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July 17, 2019

Trump admin begins enforcing Title X family planning rule

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    The Trump administration on Monday announced that it will immediately start enforcing a final rule that bars health care providers and clinics that receive Title X family planning grants from providing or referring patients for abortion care.

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    HHS in February issued a final rule that requires recipients of Title X family planning funds "to separate their Title X project—physically and financially—from any abortion activities." As such, the final rule prohibits the federal government from dispersing Title X family planning funds to health care providers that offer abortions and abortion referrals in the same locations that they offer family planning services. However, providers under the final rule can refer patients for emergency abortion care when necessary.

    The final rule also eliminates a federal policy that requires health care providers to offer abortion counseling to qualify for Title X family planning funds, and instead requires that Title X recipients refer pregnant patients for prenatal care.

    In addition, the final rule broadens the definition of "family planning" to include adoption, abstinence, infertility management, and natural family planning. Under the final rule, providers will be required to offer "a broad range of … methods and services," which do not all have to be medically approved.

    The final rule also seeks to address a coverage gap for U.S. residents whose employers do not offer health insurance coverage for contraceptives and sets new standards for minors seeking care.

    The final rule originally was scheduled to take effect May 3. However, federal judges in California, Oregon, and Washington issued preliminary injunctions blocking the final rule. The administration appealed each of those injunctions.

    In June, a three-judge panel for the 9th U.S. Circuit Court of Appeals ruled unanimously to allow the final rule to take effect as the administration challenges the preliminary injunctions. The panel in their ruling wrote that the final rule is "reasonable interpretation" of Title X and the administration likely will be successful in showing the final rule should be upheld.

    In response to the panel's ruling, a number of abortion-rights advocates, including Planned Parenthood, as well as 20 U.S. states and the District of Columbia filed a request for an emergency stay of the ruling. However, in a 7-4 vote issued last week, an en banc panel of the 9th U.S. Circuit Court of Appeals upheld the June decision, meaning the rule could take effect. California, Oregon, and Washington, have requested the appeals court revisit its decision, and the court is doing so on an expedited basis.

    Trump admin says it has begun enforcing final rule

    In the meantime, the administration has started enforcing the final rule in line with the en banc panel's initial ruling.

    Diane Foley, head of HHS' Office of Population Affairs, on Monday told Title X grantees that the most recent court ruling meant many of the final rule's provisions have taken effect, including its provision requiring that any family planning services funded through Title X be financially separated from abortion services.

    The final rule's requirement that Title X-funded services and abortion services be performed in separate facilities will not take effect until 2020, The Hill reports.


    Planned Parenthood on Monday called the final rule a "gag rule" against doctors that is designed to remove abortion providers from the Title X program. The organization said it will not comply with the new rule and plans to fight it in court.

    Planned Parenthood President Leana Wen on Monday said the organization will use emergency funding to continue operating. "While we are incredibly concerned by this harmful rule, our doors are still open," Wen said. She added, "We will not stop fighting for all those across the country in need of essential care. Planned Parenthood will not stop working to block this dangerous and unethical rule that allows the government to censor our doctors and nurses from doing their jobs."

    Julie Rabinovitz—president and CEO of Essential Access Health, a Title X grantee in California that filed a lawsuit challenging the rule—said she is "disappointed" that HHS would implement the final rule "and jeopardize access to care while we are still in the early stages of the judicial process" (Diamond, "Pulse," Politico, 7/16; Hellmann, The Hill, 7/15).

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