HHS on Friday outlined how Title X family planning grantees can show they're following new federal rules aimed at curbing abortion referrals—the first step to the Trump administration's major overhaul of the program.
HHS' Office of Population Affairs, which oversees Title X, has given grantees until Aug. 19 to give assurances they are no longer referring pregnant women for abortions. Grantees can now only offer "nondirective" abortion counsel at most. That means women would have to ask a physician or advance practice physicians about all options.
The Office of Population Affairs said in the guidance it plans to be flexible for how clinics show they're in compliance. They will have to be able to offer evidence they're following the new standard by Sept. 18.
"OPA does not plan to not use any rigid formula to assess compliance with the final rule and recognizes that compliance by each grantee warrants particularized evaluation," the agency said. "Accordingly, OPA plans to make an individualized determination in each case."
Title X dispenses about $290 million to grantees each year. The grantees can be state health departments or medical organizations. The money then is disbursed to clinics, health centers and even hospitals that are part of a state's network.
But the politics around the Trump administration's program overhaul have roiled the network, in which women's health clinics that may offer abortion as just one of their services can play a big role. President Donald Trump unveiled the new regulation in May 2018 to an uproar from medical groups and women's health groups.
The major change at the heart of the new regulation is the physical separation requirement that would bar abortion clinics like Planned Parenthood from receiving program funds. That won't take effect until March 2020.
Litigation challenging the rule is still pending in the 9th U.S. Circuit Court of Appeals, with oral arguments slated for Sept. 23.
With the legal battles still ongoing, the Title X networks haven't seen a shake-up yet, as they could if the courts do finally decide that abortion can't be offered on the premises of any Title X funded clinic.
But vocal Democratic state governors have made headlines with threats to reject the federal money in light of the new regulations, and on Friday an HHS representative confirmed to Modern Healthcare that one grantee "has indicated that seven of their subrecipients will no longer be in the Title X network."
Outside of that, the representative said, "we have not received official notification from any grantee that they are refusing Title X funds."
One state has already stopped accepting federal Title X funding: Washington's health department wrote a letter to Office of Population Affairs late last month to say that it was no longer dispensing the federal grants to the state's Title X clinics. But Washington is only stalling the relationship, and hasn't filed a formal termination.
"The department hopes that these changes prove short-lived and its partnership with HHS resumes as it stood for decades," Washington's grantee authorizing official Lacy Fehrenbach wrote.
HHS this week acknowledged the contentious politics around its new regulations. On Thursday, the department refuted criticisms lobbed by major medical groups including the American Medical Association with a new fact sheet entitled "Myth vs. Fact."
The AMA joined one of numerous lawsuits against the Trump administration over the rule on the grounds that it violated medical ethics by dictating the types of advice doctors can offer their patients.
In this fact sheet, the Trump administration disputed the characterization of the Title X rule as a "gag rule" that prohibits mention of abortion, since doctors and advanced practice clinicians can offer patients a list of "comprehensive healthcare providers" that include some who "perform abortion as part of a comprehensive healthcare practice."