Public Funding for Contraceptive, Sterilization And Abortion Services, 1994.

In 1994, federal and state funding for contraceptive services and supplies reached $715 million. Funding totaled $l48 million for contraceptive sterilization and $90 million for abortion services. According to a survey of state health, Medicaid and social service agencies, reported spending on contraceptive services and supplies increased by 11% between 1992 and 1994. In the same period, spending under Title X rose by 37%, making it the third largest public funding source for contraceptive services and supplies. The largest source of public funds for family planning services continues to be the joint federal-state Medicaid program. Medicaid family planning expenditures increased by only 4% between 1992 and 1994, a sizable decrease in growth from previous years. State funds continue to be the second largest source, providing almost one-quarter of reported public expenditures in 1994. The maternal and child health and social services block grants remain relatively minor sources of support nationally although ma handful of states they provide the majority of public-sector funds. State governments were virtually the sole source of public support for the 203,200 abortions provided in 1994 to low-income women. Despite the loosening of federal abortion funding criteria in FY 1994 permitting payment in cases of rape and incest, federally funded abortions numbered only 282. (Family Planning Perspectives, 28:166-173,1996)

The average American woman will spend almost half of her life making decisions about childbearing. At various times during her reproductive years, a woman who is sexually active and unprotected by contraceptive sterilization will face the risk of unintended pregnancy. Approximately 31 million women aged 13-44 currently face this risk; half of these women are in need of subsidized family planning services either because they have low incomes or they are young. (1) Government-sponsored assistance in providing reproductive health care services has proven to be a key resource in helping low-income women and teenagers attain their childbearing goals.

Public funds to provide subsidized family planning come from diverse federal and state programs. The federal government makes funds available for family planning services through four major sources: Title X of the Public Health Service Act, and Titles V, XIX and XX of the Social Security Act. The latter three sources are better known as the maternal and child health (MCH) block grant, Medicaid and the social services block grant, respectively. The importance of each of these individual funding sources for family planning services varies across states, since each state can structure its family planning effort individually.

Title X is the only federal program with the primary purpose of providing family planning services. While no longer the major source of public funds for these services, Title X is still vital. (2) Title X funds allow clinics to offer services to the uninsured at reduced fees and to women in managed care plans who seek services outside their provider network. Clinics established with these funds also provide essential services to women who rely on Medicaid or other funding sources.

The U.S. Department of Health and Human Services (DHHIS) administers the Title X program and awards family planning--specific grants through its 10 regional offices to a variety of public and private agencies. In FY 1994 (October 1,1993, through September 30, 1994), the DHHS Office of Population Affairs awarded 85 Title X service grants to agencies in each of the 50 states, the District of Columbia and eight U.S. jurisdictions. Forty-four of those grants went to state government health agencies and 41 went to nonstate agencies, including regional family planning councils, Planned Parenthood affiliates and public and community health services entities.

In contrast, the MCH and social services block grants go exclusively to state government agencies. These funds may be used by the state or passed on to other government and private-sector agencies. The states can use these block grants to make a wide variety of services available and can decide what portion of funds, if any, to designate for family planning services. Under the MCH block-grant program, the federal government requires states to match every four federal MCH dollars with three state dollars, and these funds are then allocated by the state health agency. Social services block-grant funds, for which there is no matching requirement, are allocated by the state social services agency.

The fourth major source of family planning funds is Medicaid, a program that uses both federal and state funds to provide medical care to low-income populations. Unlike other federal programs that fund family planning services, Medicaid is an entitlement program, in which funding is reimbursement for services provided to eligible clients and is not a set congressional appropriation. The federal government reimburses states for a portion of their Medicaid expenditures based on a reimbursement rate set by DHHS that is inversely related to each state's median income. The reimbursement rate varies between 50% and 80% of the cost of providing services. However, family planning services receive a preferential reimbursement rate of 90% in all states. Because DHHS has never issued a formal definition of family planning services, there is some variability among the states regarding what services are included under this rubric. (3)