Printer Friendly

Administering Title X: The States' Role.

Although Title X is a categorical program whose funds must be spent on the provision of family planning services, it is sufficiently flexible to accommodate the diverse ways in which states administer health care services. At the national level, the program is administered by the Office of Population Affairs, within the Department of Health and Human Services. Each year, Congress decides how much funding to appropriate for Title X, and the Office of Population Affairs allocates funds among the 10 federal regions.

Public and private, nonprofit agencies apply to their regional health coordinator for funds to provide contraceptive and related services and to undertake training, technical assistance and other support; the health coordinator awards grants on a competitive basis. Grantees are responsible for ensuring that the full range of services required by Title X are provided. Most distribute program funds to subgrantees (officially known as delegate agencies) on the basis of an assessment of state and local needs, including the number of women in need of subsidized contraceptive services, the prevalence of poverty and the availability of other public support for family planning.

Growth of the States' Role

Since Title X's inception, there have been two major waves of consolidations among grantees. The first wave occurred in the mid-1970s, when the number of family planning project grants declined from more than 400 to about 200. (29) The second occurred a decade later, during the Reagan administration, when the number of grantees fell below 100, where it remains today. (30)

The federal government helped spur these consolidations by actively encouraging the states (and territories) to assume responsibility for the administration of federally funded family planning programs. The current configuration of public and private, nonprofit family planning providers that receive funding through Title X is the result of the federal government's efforts to give states the opportunity to be involved in the provision of family planning services.

Most states and territories have chosen to play a central role. As Table 1 (pages 12-13) indicates, in 1994, the health department was the sole Title X grantee in 27 states and seven U.S. territories, and a grantee (usually the primary one) in another 10 states. The remaining 13 states, the District of Columbia and Puerto Rico chose not to apply for Title X grants; in these jurisdictions, Title X funds were awarded to private, nonprofit family planning agencies. (31) No state health agency has ever been turned down for a Title X grant. (32)

In 1994, a total of 85 primary grantees received Title X support; the number of grantees per state ranged from one to six. Fifty-one of these grantees were state, territorial, local or municipal health departments; 14 were independent family planning councils (regional, nonprofit umbrella agencies); seven were affiliates of the Planned Parenthood Federation of America; and 13 were other types of community agencies, such as hospitals.

State Administrative Structures

As is evident in Table 1, states and territories that receive Title X funds use a variety of administrative structures to deliver family planning services funded by the grant. States in which the health department is the sole grantee may choose to provide services directly, delegate funds to other providers or do both. For example:

* Mississippi, like many southern states, provides services exclusively through its own network of state health department clinics.

* Maryland operates its own clinics, but also delegates funds to public-sector providers, such as Baltimore's city health department, and to private agencies, such as Planned Parenthood of Maryland.

* Arkansas uses most of its grant to operate its own network of clinics, but delegates some Title X funds to community action agencies in isolated rural areas.

* North Dakota provides no services directly; instead, it funds county health departments and community action agencies to do so.

* Vermont also provides no direct services, instead choosing to subcontract all services to a single private agency (a Planned Parenthood affiliate).

States in which the health department is not the sole grantee delegate funds for service provision. For example:

* The Texas health department delegates its grant to county health departments and private providers.

* The Iowa health department allocates its funds to hospitals and community action agencies.

Local health departments typically use their Title X funds to provide direct health care services, leaving other Title X--supported services (such as data collection, bulk purchasing of supplies and coordination of services) to state agencies; only the largest local health departments have the resources and personnel to handle these additional functions. (33)

Twenty-nine state health departments delegate Title X funds to at least one private, nonprofit agency, including university medical centers, community action organizations, community health centers and nursing service organizations. Many of these agencies are located in areas that have no other reproductive health care provider. (34) Some 814 delegate agencies received Title X funds in 1991; together, grantees and their delegate agencies operated approximately 4,100 clinics. Of these clinics, 58% were administered by state and local health departments; 17% by Planned Parenthood affiliates; and the remaining 25% by hospitals, regional or local family planning councils, Indian nations and community organizations. (35)

As a result of the various ways in which Title X is administered, the more than four million women who receive services funded by the program rely on a variety of providers, depending on the state in which they live (Table 2, pages 16-17). Overall, close to half of these women obtain services in clinics operated by state and local health departments, and more than a fourth go to Planned Parenthood affiliates.

References

(29.) House Report 95-1191, 95th Congress, Second Session, 1978; and Subcommittee on Child and Human Development of the Senate Committee on Human Resources 95th Congress, Second Session, Family Planning Services and Population Research Act Extension of 1978: Hearing to Extend Appropriations Authorizations for Five Fiscal Years, Washington, D.C., 1978.

(30.) Office of Population Affairs, DHHS, "Family Planning Program FY 1988 Program Grants and Contracts by State," Washington, D.C., 1994.

(31.) ----, "Family Planning Grantees, Delegates, and Clinics: 1994-1995 Directory," Washington, D.C., 1994.

(32.) J. Bennett, Office of Population Affairs, personal communication, July 1995.

(33.) D. Chase, Hennepin County, Minnesota, Health Department, personal communication, Sept. 15, 1995.

(34.) S.K. Henshaw and A. Torres, 1994, op. cit. (see reference 8).

(35.) Ibid.

Table 1

The majority of states and territories are Title X grantees, but they administer their grants in diverse ways.
Health department receives 100% of Title X funds

 Exclusively funds Operates clinics Operates clinics
and operates clinics and funds public and and funds
 private agencies private agencies

 Florida Georgia Alabama
 Louisiana Maryland Arkansas
 Mississippi Oklahoma Delaware
 North Carolina New Mexico
 South Carolina
 Tennessee
 Virginia
 American Samoa
 Guam
 Mariana Islands
 Marshall Islands
 Micronesia
 Palau
 Virgin Islands

 Exclusively funds Funds public and Funds private agencies
and operates clinics private agencies


 Florida Idaho Hawaii
 Louisiana Illinois Nebraska
 Mississippi Kentucky Rhode Island
 North Carolina Michigan Vermont
 South Carolina Montana
 Tennessee New Hampshire
 Virginia North Dakota
 American Samoa South Dakota
 Guam West Virginia
 Mariana Islands
 Marshall Islands
 Micronesia
 Palau
 Virgin Islands
 Health department Health department receives
receives 66-94% of Title X
 funds
 <65% of Title X funds

Funds public and Funds private agencies
private agencies Funds public and private
 agencies

 Colorado Iowa Nevada
 Kansas New Jersey
 New York
 Ohio
 Oregon
 Texas
 Washington











 Health department
 receives no Title X funds

Funds public and
private agencies


 Colorado Alaska
 Kansas Arizona
 New York California
 Ohio Connecticut
 Oregon District of Columbia
 Texas Indiana
 Washington Maine
 Massachusetts
 Minnesota
 Missouri
 Pennsylvania
 Utah
 Wisconsin
 Wyoming

 Puerto Rico


(*)Title X funds are granted to nonstate public or private,

Source: Office of Population Affairs, Department of Health and Service,
"Family Planning Grantees, Delegates, and Clinics: 1994-1995 Directory,"
Washington, D.C. 1994.


Table 2

Patients in most states receive services through a variety of Title X--funded clinics.
STATE PERCENTAGE DISTRIBUTION OF PATIENTS
 SERVED,1994
 Health Hospital Planned
 department Parenthood

Total 44 8 30
ALABAMA 98 0 0
ALASKA 80 20 0
ARIZONA 30 22 44
ARKANSAS 97 0 0
CALIFORNIA 28 10 41
COLORADO 44 27 19
CONNECTICUT 7 13 74
DISTRICT OF COLUMBIA 30 7 35
DELAWARE 60 0 40
FLORIDA 86 1 6
GEORGIA 88 6 6
HAWAII 28 11 14
IDAHO 82 0 18
ILLINOIS 46 10 26
INDIANA 0 2 92
IOWA 1 15 52
KANSAS 87 0 13
KENTUCKY 84 2 9
LOUISIANA 97 0 2
MAINE 0 0 27
MARYLAND 65 4 29
MASSACHUSETTS 0 10 0
MICHIGAN 66 4 28
MINNESOTA 23 0 67
MISSISSIPPI 100 0 0

STATE PERCENTAGE
 DISTRIBUTION OF
 PATIENTS SERVED,1994
 Other Total


Total 18 100
ALABAMA 2 100
ALASKA 0 100
ARIZONA 3 100
ARKANSAS 3 100
CALIFORNIA 21 100
COLORADO 10 100
CONNECTICUT 6 100
DISTRICT OF COLUMBIA 28 100
DELAWARE 0 100
FLORIDA 6 100
GEORGIA 1 100
HAWAII 47 100
IDAHO 0 100
ILLINOIS 18 100
INDIANA 6 100
IOWA 32 100
KANSAS 0 100
KENTUCKY 4 100
LOUISIANA 1 100
MAINE 73 100
MARYLAND 2 100
MASSACHUSETTS 90 100
MICHIGAN 2 100
MINNESOTA 10 100
MISSISSIPPI 0 100
MISSOURI 17 6 34 42 100
MONTANA 22 0 54 25 100
NEBRASKA 0 5 51 44 100
NEVADA 57 0 25 18 100
NEW HAMPSHIRE 0 9 48 43 100
NEW JERSEY 4 9 65 22 100
NEW MEXICO 38 21 5 36 100
NEWYORK 15 20 54 11 100
NORTH CAROLINA 96 0 0 4 100
NORTH DAKOTA 74 0 0 26 100
OHIO 5 8 64 23 100
OKLAHOMA 91 2 0 7 100
OREGON 63 0 37 1 100
PENNSYLVANIA 4 25 37 34 100
RHODE ISLAND 0 11 0 89 100
SOUTH CAROLINA 96 0 3 1 100
SOUTH DAKOTA 16 7 0 77 100
TENNESSEE 89 0 8 2 100
TEXAS 6 16 34 44 100
UTAH 0 0 92 8 100
VERMONT 0 0 100 0 100
VIRGINIA 100 0 0 0 100
WASHINGTON 31 0 63 6 100
WEST VIRGINIA 56 2 0 42 100
WISCONSIN 0 0 86 14 100
WYOMING 31 0 0 69 100

Source: The Alan Guttmacher Institute, special tabulations from 1995
survey of clinics providing family planning services.

Note: Percentages may not add to 100 because of rounding.
COPYRIGHT 1996 Guttmacher Institute
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996 Gale, Cengage Learning. All rights reserved.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Public Health Service Act
Publication:Title X at 25: Balancing National Family Planning Needs with State Flexibility
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jan 1, 1996
Words:1692
Previous Article:The Role of Title X in Family Planning Service Provision.
Next Article:Lessons Learned from the 1981 Block-Grant Experience.
Topics:


Related Articles
Statistical agencies: a comparison of the U.S. and Canadian statistical systems.
LEXIS-NEXIS' "STATISTICAL UNIVERSE"; AGREEMENT WITH DUN & BRADSTREET.
Pain Relief Promotion Act of 1999 A Bill.
Health and Health Care Issues Examined at Annual Joint Statistical Meetings.
Title X: A Delicate Balance.
The Role of Title X in Family Planning Service Provision.
The Impact of Restructuring Title X.
Provision of contraceptive and related services by publicly funded family planning clinics, 2003.
Formula Grants: Funding for the Largest Federal Assistance Programs Is Based on Census-Related Data and Other Factors.

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters