Community Health Centers Participation in Title X Family Planning Program Expected to Fall Further

WASHINGTON, D.C. and NEW YORK, N.Y. (April 14, 2020) – Community health centers in many parts of the nation are poised to make significant changes in Title X program participation, according to a new report produced by researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

The report, which comes at a time of heightened concern over access to primary health care during the COVID-19 pandemic, surveyed community health centers during January and February 2020, to assess their current and future Title X participation plans, ahead of March 4, the date on which the administration’s rule took full effect. Among the rule’s key provisions are major new restrictions on how Title X clinics counsel pregnant women and in the financial management rules they must maintain. In 2018, community health centers served more than 6 million low-income women of childbearing age.

The survey found that two-thirds of all community health center respondents either were not participating in Title X and had no plans to do so, or else were previous participants that already had left the program. Another one-third either were current participants that planned to remain or were considering applying to the program. The survey also found that community health centers that were not participating in Title X but planned to apply in the future were more likely to be located in the south or in the western regions of the country.

Among those health centers planning on leaving the Title X program or that already have done so, the survey found, 70 percent cited concerns that the new requirements would compromise quality of care, and 66 percent said they were worried that restrictions could negatively affect their patients’ health.

One third of all respondents anticipated a major surge in need in their communities, but only 9 percent reported that their health center would be able to accept an increase of 50 percent or more in new family planning patients. This estimate of additional treatment capacity came before the surge related to the COVID-19 pandemic, which can be expected to intensify resource strains on health centers. 

“The results of this study underscore the problems created by the Title X rule,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH and one author of the brief. “The most shocking finding is that 70 percent of respondents planning on leaving the program would cite the impact of the rule on the quality of their care.”

“The Title X rule is threatening to drive away the nation’s premier primary care network,” said Feygele Jacobs, DrPH, president and CEO of the RCHN Community Health Foundation. “Coupled with the loss of other providers, the exit of health centers from the Title X program could have dire consequences for medically underserved communities.”  

The analysis, “How Will the Title X Family Planning Rule Affect Community Health Centers?” was conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.

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The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.