‘damaging And Punishing’: Birth Control Clinics Serving Millions Face Federal Funding Cliff

Clinics that provide free and subsidized birth control and other reproductive health services to millions of low-income people nationwide are warning that access could soon be cut off if the federal government continues to delay the funding process.

The Department of Health and Human Service’s Office of Population Affairs has not yet released the guidance dozens of health care organizations around the country need to apply for a funding cycle that begins on April 1. They had been scheduled to receive that guidance by the end of last year.

Clare Coleman, the CEO of the National Family Planning and Reproductive Health Association, which represents most providers in the Title X Family Planning Program, said they have not received an explanation for the delay from the Trump administration.

Last year, the Trump administration issued formal notices freezing tens of millions in Title X funding, which it restored months later after Coleman’s organization sued. She said this year’s turmoil, in contrast, has been marked by “radio silence.”

“If they want to change the program, there’s a mechanism to do that,” said Coleman, noting that President Donald Trump overhauled Title X through rulemaking in his first administration. “But to simply withhold money that Congress already appropriated for services that are time sensitive is damaging and punishing.”

HHS did not respond to questions about the status of the guidance and the possibility of a funding lapse.

More than three dozen Democratic senators led by Mazie Hirono (D-Hawaii) are demanding “immediate action” in a letter sent to HHS Secretary Robert F. Kennedy Jr. this week and shared first with POLITICO.

“The repercussions for critical health care will be catastrophic,” the senators wrote. “Any gap in Title X funding could result in over two million patients losing access to contraception and preventative care, worsen maternal health outcomes, and increase sexually transmitted infections. It will also risk layoffs of essential health care providers and staff who provide care for patients at thousands of Title X clinics nationwide, worsening the national maternal and reproductive health care crisis.”

The delays are just the latest challenge for the more-than-$200 million annual program, which has long been a political football subject to shifting agency regulations, lawsuits, and repeated attempts by Republican lawmakers to eliminate its funding.

Although Title X has been prohibited since its inception in the 1970s from paying for abortions, conservatives have long targeted its budget due to a requirement that its clinics offer non-directive counseling about all pregnancy options, including abortion, if patients request it.

With just a few weeks left of funding, clinics are making contingency plans in the event they need to reduce clinic hours or services, lay off staff, or close some facilities entirely. Even if the guidance were released immediately, several health care providers around the country said, there would not be enough time to process the applications before current funding runs out at the end of March.

HHS typically takes several months to review the information, which include details like the number of patients the clinic sees, what services are provided, and “what we envision over the course of the next year,” said Kristie Bardell, the CEO of the nation’s largest Title X grantee, the nonprofit Every Body Texas.

Bardell told POLITICO that her organization is bracing for “astronomical impacts” if there isn’t a last-minute funding extension, with tens of thousands of patients forced to pay out of pocket for care that used to be free. The impact will be especially acute in Texas, she stressed, because the state never expanded Medicaid under the Affordable Care Act and a quarter of women of reproductive age lack health insurance and depend on programs like Title X for care.

“Individuals will have a lapse in services,” warned Bardell. “A lot of the people that we serve will be contemplating, ‘Hey, do I get a Pap smear, or do I pay my electric bill?’”

During a visit to Washington last week, Bardell discussed the group’s concerns with the offices of Texas’ senators and representatives, who she said were unaware of the problem but “very supportive.” Other grantees around the country have also been pleading with their state and federal elected officials to pressure the Trump administration.

The head of one health care network in the South that manages more than 120 clinics, speaking on background due to fear of retaliation from the Trump administration, said she and her colleagues are “putting in calls to congressional offices to ask for their help.”

“Our ask is really straightforward and quite simple, as well as in keeping with the way that the Title X program has always run, even in the past Trump administration and other Republican administrations, which is the prompt release of required guidance,” she said.

She added that the delay risks an interruption in services, including “contraception and basic fertility services, as well as STI testing and treatment and some preventive health services, like breast and cervical cancer screenings.”

Title X funding has remained flat for several years, despite mounting demand for family planning services after the Supreme Court overturned Roe v. Wade in 2022.

Since Trump returned to the White House in 2025, providers in the program have been expecting the administration to reimpose the rule from his first term that barred Title X clinics from offering abortion referrals or counseling patients about terminating a pregnancy. Yet there has been no notice such a change is coming more than a year into the second term.

The current silence, Coleman said, makes it harder to bring a legal challenge even if a funding lapse occurs because of the lack of evidence of the administration’s actions.

The organization that runs Title X services in California, Essential Access Health, said the current chaos comes as it is still struggling to recover from last year’s months-long funding freeze.

“Every day this uncertainty drags on, concern about the future of our nation’s family planning program grows,” the group’s CEO Nomsa Khalfani said, adding that her organization remains “in the dark” about when the guidance and funding will be released and the reasons for the delay.

Sen. Patty Murray (D-Wash.), who signed the Senate letter to Kennedy, said she and her colleagues will keep pushing until they get a response.

“Instead of cutting even more Americans off from health care, this administration needs to promptly provide funding for existing Title X clinics so that patients across the country can get the birth control and cancer screenings they need,” she told POLITICO.