CLIENT ALERT: HHS Issues Final Rule Modifying Title X Family Planning Program

By | Published On: March 4, 2019

Today, the U.S. Department of Health and Human Services (HHS) published a final rule, Compliance With Statutory Program Integrity Requirements, dramatically revising the Title X family planning program regulations. The proposed rule (published on June 1, 2018) received more than 500,000 public comments.

Key changes to the Title X family planning program regulations include, but are not limited to, the following:

  • Prohibits Title X projects from referring for abortion as a method of family planning. According to the final rule, if a pregnant woman asks for an abortion referral for family planning purposes, the Title X project’s response would be to say that it does not refer for abortions, and then to offer her, if she desires, a list of comprehensive primary care providers (including providers of prenatal care). That list may include (but not identify) such providers that also perform abortions.
  • Requires clear financial and physical separation between Title X projects and programs or facilities where abortion is a method of family planning. In assessing whether there is adequate separation, HHS will consider various factors, such as the degree of separation from facilities (g., shared phone numbers, email addresses, and websites).
  • Eliminates the requirement that a Title X project provide options counseling to pregnant women (including prenatal care/delivery; infant care, foster care, or adoption; and abortion), but permits nondirective counseling (including counseling regarding abortion).
  • Requires that Title X grantees include, as part of their applications, a list of subrecipients and agencies or individuals providing referral by name, location, expertise and services provided or to be provided. For purposes of the subrecipients, Title X grantees must provide a clear explanation of how the grantee will ensure adequate oversight and accountability for quality and effectiveness of outcomes among subrecipients.
  • Requires that Title X projects provide documentation (or other assurance satisfactory to HHS) that it has in place and implements a plan to comply with State and local laws requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, incest, intimate partner violence, and human trafficking.
  • Requires that Title X projects counsel minors on how to resist attempts to coerce them into sexual activities.
  • Requires that Title X projects encourage meaningful parent/child communication and family participation, especially in a minor’s decision to seek family planning services.
  • Clarifies that women who are unable to obtain employer-sponsored insurance coverage for certain contraceptive services, due to their employers’ objections based on religious beliefs or moral convictions, may be eligible for free or low cost access to family planning services through Title X under the “good reasons exception.”

The final rule becomes effective May 3, 2019.

Title X projects have until a later date to comply with certain specific requirements set forth in the final rule. For example, Title X projects have until July 2, 2019 to comply with the financial separation requirements and until March 3, 2020 to comply with the physical separation requirements.

If you have any questions regarding the final rule, please contact Carrie Bill Riley ( or Christopher J. Frisina (

Webinar: On March 19, 2019, FTLF will host a webinar to provide an overview of the changes to the Title X Program. Learn More or Register Here.

Learn more about the FTLF Team