the process before they withheld these funds. It's possible that we won't have any movement in that case until the latter part of June. So again, that's really tough on these affected grantees. They are trying to move their way through a very complicated series of decisions. And I do expect layoffs, and I do expect closure. So, the last part of what we're working on is telling the story. You know, as I said, when you walk into a Title X funded health center, there's no label on the door. So, there's lots of folks who are getting access to care, subsidized care in a Title X funded health center. They have no idea. It's a really complex network. It looks different in every state. The grantee networks are different in every state. So sometimes when people ask me to talk about Title X, I'll ask them to pick a couple of states so I can be as specific as possible about how care is organized and delivered in that certain state. But this is the story that needs to be told. And there's been a lot of interest. I'm thrilled to say folks seem to really understand the immediacy of this impact that you can't just turn off federal funding and these agencies survive. Clearly, the federal government doesn't care. But our folks remain absolutely unified and committed. They're going to offer as much quality care as they can. They're going to keep open as many health centers as they can. And we're going to try to stay in this fight. So, one of the things I've been thinking about as we've been talking that we haven't maybe highlighted as much is the role that Title X plays in ensuring young people have access to affordable contraception and the way that is also currently under attack.

Clare: Yeah, Title X is just a lifeline for adolescent health under the Public Health Service Act program and under the Title X statute. As I said, we serve everyone, and we have to serve everyone with confidentiality. Our health centers do need to adhere to state law, and our job is to be there to meet the needs and the values of everybody who comes through the door. So, adolescents seeking education and seeking clinical care are going to have confidential access to care in the Title X system. That's really the gold standard for confidentiality across federal health programs, and it is incredibly important. One of the big setbacks in the last couple of years has been a successful effort, at least in Texas, to undo that protection. Right now, in Texas, adolescents seeking healthcare in Title X funded systems do not have confidentiality, but that is an aberration, and we believe it is a misreading by courts of the federal requirements. So, protecting confidentiality for everyone is absolutely essential. I've said many times before that intimate relationships don't automatically get safe when a legal adult. So, every single person coming into a health center deserves confidentiality. It may be more or less important to you on any given visit. There may be certain services that you think are sensitive or certain tests that you think are sensitive, but it's up to you to tell us what you need, what you value, and what you hold dear. And it's our health center's responsibility to make sure that you're protected. And that's another core value, I think, of the Title X program. It's a commitment that our workforce has shared for 54 years.

Jennie: Yeah, it just seemed like one of those really important things to pull out because we have seen young people be the opening wedge to broader attacks. We saw that with abortion. We're seeing it now with, I'm sure, gender-affirming care. And I'm sure this is just the beginning of the broader assault on Title X as well.

Clare: Yeah, I think it's so important to think about: what does it mean to be able to [inaudible] from an adolescent and meet their needs? You know, most kids are gonna engage a trusted adult. And typically, it's really a matter of timing, right? They wanna choose which. So, if they're in a two-parent situation, there might be a parent they feel more comfortable having the conversation with initially, and they wanna choose when. So, you know, this is not a situation where for younger people don't have a trusted adult, whether they are a parent or another caregiver or a loved one who is there to talk it out with. There are some kids that are not in that situation, and they have a lot of reason to fear. And we know that mandating parental or caregiver involvement drives adolescents away from services that they need. That's not good for their health. That's not good for their wellbeing. So, what we need to do is take the barriers away and let people just get the care that they need from the providers that they trust whenever they need that care. There is another aspect to this story, which is: the government also made two awards to Oklahoma and Tennessee. And those are the states that were terminated from the program because they wouldn't counsel and refer for abortion. And that's an under-told piece of the story. I have been trying to get that word out too. I do want to say that both of those state health departments are members of NFPRHA, but I think even they are bewildered by the government sending them awards they didn't apply for. And in fact... some really fascinating stuff going on... so both of these states were terminated from Title X in 2023, after a long back and forth with the Biden administration. They both have state abortion bans, and they were saying because of their state abortion bans, they could not counsel or refer for abortion. And obviously, we have a constitution with a supremacy clause that says federal law trumps state law, so they were defying the program. And so, they were terminated. Both health departments sued the federal government. Both health departments so far in their litigation have been unsuccessful. One of those cases has been appealed to the Supreme Court, and the Supreme Court has not yet decided if they will take that case. And the other one is in the circuit courts. They have a request for a full court review. But they've lost at the district stage, and they've lost at least initially at the circuit stage. So suddenly, on the 1st of April, both Oklahoma and Tennessee got Title X awards. That's illegal. They did not apply. The government has said they are being restored. That's not a thing. The grant letters also said that it was pursuant to a settlement, but there haven't been settlements in either of these cases. And so, both Oklahoma and Tennessee have filed papers in their respective lawsuits being like, we got this money. We don't really know what it means. Are they going to let us not counsel and refer? Like, nobody will tell. So, it's a really crazy situation. And yeah, so that's something we're watching pretty closely too. Are they going to get away with this? Right. Because if Oklahoma and Tennessee are coming back to the program, we assume they won't actually take the money unless they don't have to counsel or refer. That's a violation of the current regulation, which the Trump administration has not moved to change yet. So, this is one of these situations that I think we'd be getting a lot more attention if all the other terrible stuff wasn't happening. But there's so much terrible stuff going on that this is kind of sliding under the radar.

Jennie: Clare, I always love talking to you and I can talk to you for a really long time, but maybe we should wrap it up with what I always love to end with. And that is: what can our audience do? How can our audience get involved in this fight?

Clare: Well, I'd love to refer you to our NFPRHA website because we have a landing page where you can go and look at all this information about the affected grantees. And that landing site includes information about each of the agencies all across the country that are impacted. And there are agencies in every part of the country now that are going without Title X funds. We have links to pages if people want to donate, support one or more of these excellent agencies. You can see statements from all the agencies also on our website. And so, I want to say, you know, we need to center people who are most affected. These are the folks who are most affected today. I also want to say that the risk to Title X looming is terrifying. The president last week released an initial budget proposal that eliminated Title X entirely, proposes eliminating all the money and the office and the federal staff that support the Title X program. Congress is going to begin the process relatively soon of working through what is fiscal year 26 federal appropriations. It's their role to decide what money is spent in what basket. Title X has not had a funding increase in 11 cycles but now they're proposing just zeroing out the program entirely. that will have a massive impact on access to care. So, folks who are ready to raise their voice, whether it's directly with congressional offices or in their community and networks or on social media, telling this story, we just need access to contraceptive care. The government should step out of the way. A lot of these folks doing this work in community have been doing it for their entire careers. They're good at what they do. They deliver excellent care. They care deeply about the people that they're serving in their communities, and they just want to be able to do their good work. So, that would land me in one last spot, which is if you can find out where your Title X agency is, and you can do that by Googling, drop them a note, send an email to the info line. Stop by and push a thank you card through the front door. These folks do not always get a lot of attention. They're not always on the news, but what they're doing in the community is really valuable. So, if you've had a good experience at a family planning center in the past, or you're a patient now, let them know that you're aware of what's going on, you support them and their work, and that you're going to be there for them in the community. I can't tell you what it would mean to folks around the country if they started to hear from folks saying, hey, we know this is happening and we think it's wrong and we support you and we support access to contraception and you're our neighbors and we're going to be there for you. I think it would just mean the world to the folks working in this care.

Jennie: Yeah, I always appreciate doing the little acts of kindness for all the providers. Just a flag for anybody who's thinking about doing that. Don't send anything that's like a package unless they know you're expecting it. Just for safety reasons, they would be concerned if they were getting in a random package. So, just that's one little flag. But like, letters and postcards and all that stuff is greatly appreciated. Clare, thank you so much for being here. As always, it was such a pleasure to talk to you.

Clare: I appreciate so much the work you do in the world, Jennie, and how you lift up so many voices. And thank you for giving us a chance to tell this really important story.

Jennie: Hopefully we'll have you come back with some good news at some point in the near future. We're going to fight. We'll fight and we'll fight. Thank you. Okay, y'all, I had a great time talking to Clare about all things related to Title X. As always, I learned some things that I didn't know about while we were talking, and I always learn so much from Clare, so I'm so grateful for her for being on. So, thank you, Clare, and we will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!