HHS Issues Final Regulation Aimed at Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services

Note: Title X family planning clinics are key partners in ending the HIV epidemic in the U.S., providing many individuals with HIV and STI testing and prevention services.

Cross-posted from HHS Press Office

[On October 4, 2021], the U.S. Department of Health and Human Services (HHS) issued a final rule to strengthen the Title X family planning program, fulfilling the Biden-Harris Administration’s commitment to restore access to equitable, affordable, client-centered, quality family planning services. For more than half a century, Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and preventive health services including breast and cervical cancer screening and STI/HIV testing for than 190 million low-income or uninsured individuals. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.

The final rule, “Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services - PDF” realigns the nation’s family planning program with nationally recognized standards of care, reinforces the program’s emphasis on quality, equity, and dignity for all individuals who seek Title X services, and modernizes the more than 50-year old program to better reflect the current healthcare system. This new rule replaces the 2019 Title X Rule, reversing the Trump administration’s changes to the program.

“This rule is a step forward for family planning care as it aims to strengthen and restore our nation’s Title X program,” said HHS Secretary Xavier Becerra. “Our nation’s family planning clinics play a critical role in delivering health care, and today more than ever, we are making clear that access to quality family planning care includes accurate information and referrals—based on a patient’s needs and direction.”

The final rule becomes effective on November 8, 2021, 30-days from publication in the Federal Register, and completes the federal action which began the week following inauguration when President Biden issued a memorandum directing HHS to review rules that impose undue restrictions on women’s access to complete medical information. In the spring, HHS issued a proposed rule that received more than 180,000 comments during the 30-day comment period.

“Advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality, is a priority for the Administration, including the Title X program and the Department,” said HHS Assistant Secretary for Health Rachel L. Levine, M.D. “This 2021 regulation will allow for the Title X service network to expand in size and capacity to provide quality family planning services to more clients.”

The final rule was issued in advance of a national competition for Title X service delivery grants that is anticipated later in the fall. This rule will also impact actions announced earlier including grants to support telehealth and address the dire need for family planning services following recent events in Texas and across the country to limit access to essential reproductive healthcare.

According to the 2020 Family Planning Annual Report (FPAR), the Title X program experienced a significant decline in the number of clients served in 2020. The report estimates that 63% (or 1.5 million) of the total decrease (2.4 million) in family planning patients between 2018 and 2020 can be attributed to the 2019 Title X Rule. At present, six states have no Title X services and an additional seven states have limited Title X capacity.

“The Biden-Harris Administration’s Title X rule focuses on restoring quality, dignity, and respect for the millions of individuals who rely on the nation’s family planning program because the ability to plan if and when to expand our families is fundamental to who we are and who we may choose to become,” said Jessica Swafford Marcella, HHS Deputy Assistant Secretary for Population Affairs.

Enacted in 1970 as part of the Public Health Service Act, the Title X family planning program is a critical part of America’s public health safety net, serving as a point-of-entry into care for millions and the gold standard for providing high-quality, affordable, and confidential voluntary family planning and related preventive health services, with priority given to low-income clients. Title X services are delivered through a diverse network of clinics including state and local health departments, federally qualified health centers, hospital-based sites, and other private nonprofit and community-based health centers. The 2021 rule will ensure that the predominantly low-income clients who rely on Title X services as their usual source of medical care, have access to the same quality healthcare, including full medical information and referrals, that higher-income clients and clients with private insurance are able to access.

More information about the Title X family planning program is available at https://opa.hhs.gov/grant-programs/title-x-service-grants.