Administering Title X: The States' Role.
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.
(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).
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.
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.
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|Title Annotation:||Public Health Service Act|
|Publication:||Title X at 25: Balancing National Family Planning Needs with State Flexibility|
|Article Type:||Statistical Data Included|
|Date:||Jan 1, 1996|
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