State officials are dismayed that the Trump administration has stalled the process for applying for new family planning money the states are counting on. Abortion advocacy groups worry that the delay may mean the administration is planning to target abortion providers or rewrite family planning policies. 

The funding announcement was expected by November, with states’ applications for 2018-19 due Jan. 3. But the announcement still isn’t out. The funding is provided by the Title X program, through the only federal grants focused on family planning.

Abortion advocacy groups fear the administration could use this funding opportunity to reinstate the domestic gag rule — a Reagan-era rule that prohibits Title X-funded health centers from counseling patients on abortion or referring them to abortion clinics — or to prioritize fertility awareness programs over other birth control methods.

“We think it’s quite possible that the administration is using this funding announcement as its first real opportunity to transform the program and undermine its integrity,” said Audrey Sandusky, director of advocacy and communications at the National Family Planning and Reproductive Health Association.

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“By delaying the funding opportunity announcement, the Trump administration is playing politics with women’s health,” said Dana Singiser, vice president of public policy and government affairs at Planned Parenthood Federation of America. “By failing to meet the deadline, this could cut off Title X-funded care for the thousands of people in states where they have nowhere else to turn.”

At the helm of the Title X program is Teresa Manning, deputy assistant secretary for the Office of Population Affairs at the Department of Health and Human Services. She previously worked for anti-abortion groups like the Family Research Council and National Right to Life and has said contraception is ineffective.

The Office of Population Affairs hosts yearly competitions for the Title X grants. Historically, these grants have been for longer stretches. However, in July, HHS wrote letters to funding recipients stating that all grants would end in 2018, either at the end of March or June.

Ticking clock for states

States whose grants end March 31 could be in a bind if the funding opportunity isn’t announced soon. The typical timeframe to apply is generally 45 to 60 days, according to Emily Yeatts, reproductive health unit supervisor with the Virginia Department of Health.

“Typically if a grant were to start in April, we would have applied already. We would probably have submitted it by December,” she said. “Right now, the funding is the same, but our federal funding for family planning ends at the end of March, and we don’t have any knowledge of what will come after that.” 

Virginia officials are not alone. Maine Family Planning, the sole Title X grantee in the state, also has concerns with the delay.

“This is causing some stress. It’s a little destabilizing,” said George Hill, CEO of Maine Family Planning, which provides funding for 47 health centers across the state.

As the March 31 deadline approaches, Hill said, “We have prepared as much as we can imagine we can prepare without seeing the requests.” However, the application itself is usually 180 pages, which is “not something that you can turn around overnight,” he said.

Hill, however, seemed confident that the upcoming funding opportunity would not be used to institute any of the major changes that some advocacy organizations are worried about.

“I think in order for them to issue a major policy change, they would very likely have to go through an administrative review process,” he said. “That would require publishing the policy change in the Federal Register and giving respondents at least 30 days to respond. They don’t have time to do that.” 

Vermont is another state whose three-year Title X grant was truncated to two years, requiring the state to apply for the grant cycle originally set to begin April 1, 2018, a year earlier than planned.

“The Office of Population Affairs has not yet formally begun the application process — which typically starts in September or October, with an application deadline at the end of December,” said a spokesperson for the Vermont Department of Health, referring to the timeline for previous years. The current period’s expected release date was Nov. 1. “We are hopeful that OPA will cover the gap in its timing by providing a funding extension for these critical public health services to Vermont and the other states whose grant ends March 31.”

“Uncertainty — especially when it regards funding for programs important to the public’s health — is always a cause for some concern,” added the Vermont spokesperson.

Sandusky said there’s contingency planning going on nationwide, such as “identifying how and when to shut down services” in a worst-case scenario. This could mean health centers could be forced to scale back operations, limit staff and services provided or potentially shut down clinics in their networks.

“It’s an incredibly uncertain time for providers,” she said.

Hill also speculated that if the funding announcement does not come through soon, some grantees may experience problems with staff retention.

“If you’re recruiting to replace that provider, and the word is out that this is a program that is high on the target list for the current administration, that makes it all the more difficult,” he said.

HHS did not provide any information on when the announcement would be available.

“The information requested is not public at this time. The agency will provide public notice at an appropriate time,” according to an HHS spokesperson.

“Unfortunately we’re just waiting for information on what our next steps will be,” said Yeatts.