Title X Health Centers Share the Impacts of Withheld Funds - Part 1

 

In April 2025, some organizations and health centers receiving Title X funding were given sudden notice by the current administration that critical funding would be withheld. This action by the federal government threatens roughly $65.8 million in Title X funds and implicates an estimated 846,000 patients. It has resulted in massive layoffs, stopped contracts, mental strain, and confusion for both employees and patients. As patients are not receiving the care they need due to a stop in funding, possible results could include rising rates of unintended pregnancies, rising rates of STIs, poorer maternal health outcomes, and later diagnoses of breast and cervical cancers.

 We sit down with co-founders and executive directors of some of these impacted organizations, including:

Michelle Trupiano, Executive Director for the Missouri Family Health Council, and

Danielle Lampton, and Jamie Bardwell, Co-Founder and Co-Executive Directors at Converge in Jackson, Mississippi.

Links from this episode

NFPRHA
NFPRHA on Facebook
NFPRHA on X
The Title X Network is in Crisis
Title X Freeze Widely Threatens Health Care Access

Take Action

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, I hope everybody is looking forward to having a long holiday weekend. I hope you have some fun plans. My fun plans are nothing, and I'm very much excited about it. This is one of those holidays where I stick really close to home with all the fireworks, and there are a lot of fireworks in my immediate neighborhood. It's really loud, and the poor kitties get really upset, so Luna tends to hide under my bed and just like in the far corner against the wall and there's like she's just real upset and Cinder sticks really close to me and wants to just be within a couple feet of me while they're all going off so I tend to stay home so I'm here for them because they do get pretty upset with all the fireworks. It's weird lots of other loud noises don't bother them but fireworks they really- they are not a fan. So yeah, I'm looking forward to having a pretty chill weekend. Might do some baking. We'll see. But mostly, I think it's going to be pretty quiet, which... I'm here for it. I'm excited because there is so much happening right now. We're not going to get into all of it because there are so many things happening, but I am recording this on Friday, June 27th, and there were six Supreme Court decisions handed down, not counting ones earlier in this week. So, there has been so much going on and there were so many bad rulings out of the Supreme Court. They're going to have really negative implications on people's lives that there is just a lot to talk about. And we'll have a wrap-up episode where we'll talk about some of the cases related to sexual and reproductive health. I'm in the process of scheduling that. It'll either be next week or the following week. So, there's just a lot of pieces moving. And like I said, there is so much to talk about. We already talked about Skrmetti. One of the other big ones that came down today when I'm recording it is the one around schools and LGBTQ books. And the Supreme Court said that schools have to allow parents to opt out of any information that conflicts with their religion. And the school district was pretty clear that these opt-out policies were not workable. So that means that kids are not going to be getting those inclusive books as much because the opt-out isn't workable to have to send those kids out and find something else for them to do during that time. So that just means that kids aren't going to be able to see books that represent their full lived experience. And that's pretty tragic. And there's been so much going on right now around banning books and it's always devastating because we should not be banning books. I know that seems like it should be just such a basic, simple statement, but it has really become... really been taking on steam the last several years. And you're seeing more and more of that, but I was definitely brought up with the, the read all the things, learn all you can. And as a big book person, I always make a point of reading banned books and celebrating banned books week. I usually read a banned book during that week. So, I don't know. This one struck close to home because, like I said, a big reader. The other big case that I think I'll take a moment to talk about and it relates to today's episode because it's kind of related is the Supreme Court decision that said that people don't have a right to a specific provider under Medicaid. So, this case was about basically trying to kick Planned Parenthood out of Medicaid in South Carolina. So yeah, so now the Supreme Court says that you're not entitled to a specific provider. And so, states are now free to kick Planned Parenthood out, which is what the big impetus of this case was. But I think it's just really important to note that it doesn't stop there. It's saying that you don't have the right to any specific provider. So, this could impact other sexual and reproductive health providers, not just Planned Parenthood, you know, access to gender-affirming care. I think there's going to be any kind of number of ways you can see this that is going to prevent people from accessing sexual and reproductive health. Not all providers accept Medicaid and Planned Parenthood [has] a really important role in ensuring that you were able to get affordable contraception and breast exams and STI treatment and any number of other things. And often, [for] people on Medicaid, that was like their one contact with the healthcare system and it came through Planned Parenthood. So, I just... it's going to have really big implications, and we'll talk about it when I do the Supreme Court wrap-up, but this is also one that we will do a deeper dive and do an episode just specifically focused on this and the implications around it. So, stay tuned. I'll be working on getting that out in the near future as well. But I said that's related to today's episode because there is another way that sexual and reproductive health providers have been attacked, and that is through Title X. I did an episode earlier this year talking about the ways the administration is attacking the Title X program. I'll drop a link in our show notes so that way you can refer back to what has been going on. We're not really going to talk about all of the things that have been happening in this episode.

Jennie: This episode, we're really lucky to have two Title X providers come on and tell their stories of what have been the implications of the administration withholding funding from them. So, I'm very excited to share that with you. We have three more providers that we'll be doing another episode with either next week or the following week. So I'm very excited to have you hear their stories and see what is happening. So, the two providers we have today, one is from Missouri and the other one is based in Mississippi. [music transition]

Michelle: So, my name's Michelle Trupiano. I am the Executive Director for Missouri Family Health Council. And since April 1st, when we received notice that the funds were going to be withheld, it has been very difficult for our organization and our health centers and the patients that we serve. Health centers have been navigating funding issues; they've been navigating concern from their patients about whether or not they can stay open. They've been navigating stress from their staff regarding whether or not staff are going to have to be laid off. And ultimately, patients are the ones who are going to be lost in all of this. And so, since April 1st, we've been working really hard to raise emergency funding to try to ensure that there's been no disruption in care. And since that time, we've been able to maintain all of our services, but we know that that time is not going to last much longer and that we are facing really difficult decisions in the upcoming months. Our network serves over 35,000 patients across the state from very small rural health centers to larger urban health centers. And we know everyone's going to be impacted, but especially those small rural health centers. That is where we are most concerned that those health centers rely heavily on those Title X funds. And without those Title X funds, it's going to be near impossible for those health centers to stay open. And for most of those patients, that health center is their only access point. And so, we know that the devastation is gonna be both immediate, but it's gonna have long-term consequences as a result of the crumbling of the public health infrastructure that is beginning to take place. And so, we're really concerned about maternal health outcomes in the future, about the rate and rise of STI rates, but just the fact that people may not have access to basic, we're talking basic family planning and health services is going to be really detrimental. And so, right now, our health centers are scrappy. They are committed, they are passionate, and that they are, you know, doing everything that they can to, again, not have any disruption in care. But we know that that cliff is, you know, just a few weeks away. And it is beyond disappointing that the federal government is using Title X and is using grantees as a political pawn. And that ultimately, again, it is patients that are going to be suffering. I mean, we've seen so much harm come upon the network and our patients over the last several years from abortion bans, from misinformation, that patients are already left really kind of confused and mistrustful of a healthcare system. And so, the fact that so many patients have a provider that they trust, that they know that they can go to for accurate information, that they know that they're going to be in a safe and accommodating space. And for that just to go away, and to not have anywhere else to go, is also just really, I mean detrimental to the psychological safety of our patients and again it's going to have just long-term impact and increase that mistrust and distrust of providers. We are still hopeful that the federal government will release their funds that we along with the other impacted grantees are all in compliance and have responded accordingly and while it has been 80-something days since the funds have been withheld, and we know that each day without funds is a day closer to health services being eliminated in our state, that the federal government will see that we are in compliance and that they will release those funds so that, again, services can continue without disruption and that we can continue to meet the needs of over 35,000 patients throughout the state.

Danielle: I'm Danielle Lampton, co-founder and co-executive director at Converge, based in Jackson, Mississippi.

Jamie: And I'm Jamie Bardwell, the other co-founder and co-director of Converge, also based in Jackson, Mississippi. I will never forget being on a plane headed to DC for the [National Family Planning & Reproductive Health Association] conference and getting a text that said, I'm hearing Converge is on the withheld grant list. And I remember sobbing on this plane and texting Danielle and you calling me immediately and having this like almost out of body experience. And that image is forever stuck in my brain when I think about this situation that we are in.

Danielle: And it's also, in a lot of ways, a good reminder that this withholding of funds has massive impacts for our communities, for policy in our states. It also has real impacts on the people who do this work, like us. So, I was not traveling to the NFPRHA conference because my father has a terminal illness, and I needed to be a bit closer. And so, we get this initial news. We're separated. Jamie's on a plane about to take off. You were on the tarmac. I am alone in our office. And I remember thinking something that I still think almost every day, which is, what can we even do? Because I think the first emotion is utter powerlessness and fear. We're terrified. I'm still terrified. I guess now we're over three months in. We at Converge had to lay off half of our staff. That was 10 people. Those are 10 people who gave up a lot to dedicate their time to quality reproductive care in the Deep South. So, we miss them. We had to stop contracts with our clinical partners, of course, which means that in short order, clinics had to start reducing hours, scaling back services, charging for care that otherwise was free or low cost. Those clinics are also experiencing the kind of mental strain that we at Converge are experiencing, and grantees all over the country, people, in the movement and in other movements are feeling that terrible pressure, the crushing sense of powerlessness. It's terrible and it's having I think lasting impacts all over our movement.

Jamie: You know, of course this is the anniversary this month of the Dobbs decision and there are so many parallels in Mississippi, especially around post-Dobbs and post the Title X freeze, because back when Dobbs happened, so many people in Mississippi already thought abortion was illegal anyway, because it's so confusing, this network of laws and, you know, the average person who needs this care cannot understand what is legal, where, when, and how. I mean, I think I barely had an understanding of this, and I do this all day long. And so, when the Title X funds were frozen, we had almost the same thing. It was like, okay, well, where could I go for contraception that's free or low cost? No one knows. You know, we're still considered a Title X grantee, but we have no money. So, what about these clinics that were receiving funding from us in March of this year, but come April, we can't give them any money? You know, we were all at a loss really as to how to explain this because there was no information coming from HHS. And the consequence again was this massive confusion. And when you have so much confusion, people just don't get the care that they need. And, again, that includes not getting birth control—which of course contraception is basic health care that people want—but it also means that patients are going to have to delay or even just forego preventive care because it won't be able to be offered at a discount because the only place open is too far away, wait times... a lot of health outcomes are going to suffer. We think there are going to be rising rates of STIs and increasing rates of STIs that are perfectly treatable that simply go without treatment. Unintended pregnancies, later stage diagnoses of breast and cervical cancers. Of course, later diagnosis often means a terrible outcome for women. So, I think there are going to be these sorts of measurable health outcome impacts, but to Jamie's point, there's also this terrible impact of chaos in a space where we're already working about as hard as we can to get reliable, consistent, medically accurate information to our neighbors. And now having this additional confusion means that it's even harder to help people know where they can get what to them is really simple, basic healthcare. And, you know, we... created an entire Title X network basically from scratch when we won this grant for the first time in 2022. I mean, prior to Converge winning the grant in 2022 for Title X, the Mississippi State Department of Health had been the sole Title X grantee, and they used Title X funds to prop up their health departments. And what we found from actually working at the health department was that people were not getting the quality care that they needed and wanted. And we felt strongly then, and obviously we do now, that we need to be part of the solution of figuring this out. So, we left the health department and with very little money, $150,000, and I was about to have a baby, and we thought to ourselves, like, we can figure this out. And we spent, you know, a good two years talking to clinics, talking to patients, doing all this groundwork. And so, when we applied for the Title X grant, we were like, we have a great strategy. And we won. It was a huge deal. And so, we started working very quickly with community health centers because that's really the medical home model that we would want people to have access to. The health departments were really providing just kind of bare bones care, kind of your traditional public health services, but not the quality care that we wanted people to have. And it was a slog to get all of these FQHCs to say yes to Title X, especially with such a kind of bad taste in their mouth from previous attempts at trying to do Title X with the health department, where there was no money involved. And we were offering them money and technical assistance. And we actually were eager to return their phone calls and answer all their questions. And so, we created this beautiful statewide network. And it was going so well. And for it to happen in this way, I will never get over how heartbreaking the whole thing has been. For us as leaders, for our organization, and obviously for the people that we serve, it has been, I think, the worst possible outcome I could have imagined in this administration.

Danielle: And there's something especially difficult about the timing for us. It felt... for us, for our team, for our clinical partners, we're hitting our stride in Mississippi and Tennessee. We are facing a crisis of access, a crisis of mis- and disinformation, a super hostile policy environment, but we're building. We're doing it. And I think that we... anticipated that the incoming Trump administration would mean we'd have to get super focused on holding the line as many places as we could for as long as we could. I did not anticipate taking such a serious hit so early. We didn't get the chance to do any of the things we wanted to do. We didn't even get to do the shouting. Yeah. But... I think that is also true that from this experience of the funds being withheld, we have been reminded of the thing that also saw us through and continues to see us through post-Dobbs, which is the solutions for the needs down here in the South—the solutions come from the soil, the solutions come from the place. So, in community with our clinics, with our patient advocates, with each other, we've been able to gather ourselves and think about that same question we had at the beginning which is: what can we do to continue to demand that we receive some information from HHS about our funds that are currently withheld? We have complied with their request for information and would like for them to then provide us an update. We received nothing. What we have decided is that we can continue to increase the number of places people can get access to contraception. It feels like the political winds are definitely blowing in the direction of increased pressure to stop certain kinds of contraceptive care, to restrict or limit certain kinds of contraceptive methods. And so, we're out there with our telehealth operation trying to make sure that people know that they can still get a wide array of contraceptive methods, but it's devastating that we're here. And man, none of it had to be this way.

Jamie: And after the initial shock and sadness and disappointment, we very quickly realized, okay, we have a job to do here. There are no Title X designated clinics in Mississippi. And we must serve our people. And so, we very quickly committed that we would not stop telehealth. We had no Title X funds supporting it. So, we're relying on private donations, which we had never really done any kind of campaign to raise money for individuals because we didn't need to, right? And using foundation and private money for our telehealth operation, we continue to do free at-home STD test kits and treatment. The only organization in Mississippi doing that, still doing that. And then we thought, well, gosh, like, why not us? Why can't we also have a clinic presence? Like, we've been saying, okay, clinics, we'll give you this money if you'll agree to these standards and quality improvements. And we thought, we know all about that. So, we signed a 12-month lease for a clinic space in the Jackson Medical Mall. And it's an underserved area of Jackson where the main tenants had decided this summer to leave and go out to the nice suburbs. And so, there's this huge void in here. And to Danielle's point, we're doing the opposite of fleeing. We are committing that we're going to be here. And so, September 1st, the Converge Clinic will operate. And it is so exciting to know that we would have not moved into this space so quickly of offering direct clinical care, brick and mortar, without having lost our Title X funds. And that's kind of weird to say, but Title X is really complicated and takes so much time to administer. And so, we were really focused in on that, right? And we had decided before we even started Converge that a brick-and-mortar clinic was one of our dreams. And how beautiful that we have come back to this, unfortunately in this way, but because we did have some time to think, okay, if we're not doing Title X administrative stuff, we do have the bandwidth then to have a brick-and-mortar clinic and it's the clinic of our dreams, right? It's all the feedback we've ever received from patients and we're doing it. And it's, and that's the thing that's really gotten us through the last few months is this forward momentum and excitement that we all feel that we can do something for our people.

Danielle: And we can't give up because when you commit to this work, you commit to holding the line. And we're aware that we are certain to take more losses it's gonna get worse before it gets better and it's gonna get better in an uneven pace it's gonna get better everywhere before it gets better in the South so we want to hold the line for our people and I think we're hoping to remind people that you don't have to give up, that you can get caught trying something else. What we have been hearing is that many funders are still waiting to see how bad it's going to get. And we encourage them to come down to Mississippi and talk with us, meet with our patient advocates, and see how bad it is becoming. And we don't deserve to have to wait to see how bad it's going to get. We deserve a vision of abundance that tells us however bad it is, together we can dream and work toward the best. And that's really what Converge is based on is this desire for folks here in the South who we love, who we are, that we deserve the best. We're not waiting to see how bad it's going to get. It's really bad. We deserve better. And we can just act on that.

Jennie: Okay, y'all, I hope you enjoyed the stories from these amazing Title X providers. I am so grateful to them for sharing their stories and so that you can hear from them what the implications of this withholding of funds has meant to them and to their programs. Like I said, we have three more providers that are going to be sharing their stories in the near future. So, stay tuned. It'll either be next week or the following week. And then we'll have the Supreme Court break down, you know, whichever week we don't have the Title X one. With that, hope everybody has a wonderful holiday weekend and I will see y'all 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, J-E-N-N-I-E at reprosfightback.com or you can find us on social media. We're at rePROs Fight Back on Facebook and Twitter or @repros fb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all.