HHS has come up with a Missouri compromise on conflicting rules for state and federal family-planning grants, and the Show Me State has accepted the deal.
Clinics that accept the federal grants won't have to worry about violating new language in the state grant contracts that prohibits recipients from making "direct referrals" for abortions. The issue was whether the state language conflicted with a requirement under the federal Title X program that grantees provide pregnant women with information on their options, including abortion referrals.
At least 19 clinics that had received grants from both programs decided not to sign three-month state contract extensions that began July 1 (July 30, p. 20). Many clinics were scared off by the penalty for violating the state rules-the return of all money received under the state grant. With the compromise, those clinics should be able to apply for the next round of state grants, this time for the nine months beginning Oct. 1. Clinics must apply for the grants by Aug. 29.
In a letter last week to the Missouri Family Health Council, HHS' Office of Population Affairs said its legal opinion is that the state and federal programs don't necessarily contradict each other. The federal program defines "abortion referral" as supplying a patient with a contact list of local providers but prohibits a clinic receiving federal money from taking other steps that encourage abortions, such as making appointments, said the Aug. 2 letter. The not-for-profit council receives Missouri's Title X grants and parcels out the grants to providers.
The Missouri Department of Health, which oversees the state family-planning grants, said in a news release that it would not punish clinics that participate in both grant programs for meeting the federal guidelines. The department said it accepted the letter as a substitute for a remedy that the state law spelled out-namely, an order from HHS Secretary Tommy Thompson to each clinic demanding that they meet the federal program rules.
Using a legal interpretation to make the conflict vanish into thin air kept Thompson from having to issue a written ruling against abortion opponents. They are among the Bush administration's strongest supporters, but they are also wary of Thompson for his expressed support of embryonic stem cell research. Missouri abortion opponents had pushed for the new state language but claimed they never intended to shut off the state grants to Title X recipients. According to press reports, they sought the language as a further expression of disapproval of abortion by the state.
As a practical matter, the Kansas City (Mo.) Health Department's women's health program handles referrals the way HHS envisions. Hilda Fuentes, who heads the department's maternal and family health division, said information and neutral advice is given to pregnant women on prenatal care, adoption and abortion, including a list of providers, but the process ends there.
Meanwhile, the city department has delayed its plans to shut down the women's program, which was scheduled to close Aug. 3 after the department dropped out of the state family-planning program, Fuentes said. No new patients will be accepted, but patients already enrolled in the program will continue to receive care while Kansas City's City Council considers ways to replace the state financing, she said.