July 22, 2025 • 45 mins
Find part 1 of this episode here.
In April 2025, some organizations and health centers receiving Title X funding were given sudden notice by the current administration that critical funding would be withheld. This action by the federal government threatens roughly $65.8 million in Title X funds and implicates an estimated 846,000 patients. It has resulted in massive layoffs, stopped contracts, mental strain, and confusion for both employees and patients. As patients are not receiving the care they need due to a stop in funding, possible results could include rising rates of unintended pregnancies, rising rates of STIs, poorer maternal health outcomes, and later diagnoses of breast and cervical cancers.
We sit down with CEOs and executive directors of some of these impacted organizations, including:
Stephanie McDowell, Executive Director of Bridgercare in Montana
Ayana Bradshaw, President and CEO of AccessMatters in Pennsylvania
Amy Moy, Co-CEO with Essential Access Health in California and Hawaii
For more information, check out Well...Adjusting: https://podcasts.apple.com/us/podcast/well-adjusting/id1649386566
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (00:03):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
Hi, rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I have dropped a bigball the last two weeks for you.
I'm so sorry.
(00:24):
We had big and exciting news.
And if you weren't following uson social media, you don't know
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(00:47):
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Never miss out on a moment likethis again.
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have designs from our in-housedesigner, which was our previous
(01:31):
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Y'all, I love all of it somuch.
I have been, keep going back onwhat I want to prioritize for
ordering myself first and notbuy all the things because
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(01:54):
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You can find us on Bonfireagain.
The link is in the show notes.
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(02:15):
You may have seen the designsbefore.
If you have seen us out andabout, it's our really great
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Super cute.
Liberal Jane, as always, doessuch an amazing job designing
(02:35):
things.
I hope y'all will go and checkout the store and buy yourself
some stuff so you can rock yourrePROs Fight Back swag out in
the world.
That is the biggest thing.
And y'all, it launched onearlier this month and it
really, as I recorded my intros,I felt like I had all these
other things to talk about andkept forgetting to tell you
(02:56):
about the store.
I am so sorry.
But please, please check itout.
I hope you love the stuff asmuch as we all do I guess maybe
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if you also want to support usby donating you can do that as
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If you donate $25, you get ourarray of wonderful stickers
(03:17):
that Liberal Jane designed.
For $50, you get the stickersand the bag that says abortion
is human right not a dirty word.
Or you can go buy the stuff onthe merch store although the
stickers aren't in the merchstore because bonfire didn't
have a stickers option.
So, if you want stickers, theonly way to get them is by
donating specifically throughour website.
So yeah, I hope you enjoy allthat.
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If you love the podcast, itwould be really great if you
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It helps other people find andenjoy the podcast.
Okay, I feel like that isenough.
(04:00):
Mostly, I'm just still superexcited about the store.
It still feels pretty surreal.
Thank you to the people whohave already bought things.
We're very excited to see that.
And I hope you all will checkit out as well.
I think I'm going to keep theintro really short and maybe not
talk about anything else.
We have a wonderful episode.
We have three more Title Xproviders coming on to share
(04:23):
their stories about theirfunding being frozen by the
Trump administration.
And so, I think I'm just goingto turn the episode over to them
so you can hear from them whatthis funding freeze has meant
for them.
And this is a really importantmoment and to think about how
(04:55):
they are all working together toprevent those who are the most
marginalized from accessingsexual and reproductive health
care services.
So with that, let's turn to theamazing Title X providers who
shared their stories with us.
Stephanie (05:11):
Hi, my name is Stephanie McDowell.
My pronouns are she/her.
I'm the executive director ofBridger care and Montana Family
Planning.
First, as a fan of the pod,this is so cool.
I think most people wouldn'tconsider my job glamorous,
though I totally love my job, sothat's okay.
But today feels pretty dangglamorous, so that's really cool
(05:32):
to have our story shared onthis platform.
So, thank you again for havingme today.
First, I want to explainMontana Family Planning and
Bridgercare and what we do.
So, Bridger care has served asa subrecipient of Title X
funding since 1972, and we tookover management of the Family
(05:54):
Planning Clinic Network inMontana in 2022 and protected
access to care for over 15,000patients annually when we did
that.
So, Bridgercare not onlysupports 20 clinics to provide
care across the state, but weare also a direct service
provider in Bozeman, Montana,and we serve over 5,500 patients
(06:15):
a year.
55% of our patients receiveservices on the sliding fee
scale.
So, we feel really fortunate tohave the experience of being
direct service providers, whounderstand what the other 19
clinics in our state experienceas sexual and reproductive
health care experts every day.
Bridgercare's Title X programis called Montana Family
(06:39):
Planning.
And we started this programwhen Bridgercare competed the
state of Montana for the Title Xgrant in the year 2021, after
Montana's legislature passed abill that was in direct conflict
with the terms of the federalTitle X grant.
So, in winning the Title Xgrant in Montana, we were able
(07:01):
to protect funding for our 20clinics across Montana.
And so, that means thatBridgercare receives $2 million
from the federal government eachyear to support 20 clinics
across the state of Montana,including our own Bridgercare,
or Planned Parenthoods and somesmaller rural clinics spread
(07:23):
around the state.
These clinics provide serviceslike birth control, annual
wellness exams, STI testing andtreatment, options counseling
for pregnancy, infertility care,cancer screening, biological
pain management, and more.
And all of the Title X servicesare offered on a sliding fee
(07:45):
scale with the fees that arebased on patient's income.
So, Montana Family Planning isBridgercare's program and is
Montana's statewide network offamily planning clinics that
provide access to sexual andreproductive health care.
We focus on removing barriersso that everyone can receive the
high quality care they deserve.
And we do this with federalTitle X money.
(08:07):
So, Title X is the nation'sonly dedicated source of federal
funding for family planningservices.
And the mission is simple.
It's to provide high qualitysexual and reproductive health
services for people who areuninsured or who have low
incomes who may otherwise lackaccess to health care.
So annually, the National TitleX Network provides health care
(08:31):
to nearly 4 million adults andteens.
And Title X is administered bythe Federal Office of Population
Affairs within the U.S.
Department of Health and HumanServices.
So, the challenge that we arefacing at Bridgercare and
Montana Family Planning and our20 clinics is that we have been
operating without federalfunding for three months now.
(08:51):
So this is critical,life-changing care that has a
profound impact on our patients.
And every day that it isthreatened impacts real people
in Montana.
In Montana, the Title X Networkis comprised of, as I
mentioned, 20 clinics whoprovide expert information
safety net care to over 15,000Montanans a year.
(09:14):
And the vast majority of thosepatients are people who are low
income between the ages of 18and 45.
And alarmingly, 60% of thewomen who received contraceptive
services from our network hadno other contact with the
healthcare provider that year.
So we are the only source ofcare for 60% of the patients who
(09:37):
sought care with us.
In Montana, 51 out of 56counties are considered
healthcare provider shortageareas.
So the loss of Title X fundingtruly threatens to create
devastating gaps in care in ourstate.
I am happy to say that despitethe funding freeze,
(09:59):
Bridgercare's network of 20clinics continues to provide
services with the support ofprivate donations.
So, we have not had to closeany of our clinics or lay off
any staff thanks to the supportof private donations.
So, so grateful for our alliesand supporters out there.
And we really want our patientsto know that we are still
(10:20):
providing care and they are ourpriority.
Right now, our primary concernis ensuring that access to
family planning and sexual andreproductive health care is
uninterrupted for our mostvulnerable Montanans.
We don't want them to beimpacted by these power grabs in
Washington.
So BridgerCare and our networkof 20 family planning clinics
(10:43):
across Montana, we providecontraception and other sexual
and reproductive health servicesto people who want it but can't
afford it.
So this is, again, critical,life-changing care, and it has a
profound impact on ourpatients.
So, Title X has really servedas the cornerstone of safety net
(11:03):
care for millions of peopleacross the US by providing
contraceptive access that helpspeople avoid pregnancies they do
not want and to plan and spacepregnancies they do want.
And in 2023, 83% of Title Xclients had family incomes at or
below 250% of the federalpoverty level.
(11:24):
So this really matters becausehigh quality sexual and
reproductive health careempowers people to make
decisions that are right forthem.
It's central to their abilityto make decisions about their
lives, including when or whetherto consider having children.
And annually, we also providepreventative and sexual and
(11:45):
reproductive health care,including in Montana, over 4,100
clinical breast exams per year,over 3,600 screenings for
cervical cancer, and over 21,000screenings for STIs.
So, not only are we helpingpeople decide when or whether to
(12:05):
consider having children, we'realso helping them with their
healthcare, preventativehealthcare and screenings that
they need.
Services are alwaysconfidential and are provided at
low or no cost.
We have 20 clinics across thestate.
Most of them are small ruralhealth departments, but we also
have independent nonprofits likePlanned Parenthoods and
(12:28):
community health centers in ournetwork.
You can find a clinic near youby visiting our website at
www.montanafamilyplanning.org,if you're in Montana or in a
nearby state.
The services that are offeredat each of our clinics might
vary, and some offer additionalservices that go above and
beyond the basics.
(12:49):
While most of our clinicsaccept walk-ins, we encourage
you to call ahead just to makesure that the staff and the
services you need will beavailable.
And then we also providelanguage translation that's
available free of charge topeople who need it.
All of our clinics serve allidentities.
So, we work to be free fromdiscrimination.
(13:11):
That's just our starting point.
We work every day to make ourclinics more welcoming, safe,
and inclusive, and prepare tocare for people of all
identities.
We also serve people of allincomes.
So, Title X is really intendedto remove cost barriers to high
quality sexual and reproductivehealth care.
And services are alwaysprovided on a sliding fee scale,
(13:32):
which is based on your income.
So whether you make zerodollars or a million dollars,
our clinics will serve you.
And we serve clients with orwithout insurance or Medicaid
and really clients across thesocioeconomic spectrum.
So if you don't have insuranceor Medicaid or you can't use it
for some reason or if a serviceisn't covered, we'll make sure
(13:55):
that the cost doesn't preventyou from receiving the care you
need.
There's also a misconceptionthat people who need insurance
healthcare or have insurance orcan afford healthcare, that they
should go somewhere else.
And really that's not true.
We love it when our patientsstay with us throughout their
lives, if that's what they wantto do and if they like their
(14:16):
care.
Their insurance coverage andtheir payments help support care
for people who can't afford itor who don't have insurance.
And to give you an idea ofthis, in the Montana Family
Planning Program, 30% of ourpatients don't have insurance.
25% of our patients are onpublic insurance like Medicaid,
and then 44%have private insurance, so we do see a lot of people who have insurance coverage. And it’s really important to point this out because a) what I mentioned before, you can still come to us with insurance, just like you can if you don’t have insurance, and b) many people still can’t afford healthcare because of high deductibles or co-pays. So, we really want folks to know that we will meet them where they are and provide the care that they need.
(14:39):
And then lastly, our patients'privacy is really important to
(15:08):
us.
We take privacy seriously.
We offer unparalleledconfidentiality protections for
clients who need them.
We help you understand whetherbilling insurance could limit
your privacy.
And then we help you go theextra mile to make sure it's not
minors.
So, people under 18 do not needparental permission to seek
care at a Title X clinic inMontana.
(15:29):
And nobody needs agovernment-issued ID or to be a
U.S.
citizen to access our care.
So, this freezing of thisfunding for a state like Montana
really does have a profoundimpact.
We are a very rural state.
To give you an idea, we have7.7 people per square mile in
(15:50):
our state.
Our clinics are reallystrategically spread across the
state to ensure that people whowant birth control but can't
afford birth control have accessto quality care.
And I do want to share somestories from our clinics just to
give you an idea of the peoplein our state providing care, but
also some of the patients thatwould be impacted by these
(16:14):
funding freezes.
So, one rural clinic was ableto accommodate a new client who
needed an urgent appointmentbecause their IUD was expelling.
The client had just moved toMontana and drove multiple hours
for their visit, which is acommon experience in this part
of the state, and they werethrilled to get the care that
(16:34):
they need when they needed it.
Another rural clinic is sharingthat they're seeing a lot of
clients coming in with babiesand young children in tow, and
the staff go the extra mileholding and watching kids during
appointments so that theclients can get the care that
they need.
Sometimes clinics say they stayopen late or they open early to
(16:55):
accommodate people with workschedules that conflict with
traditional clinic hours.
We see teens coming in that arenervous and scared.
So, our clinics help them withpaperwork and filling out their
sliding fee scale so they knowthey will not have to pay
anything or not to worry aboutconfidentiality.
And often by the time theyleave, they're confident and
(17:16):
secure and they are relieved tohave our services and be able to
get the birth control from usat no charge or on their own
terms.
We support clients facingintimate partner violence to
access care on their terms andin the way they decide they need
support.
This often means findingcontraception or making
referrals for additional carethat can be kept concealed or
(17:38):
private.
We provide education in ourcommunities and answer questions
like, How do I know if I'm gay?
How do I know if I have an STI?
What do I do if I think I'mpregnant?
And we respond with values,neutral answers, and we empower
people with medically accurateinformation to make decisions
that are right for them.
(17:58):
So in Montana, we make room forall sorts of beliefs about
family planning andcontraception that are
patient-centered.
Many of our rural Montanafamily planning clinics have
recently had physicians fromtheir local hospitals calling to
get help diagnosing STIsbecause our clinics are
considered experts in thesetopics.
(18:18):
One of our clinics had apatient travel two hours for
care because she knew her visitwould be kept private and she
loved her clinician.
Another rural Montana familyplanning clinic also shared a
story about a teen patient whocame in to get birth control
several years ago and since thenhas brought in multiple teen
friends to access care.
(18:39):
And the clinic said that manyof the teens had come in with
her, were timid and nervous atfirst, and so she would help
them with their intake andpaperwork.
And by the end of theappointment, the teens were
feeling empowered and werespeaking out about their own
wants and needs.
And so, I share these storiesbecause these clinics are full
(19:00):
of people who care about theirpatients and their communities.
And their patients are realpeople who are impacted by the
care they receive.
These are people who want birthcontrol and sexual and
reproductive health care, butthey can't access it because of
cost or where they live.
And so ultimately, Title Xcreates access to full bodily
(19:22):
autonomy for people who werepreviously not able to access it
because of economic reasons.
And everyone who cares aboutcontraception should care about
Title X.
So, thank you for having me ontoday and listening and learning
more about Bridger care andMontana Family Planning.
(19:43):
Sending lots of care out to ourlisteners.
Take care of yourselves.
We need you all.
Thank you.
Ayana (19:51):
Hi, thank you so much for the opportunity to speak with
you today about Title X andspecifically about the
withholding of our Title Xfamily planning funding in our
region.
So, my name is Ayana Bradshaw.
I am the president and CEO ofAccess Matters.
We are a nonprofit organizationlocated in Philadelphia,
(20:13):
Pennsylvania.
And our mission is to protect,expand, and enhance access to
sexual and reproductive healthcare and information for all
people.
And we have had the honor andthe privilege of administering
the Title X family planningfunding in our region for over
50 years.
For over 50 years, we've hadthe privilege of partnering with
(20:34):
trusted healthcare providers.
And we are in the five-countyarea of southeastern
Pennsylvania to ensure thatpeople, regardless of their
income, regardless of theinsurance status or their
background, can access the carethey need to live healthy and
full lives.
But right now, our community isfacing a significant crisis
(20:55):
without warning.
This was on March 31st.
I remember the minute that thishappened.
Our Title X funding waswithheld pending federal review.
So, that's almost three monthsthat we have not had this
funding.
And that decision has alreadyhad such devastating
consequences, not just for ourorganization, but for the
(21:17):
providers, the staff, and thethousands of patients across
southeastern Pennsylvania thatrely on these services.
At Access Matters, we'veactually had to temporarily lay
off team members.
These are amazing people,dedicated people who have spent
their careers supportingcommunity health.
But the impact goes evenfurther.
Our provider network, andthat's our clinics, our health
(21:40):
centers that we fund, they arealso grappling with making
similar heartbreaking decisionsrelated to laying off staff,
hours being cut, And what wouldbe most detrimental is if some
of our clinics are forced toclose.
And the patients, well, they'rethe ones who are going to bear
the brunt of all of this.
So as I mentioned, we support afive-county area in
(22:03):
southeastern Pennsylvania.
So, that means that we supportPhiladelphia, Montgomery,
Chester, Delaware, and Buckscounties.
This is a region inPennsylvania that already
struggles with healthdisparities.
Many of the people that weserve, they face
disproportionate barriers tocare, whether or not that's due
to income, lack ofinsurance....we know that there
(22:23):
are racial inequities,transportation issues.
And Title X has been one of thefew programs that they could
count on.
And not everyone knows this,but Title X is not just about
birth control.
It funds a wide range ofessential health services.
So, when you think of thingslike STI testing and treatment,
(22:46):
cancer screenings, reproductivelife planning, health education,
so much more, it's oftentimesthe first point of contact that
someone has with the healthcaresystem.
I like to say it's a gateway.
And through that first visit,providers are often identifying
other issues so if you thinkabout it as you're going into a
(23:07):
clinic for a first time you mayfind out that you have high
blood pressure or providers mayidentify depression and food
insecurity and housinginstability, and really truly
help connect people to thesupport they need.
So, these visits are more thanjust medical care, they are a
gateway to stability.
And here's something else thatpeople may not realize, but
(23:31):
Title X guaranteesaffordability.
So, under this program, anyoneliving at or below the federal
poverty level receives care andthey get it free of charge,
completely free of charge.
And for those that are justabove that threshold, clinics
are using sliding fee scales.
So, that means that a patientis charged based on what they
can actually afford.
No one is going to be turnedaway because they don't have the
(23:53):
money.
But now, where we are rightnow, with this withholding, with
these funds being withheld,clinics may no longer be able to
honor that promise.
If they can't offer the slidingscale or if they lose the
support that allows them tooffer free care, people who are
already struggling, do you thinkthey're going to pay for this
care?
They're going to stop seekingcare altogether.
(24:14):
It also affects access toaffordable prescriptions.
So, many Title X providersparticipate in a program called
340 drug pricing.
This is a program that allowsproviders to offer discounted
medications.
So, that can include thingslike birth control and HIV
prevention medications like PrEPand PEP and other essential
(24:36):
prescriptions.
And so if you don't have theTitle X designation, then many
of those clinics are going tolose access to 340B pricing.
That means that their patientswill lose access to medications
they need to stay healthy.
And we know this is alreadyhappening.
We've talked to our providers.
They are so concerned abouttheir patients who no longer can
(24:57):
afford these prescriptions.
This is also gonna hit maternalhealth really hard, and
especially Black maternalhealth.
So in Pennsylvania, Black womenare more than twice as likely
to die from pregnancy-relatedcauses than white women.
And we know that Title X helpsto fight that disparity.
Title X allows for earlyscreenings, it allows for
(25:18):
preventive care, and it alsohelps to connect women in
maternal health services.
And so pulling this fundingnow, that only deepens those
inequities.
I want to go even beyond theindividual, because we know that
impact of the individuals.
But what may not be realized isthat this actually hurts our
economy.
So, for every dollar investedin Title X, we save about $7 in
(25:42):
downstream costs.
It helps people stay in school.
It helps people participate ina workforce, plan their futures.
So when we pull support likethis, we're not just cutting
care, we're actually cuttingopportunity.
And this is where the advocacycomes in because at Access
Matters, every single day sinceMarch 31st, we have been
advocating for the reinstatementof these funds.
(26:05):
It's not just for us, but it'sfor the providers and the
patients who rely on them.
But we need more people tounderstand what's at stake.
I always say that Title X isthis silent program.
For decades, Title X has beenquietly protecting our
communities.
And because it's been here forso long, I don't think a lot of
people even realized what it wasor how much it did.
(26:28):
But now is the time foreveryone to pay attention.
We all need to pay attentionbecause if we don't act, the
consequences are going to ripplefor years.
We know that there are going tobe more untreated infections.
There are going to be more latestage cancers.
There are going to be moreunplanned pregnancies, more
preventable deaths.
(26:48):
More people are going to fallthrough the cracks.
And so that's why I'm sograteful for this opportunity
today, for this platform,because we need multiple voices
talking about this.
We need multiple peopleadvocating about this.
And we need our Title X fundingrestored.
We need it now.
Thank you so much for thisopportunity.
(27:10):
Again, I am truly grateful.
Amy (27:14):
I'm Amy Moy, co-CEO at Essential Access Health, and our
organization advancesreproductive equity and
champions high quality,equitable access to sexual and
reproductive health care forall.
We have been a Title X granteesince the program was
(27:34):
established about 55 years agoby Congress with bipartisan
support.
And we have been the proudTitle X grantee in the nation
with the largest Title X systemin the country.
Our California providernetwork, which we have been the
grantee for the state since theprogram was established, has
(27:58):
over 60 healthcare organizationsin our network.
And we have the privilege andhonor of being able to serve as
the Title X grantee in the stateof Hawai'i ever since 2022.
Collectively, the Hawai'i andCalifornia Title X networks
provide care to over 500,000patients at more than 300
(28:22):
healthcare sites.
The Trump administration'sdecision to withhold our Title X
awards for California andHawai'i was unlawful and
unprecedented and causedimmediate harm.
The impact that we felt overthe last three months when no
Title X funds have been comingto Essential Access Health or
(28:45):
the extensive provider networkwe support has been devastating.
There have been difficultdecisions to be made around our
staffing structure and we knowthat the healthcare
organizations that we fund havehad to similarly look at what
(29:05):
decisions need to be made ifthese funds were not released.
We know that more than ninetypercent of the Title X funding
that is received in the Hawai'iand California provider network
supports their critical staffinginfrastructure.
And without Title X funds, ourTitle X network providers have
(29:30):
reported that there would be areduction in the health care
workforce.
And we know that many serviceareas in Hawai'i and California
were already facing providershortages and contraceptive
deserts.
Many of the Title X providersalso use those funds for
community outreach and educationthat links patients to care.
(29:54):
And without Title X funding, alot of those activities were
halted and there was a need toconsider either eliminating in
full or drastically reducingsome of that programming.
We also know that Title X fundsare critical in ensuring access
(30:15):
to care, particularly for thosewho face barriers to getting to
a health center.
Title X funds can supportmobile clinics to do outreach in
underserved populations andneighborhoods without a brick
and mortar health center.
Title X funds also supportextended clinic hours and teen
(30:39):
clinic hours for patients thatmight have difficulty coming
during some regular nine to fivehours.
They support transportation toclinics.
So, these funds are so criticalto ensure and support the
delivery ofhigh quality sexual and reproductive health services. The funding also supports provider training and supports to make sure that access to best practices and the highest quality care is available for patients who rely on Title X-funded health centers and Title X funding for care.
While we are greatly relievedthat now with the release of
(31:19):
funding for essential access forour Title X award, that release
of funding is a necessary andoverdue step, but it doesn't
erase the harm that was causedby this arbitrary, illegal, and
immediate withholding of thecritical resources in the first
place.
And while we're greatlyrelieved that we will be able to
(31:40):
get these vital funds out tothe field, and we are going to
be working as hard as we can toget these vital funds out as
quickly as possible, we knowthat also this may be a
temporary reprieve.
We also know that thewithholding of Title X funding
didn't happen in a vacuum, thatwhile the release of Title X
(32:03):
awards for California andHawai'i is a glimmer of hope and
good news for the providers andpatients who rely on this
critical funding source, we knowthat this is also coinciding
with other threats and actionsthat are creating
distress, duress, and disruptions to accessing time-sensitive sexual and reproductive health care, particularly for patients with lower incomes, including the sweeping reconciliation bill that was just signed into law that slashes Medicaid, targets trusted providers, and takes away health care from an estimated 17 million people.
(32:31):
And we also know that studiesshow that more than 70% of
family planning services isactually covered by Medicaid.
(32:52):
So, cuts to Medicaid, trustedproviders being carved out and
unable to be able to providecritical care for patients that
rely on Medicaid for coverage ofthese vital health services
is also going to be devastatingto the family planning system.
(33:14):
And we also know that while therelease of some of the family
planning dollars is a relief forthe moment, and we know that
the process by which it waswithheld was wrong.
And the administrationbasically did the wrong thing,
the wrong way.
These actions also come againsta backdrop of other
(33:36):
unprecedented and ongoingattacks and the future of Title
X and also access tocontraception remains at risk
nationwide.
We know that there's thepotential for new program
regulations that may hinder andput a question around what
(33:57):
services may be provided orcovered under the Title X
program, what entities may beeligible for Title X funding in
the future, and just the scopeand breadth of the program is in
question under thisadministration and Congress.
The president's budget proposalincluded elimination of the
(34:20):
Title X program completely.
And we are also waiting to seehow Congress moves forward with
their appropriations process tosee how Title X funding is going
to be handled in theirappropriation process for fiscal
year 25 to 26.
So, the withholding of funds isone piece that was and
(34:43):
continues to be something thatwe did not expect for its
unprecedented nature, kind ofmidstream funding being
withheld, released for some, notfor others without clear
process or indication and awithholding of funds without any
cause or ability to be able tomake any potentially needed
(35:06):
action that might be needed forcorrective action.
And we are just moving forwardwith these funds as best as we
can now, while also being verythankful that state legislative
leaders in California andHawai'i and under the leadership
of Governors Newsom and Greenrecognize the important role
(35:29):
that family planning servicesplay in our individual, family,
and community health andwell-being, as well as our
economic security.
And they move forward with howhaving an allocation for state
investments in these vitalservices to be able to support
the family planning providersafety net over the coming year,
(35:52):
as well as being able tosupport the patients that rely
on services that they need thatwe know are time sensitive,
including contraception, STIprevention and treatment, and
even cancer screenings.
I think moving forward, what weare hoping is that we will be
able to communicate with ourcongressional leaders, continue
(36:16):
to hopefully have dialogue withthis administration, as well as
state leaders and our communitypartners about the value of
Title X and how critical it isto continue to protect this
vital program and ensure thatpatients can get the family
planning care they need when andwhere they need it from the
(36:39):
providers that they trust intheir local communities.
I think it's also important tonote that the health centers and
many organizations that aredirect Title X grantees, it's
not only Title X.
Many of these healthcareorganizations receive multiple
federal grants because of thepiecemeal nature of our federal
(37:03):
funding system, our healthcaresystem.
You have the big behemoth ofMedicaid that is covering, and
it varies, of course, by state,the number of people and their
income eligibility, but coveringsome level of direct service
for many folks with lowerincomes, but then we know that
(37:25):
Medicaid rates and reimbursementrates do not cover the full
cost of providing care.
And we know that not everybodyis eligible to receive Medicaid
across the country who may be inneed of support and care that
may be otherwise unaffordable tothem.
So, what is happening now withthe cuts to Medicaid, the
(37:49):
threats and withholding of TitleX funding, it's also on top of
withholding of benefits, RyanWhite [HIV/AIDS] funding or
other critical funding sourcesthat make up, that are the
patchwork of our healthcaredelivery system.
And what we're seeing acrossthe board is not only at this
(38:10):
time our funds being abruptlywithheld with some level of
notification, some funding andnotices of award are just being
delayed and not even without anynotice or justification or
reason.
Just for example, the CDCreleased some notice of awards
(38:35):
for HIV prevention for a programperiod that was set to start
June 1.
There was no notice, there wasno indication of when or if
these notices of awards werecoming.
So these are just two examplesin a broader healthcare system,
also with patients and providerssuffering the stress of of
(38:56):
worrying about will ICE agentsarrive at their health centers?
Is this a safe place to go?
Will patients still come to getthe care that they need?
All of these things arehappening at once and it's
somewhat of a perfect storm outthere.
So, while maybe some healthcenters could navigate some
(39:19):
level of instability with TitleX funding, Title X funding
alone, it's that it's also...
and for some, it's absolutelydevastating if they don't have
other sources of resources tohelp provide these care, but
it's also happening on top ofall of the other things.
One other thing to note is evenwhen notices of awards are
(39:43):
granted and there's technicallymoney for organizations in the
grants management system, wealso have heard across the board
delays in being able to drawdown the funding that's been
awarded.
And so, the consistency andreliability of this funding is
(40:03):
just not existent.
And this has really real-worldimplications as you mentioned
when it comes to keeping doorsopen keeping inventory of
contraceptive methods on theshelf and available, keeping
staff.
And then we know that there arehealthcare shortages.
(40:24):
So when we have these momentsof crisis, we have a breakdown
of the system that gets harderand harder to rebuild.
This is a time of...
and it does seem to be somewhatinteresting...
for the folks that still havetheir funding being withheld,
not having any specific clearguidelines or timelines for
(40:49):
having to receive it, it'sawful.
Our hearts are with colleaguesthat are continuing to have the
funding.
But I do think that this hasbeen a wake-up call for a field
that since 1970 has largelyrelied on this funding stream,
that it's really time to thinkdifferently, to show up
(41:11):
differently, to focus energy inother ways, to think about if
the goal is making sure thatpeople have access to the family
services they want and need.
What are the other ways that wecan do that?
Because, you know, this kind ofcycle of the pendulum shifting
(41:32):
when it comes to these federalfunds, it's just, it's no way to
live.
You know, we need to kind of bethinking bigger and beyond
that.
Title X and also be thinkingabout when we have moments when
the Title X federal funding isat risk, when the purpose and
intent of the program is beingthreatened and could be reshaped
(41:58):
in a way that is not inalignment with the purpose and
intent of the program by whichCongress established in statute.
We also have to be thinkingabout the future, that while
Title X is a critical resource,We also know it was created in
1970.
There are ways that we can andshould be thinking about this
(42:19):
program differently to meet amodern healthcare system, to
really meet the needs ofpatients and providers.
And so, I think it's alsoimperative and incumbent on the
field as well as in those whocare about family planning
services to be thinking about: how do we minimize risk in this (42:36):
undefined
moment?
How do we maximize Title Xfunding and protect it for as
long as we can, while alsoenvisioning and being prepared
for a moment in time knowing thecyclical nature of these things
when we can hopefully envisionand shape a stronger program.
Jennie (43:02):
Okay, y'all.
I hope you enjoyed hearing fromthe Title X providers.
I'm so grateful to NFPRHA forhelping us put this episode
together.
They gave us a great collectionof providers from all over the
country to talk about theirissues.
I'm just so grateful for NFPRHAfor that help and to all of the
providers who stood up to telltheir stories.
So, thank you all.
And with that, don't forget tocheck out our merch store.
(43:25):
The link is in the show notes.
Otherwise, you can find us onBonfire by searching for "rePROs
Fight Back." And with that, Iwill see everybody next week.
[music outro] If you have anyquestions, comments or topics
you would like us to cover,always feel free to shoot me an
email.
You can reach me at jennie@reprosfightback.com or you can
(43:46):
find us on social media.
We're at rePROs Fight Back onFacebook and Twitter or
@reprosfb on Instagram.
If you love our podcast andwant to make sure more people
find it, take the time to rateand review us on your favorite
podcast platform.
Or if you want to make sure tosupport the podcast, you can
also donate on our website atreprosfightback.com.
(44:07):
Thanks all!
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health, rights, and
justice.
Hi, rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I have dropped a bigball the last two weeks for you.
I'm so sorry.
(00:24):
We had big and exciting news.
And if you weren't following uson social media, you don't know
about it.
Oh my goodness, I'm so sorry.
But that is one, a reminderthat you should absolutely be
following us on social media.
You can find us at rePROs FightBack on Facebook, Blue sky, and
Twitter, and at @repros fb onInstagram.
(00:47):
So, find us there.
Never miss out on a moment likethis again.
But anywho, the exciting newsis we've officially launched a
merch store.
Woo! That means you can get allof our really fun rePROs Fight
Back swag for yourself now onBonfire so if you go to Bonfire
and search up "rePROs FightBack," it'll pull up our merch
(01:09):
and you can go to our specificpage on Bonfire we'll have links
in the show notes and we haveso many fun things we have mugs
and water bottles and t-shirtsand bags and these cute little
pouches and we have designs fromLiberal Jane that we have that
you may have seen if you've seensome of our stickers before We
have designs from our in-housedesigner, which was our previous
(01:31):
bag design, which is "abortionis a human right, not a dirty
word." You can order all ofthese things for yourself now.
Y'all, I love all of it somuch.
I have been, keep going back onwhat I want to prioritize for
ordering myself first and notbuy all the things because
seriously, I can't buy all thethings at once.
But I'm going to go and buy acouple of things for myself
(01:54):
because I'm so excited to rocksome of this great rePROs Fight
Back swag out in the world.
So, I hope you will as well.
You can find us on Bonfireagain.
The link is in the show notes.
And if you are following us onsocial media, we've also shared
it there as well.
So yeah, make sure to check outour really fun swag.
It's really great.
(02:15):
You may have seen the designsbefore.
If you have seen us out andabout, it's our really great
stickers that we have, fun toThank you so much.
Super cute.
Liberal Jane, as always, doessuch an amazing job designing
(02:35):
things.
I hope y'all will go and checkout the store and buy yourself
some stuff so you can rock yourrePROs Fight Back swag out in
the world.
That is the biggest thing.
And y'all, it launched onearlier this month and it
really, as I recorded my intros,I felt like I had all these
other things to talk about andkept forgetting to tell you
(02:56):
about the store.
I am so sorry.
But please, please check itout.
I hope you love the stuff asmuch as we all do I guess maybe
let me think if there's anyother housekeeping...
if you also want to support usby donating you can do that as
well.
If you donate $25, you get ourarray of wonderful stickers
(03:17):
that Liberal Jane designed.
For $50, you get the stickersand the bag that says abortion
is human right not a dirty word.
Or you can go buy the stuff onthe merch store although the
stickers aren't in the merchstore because bonfire didn't
have a stickers option.
So, if you want stickers, theonly way to get them is by
donating specifically throughour website.
So yeah, I hope you enjoy allthat.
(03:40):
And I guess the only other lastthing I would share around
housekeeping is I feel like it'salso been a while since we
talked about rating andreviewing.
If you love the podcast, itwould be really great if you
could drop us a rate or reviewand whatever podcast platform
you are listening on.
It helps other people find andenjoy the podcast.
Okay, I feel like that isenough.
(04:00):
Mostly, I'm just still superexcited about the store.
It still feels pretty surreal.
Thank you to the people whohave already bought things.
We're very excited to see that.
And I hope you all will checkit out as well.
I think I'm going to keep theintro really short and maybe not
talk about anything else.
We have a wonderful episode.
We have three more Title Xproviders coming on to share
(04:23):
their stories about theirfunding being frozen by the
Trump administration.
And so, I think I'm just goingto turn the episode over to them
so you can hear from them whatthis funding freeze has meant
for them.
And this is a really importantmoment and to think about how
(04:55):
they are all working together toprevent those who are the most
marginalized from accessingsexual and reproductive health
care services.
So with that, let's turn to theamazing Title X providers who
shared their stories with us.
Stephanie (05:11):
Hi, my name is Stephanie McDowell.
My pronouns are she/her.
I'm the executive director ofBridger care and Montana Family
Planning.
First, as a fan of the pod,this is so cool.
I think most people wouldn'tconsider my job glamorous,
though I totally love my job, sothat's okay.
But today feels pretty dangglamorous, so that's really cool
(05:32):
to have our story shared onthis platform.
So, thank you again for havingme today.
First, I want to explainMontana Family Planning and
Bridgercare and what we do.
So, Bridger care has served asa subrecipient of Title X
funding since 1972, and we tookover management of the Family
(05:54):
Planning Clinic Network inMontana in 2022 and protected
access to care for over 15,000patients annually when we did
that.
So, Bridgercare not onlysupports 20 clinics to provide
care across the state, but weare also a direct service
provider in Bozeman, Montana,and we serve over 5,500 patients
(06:15):
a year.
55% of our patients receiveservices on the sliding fee
scale.
So, we feel really fortunate tohave the experience of being
direct service providers, whounderstand what the other 19
clinics in our state experienceas sexual and reproductive
health care experts every day.
Bridgercare's Title X programis called Montana Family
(06:39):
Planning.
And we started this programwhen Bridgercare competed the
state of Montana for the Title Xgrant in the year 2021, after
Montana's legislature passed abill that was in direct conflict
with the terms of the federalTitle X grant.
So, in winning the Title Xgrant in Montana, we were able
(07:01):
to protect funding for our 20clinics across Montana.
And so, that means thatBridgercare receives $2 million
from the federal government eachyear to support 20 clinics
across the state of Montana,including our own Bridgercare,
or Planned Parenthoods and somesmaller rural clinics spread
(07:23):
around the state.
These clinics provide serviceslike birth control, annual
wellness exams, STI testing andtreatment, options counseling
for pregnancy, infertility care,cancer screening, biological
pain management, and more.
And all of the Title X servicesare offered on a sliding fee
(07:45):
scale with the fees that arebased on patient's income.
So, Montana Family Planning isBridgercare's program and is
Montana's statewide network offamily planning clinics that
provide access to sexual andreproductive health care.
We focus on removing barriersso that everyone can receive the
high quality care they deserve.
And we do this with federalTitle X money.
(08:07):
So, Title X is the nation'sonly dedicated source of federal
funding for family planningservices.
And the mission is simple.
It's to provide high qualitysexual and reproductive health
services for people who areuninsured or who have low
incomes who may otherwise lackaccess to health care.
So annually, the National TitleX Network provides health care
(08:31):
to nearly 4 million adults andteens.
And Title X is administered bythe Federal Office of Population
Affairs within the U.S.
Department of Health and HumanServices.
So, the challenge that we arefacing at Bridgercare and
Montana Family Planning and our20 clinics is that we have been
operating without federalfunding for three months now.
(08:51):
So this is critical,life-changing care that has a
profound impact on our patients.
And every day that it isthreatened impacts real people
in Montana.
In Montana, the Title X Networkis comprised of, as I
mentioned, 20 clinics whoprovide expert information
safety net care to over 15,000Montanans a year.
(09:14):
And the vast majority of thosepatients are people who are low
income between the ages of 18and 45.
And alarmingly, 60% of thewomen who received contraceptive
services from our network hadno other contact with the
healthcare provider that year.
So we are the only source ofcare for 60% of the patients who
(09:37):
sought care with us.
In Montana, 51 out of 56counties are considered
healthcare provider shortageareas.
So the loss of Title X fundingtruly threatens to create
devastating gaps in care in ourstate.
I am happy to say that despitethe funding freeze,
(09:59):
Bridgercare's network of 20clinics continues to provide
services with the support ofprivate donations.
So, we have not had to closeany of our clinics or lay off
any staff thanks to the supportof private donations.
So, so grateful for our alliesand supporters out there.
And we really want our patientsto know that we are still
(10:20):
providing care and they are ourpriority.
Right now, our primary concernis ensuring that access to
family planning and sexual andreproductive health care is
uninterrupted for our mostvulnerable Montanans.
We don't want them to beimpacted by these power grabs in
Washington.
So BridgerCare and our networkof 20 family planning clinics
(10:43):
across Montana, we providecontraception and other sexual
and reproductive health servicesto people who want it but can't
afford it.
So this is, again, critical,life-changing care, and it has a
profound impact on ourpatients.
So, Title X has really servedas the cornerstone of safety net
(11:03):
care for millions of peopleacross the US by providing
contraceptive access that helpspeople avoid pregnancies they do
not want and to plan and spacepregnancies they do want.
And in 2023, 83% of Title Xclients had family incomes at or
below 250% of the federalpoverty level.
(11:24):
So this really matters becausehigh quality sexual and
reproductive health careempowers people to make
decisions that are right forthem.
It's central to their abilityto make decisions about their
lives, including when or whetherto consider having children.
And annually, we also providepreventative and sexual and
(11:45):
reproductive health care,including in Montana, over 4,100
clinical breast exams per year,over 3,600 screenings for
cervical cancer, and over 21,000screenings for STIs.
So, not only are we helpingpeople decide when or whether to
(12:05):
consider having children, we'realso helping them with their
healthcare, preventativehealthcare and screenings that
they need.
Services are alwaysconfidential and are provided at
low or no cost.
We have 20 clinics across thestate.
Most of them are small ruralhealth departments, but we also
have independent nonprofits likePlanned Parenthoods and
(12:28):
community health centers in ournetwork.
You can find a clinic near youby visiting our website at
www.montanafamilyplanning.org,if you're in Montana or in a
nearby state.
The services that are offeredat each of our clinics might
vary, and some offer additionalservices that go above and
beyond the basics.
(12:49):
While most of our clinicsaccept walk-ins, we encourage
you to call ahead just to makesure that the staff and the
services you need will beavailable.
And then we also providelanguage translation that's
available free of charge topeople who need it.
All of our clinics serve allidentities.
So, we work to be free fromdiscrimination.
(13:11):
That's just our starting point.
We work every day to make ourclinics more welcoming, safe,
and inclusive, and prepare tocare for people of all
identities.
We also serve people of allincomes.
So, Title X is really intendedto remove cost barriers to high
quality sexual and reproductivehealth care.
And services are alwaysprovided on a sliding fee scale,
(13:32):
which is based on your income.
So whether you make zerodollars or a million dollars,
our clinics will serve you.
And we serve clients with orwithout insurance or Medicaid
and really clients across thesocioeconomic spectrum.
So if you don't have insuranceor Medicaid or you can't use it
for some reason or if a serviceisn't covered, we'll make sure
(13:55):
that the cost doesn't preventyou from receiving the care you
need.
There's also a misconceptionthat people who need insurance
healthcare or have insurance orcan afford healthcare, that they
should go somewhere else.
And really that's not true.
We love it when our patientsstay with us throughout their
lives, if that's what they wantto do and if they like their
(14:16):
care.
Their insurance coverage andtheir payments help support care
for people who can't afford itor who don't have insurance.
And to give you an idea ofthis, in the Montana Family
Planning Program, 30% of ourpatients don't have insurance.
25% of our patients are onpublic insurance like Medicaid,
and then 44%have private insurance, so we do see a lot of people who have insurance coverage. And it’s really important to point this out because a) what I mentioned before, you can still come to us with insurance, just like you can if you don’t have insurance, and b) many people still can’t afford healthcare because of high deductibles or co-pays. So, we really want folks to know that we will meet them where they are and provide the care that they need.
(14:39):
And then lastly, our patients'privacy is really important to
(15:08):
us.
We take privacy seriously.
We offer unparalleledconfidentiality protections for
clients who need them.
We help you understand whetherbilling insurance could limit
your privacy.
And then we help you go theextra mile to make sure it's not
minors.
So, people under 18 do not needparental permission to seek
care at a Title X clinic inMontana.
(15:29):
And nobody needs agovernment-issued ID or to be a
U.S.
citizen to access our care.
So, this freezing of thisfunding for a state like Montana
really does have a profoundimpact.
We are a very rural state.
To give you an idea, we have7.7 people per square mile in
(15:50):
our state.
Our clinics are reallystrategically spread across the
state to ensure that people whowant birth control but can't
afford birth control have accessto quality care.
And I do want to share somestories from our clinics just to
give you an idea of the peoplein our state providing care, but
also some of the patients thatwould be impacted by these
(16:14):
funding freezes.
So, one rural clinic was ableto accommodate a new client who
needed an urgent appointmentbecause their IUD was expelling.
The client had just moved toMontana and drove multiple hours
for their visit, which is acommon experience in this part
of the state, and they werethrilled to get the care that
(16:34):
they need when they needed it.
Another rural clinic is sharingthat they're seeing a lot of
clients coming in with babiesand young children in tow, and
the staff go the extra mileholding and watching kids during
appointments so that theclients can get the care that
they need.
Sometimes clinics say they stayopen late or they open early to
(16:55):
accommodate people with workschedules that conflict with
traditional clinic hours.
We see teens coming in that arenervous and scared.
So, our clinics help them withpaperwork and filling out their
sliding fee scale so they knowthey will not have to pay
anything or not to worry aboutconfidentiality.
And often by the time theyleave, they're confident and
(17:16):
secure and they are relieved tohave our services and be able to
get the birth control from usat no charge or on their own
terms.
We support clients facingintimate partner violence to
access care on their terms andin the way they decide they need
support.
This often means findingcontraception or making
referrals for additional carethat can be kept concealed or
(17:38):
private.
We provide education in ourcommunities and answer questions
like, How do I know if I'm gay?
How do I know if I have an STI?
What do I do if I think I'mpregnant?
And we respond with values,neutral answers, and we empower
people with medically accurateinformation to make decisions
that are right for them.
(17:58):
So in Montana, we make room forall sorts of beliefs about
family planning andcontraception that are
patient-centered.
Many of our rural Montanafamily planning clinics have
recently had physicians fromtheir local hospitals calling to
get help diagnosing STIsbecause our clinics are
considered experts in thesetopics.
(18:18):
One of our clinics had apatient travel two hours for
care because she knew her visitwould be kept private and she
loved her clinician.
Another rural Montana familyplanning clinic also shared a
story about a teen patient whocame in to get birth control
several years ago and since thenhas brought in multiple teen
friends to access care.
(18:39):
And the clinic said that manyof the teens had come in with
her, were timid and nervous atfirst, and so she would help
them with their intake andpaperwork.
And by the end of theappointment, the teens were
feeling empowered and werespeaking out about their own
wants and needs.
And so, I share these storiesbecause these clinics are full
(19:00):
of people who care about theirpatients and their communities.
And their patients are realpeople who are impacted by the
care they receive.
These are people who want birthcontrol and sexual and
reproductive health care, butthey can't access it because of
cost or where they live.
And so ultimately, Title Xcreates access to full bodily
(19:22):
autonomy for people who werepreviously not able to access it
because of economic reasons.
And everyone who cares aboutcontraception should care about
Title X.
So, thank you for having me ontoday and listening and learning
more about Bridger care andMontana Family Planning.
(19:43):
Sending lots of care out to ourlisteners.
Take care of yourselves.
We need you all.
Thank you.
Ayana (19:51):
Hi, thank you so much for the opportunity to speak with
you today about Title X andspecifically about the
withholding of our Title Xfamily planning funding in our
region.
So, my name is Ayana Bradshaw.
I am the president and CEO ofAccess Matters.
We are a nonprofit organizationlocated in Philadelphia,
(20:13):
Pennsylvania.
And our mission is to protect,expand, and enhance access to
sexual and reproductive healthcare and information for all
people.
And we have had the honor andthe privilege of administering
the Title X family planningfunding in our region for over
50 years.
For over 50 years, we've hadthe privilege of partnering with
(20:34):
trusted healthcare providers.
And we are in the five-countyarea of southeastern
Pennsylvania to ensure thatpeople, regardless of their
income, regardless of theinsurance status or their
background, can access the carethey need to live healthy and
full lives.
But right now, our community isfacing a significant crisis
(20:55):
without warning.
This was on March 31st.
I remember the minute that thishappened.
Our Title X funding waswithheld pending federal review.
So, that's almost three monthsthat we have not had this
funding.
And that decision has alreadyhad such devastating
consequences, not just for ourorganization, but for the
(21:17):
providers, the staff, and thethousands of patients across
southeastern Pennsylvania thatrely on these services.
At Access Matters, we'veactually had to temporarily lay
off team members.
These are amazing people,dedicated people who have spent
their careers supportingcommunity health.
But the impact goes evenfurther.
Our provider network, andthat's our clinics, our health
(21:40):
centers that we fund, they arealso grappling with making
similar heartbreaking decisionsrelated to laying off staff,
hours being cut, And what wouldbe most detrimental is if some
of our clinics are forced toclose.
And the patients, well, they'rethe ones who are going to bear
the brunt of all of this.
So as I mentioned, we support afive-county area in
(22:03):
southeastern Pennsylvania.
So, that means that we supportPhiladelphia, Montgomery,
Chester, Delaware, and Buckscounties.
This is a region inPennsylvania that already
struggles with healthdisparities.
Many of the people that weserve, they face
disproportionate barriers tocare, whether or not that's due
to income, lack ofinsurance....we know that there
(22:23):
are racial inequities,transportation issues.
And Title X has been one of thefew programs that they could
count on.
And not everyone knows this,but Title X is not just about
birth control.
It funds a wide range ofessential health services.
So, when you think of thingslike STI testing and treatment,
(22:46):
cancer screenings, reproductivelife planning, health education,
so much more, it's oftentimesthe first point of contact that
someone has with the healthcaresystem.
I like to say it's a gateway.
And through that first visit,providers are often identifying
other issues so if you thinkabout it as you're going into a
(23:07):
clinic for a first time you mayfind out that you have high
blood pressure or providers mayidentify depression and food
insecurity and housinginstability, and really truly
help connect people to thesupport they need.
So, these visits are more thanjust medical care, they are a
gateway to stability.
And here's something else thatpeople may not realize, but
(23:31):
Title X guaranteesaffordability.
So, under this program, anyoneliving at or below the federal
poverty level receives care andthey get it free of charge,
completely free of charge.
And for those that are justabove that threshold, clinics
are using sliding fee scales.
So, that means that a patientis charged based on what they
can actually afford.
No one is going to be turnedaway because they don't have the
(23:53):
money.
But now, where we are rightnow, with this withholding, with
these funds being withheld,clinics may no longer be able to
honor that promise.
If they can't offer the slidingscale or if they lose the
support that allows them tooffer free care, people who are
already struggling, do you thinkthey're going to pay for this
care?
They're going to stop seekingcare altogether.
(24:14):
It also affects access toaffordable prescriptions.
So, many Title X providersparticipate in a program called
340 drug pricing.
This is a program that allowsproviders to offer discounted
medications.
So, that can include thingslike birth control and HIV
prevention medications like PrEPand PEP and other essential
(24:36):
prescriptions.
And so if you don't have theTitle X designation, then many
of those clinics are going tolose access to 340B pricing.
That means that their patientswill lose access to medications
they need to stay healthy.
And we know this is alreadyhappening.
We've talked to our providers.
They are so concerned abouttheir patients who no longer can
(24:57):
afford these prescriptions.
This is also gonna hit maternalhealth really hard, and
especially Black maternalhealth.
So in Pennsylvania, Black womenare more than twice as likely
to die from pregnancy-relatedcauses than white women.
And we know that Title X helpsto fight that disparity.
Title X allows for earlyscreenings, it allows for
(25:18):
preventive care, and it alsohelps to connect women in
maternal health services.
And so pulling this fundingnow, that only deepens those
inequities.
I want to go even beyond theindividual, because we know that
impact of the individuals.
But what may not be realized isthat this actually hurts our
economy.
So, for every dollar investedin Title X, we save about $7 in
(25:42):
downstream costs.
It helps people stay in school.
It helps people participate ina workforce, plan their futures.
So when we pull support likethis, we're not just cutting
care, we're actually cuttingopportunity.
And this is where the advocacycomes in because at Access
Matters, every single day sinceMarch 31st, we have been
advocating for the reinstatementof these funds.
(26:05):
It's not just for us, but it'sfor the providers and the
patients who rely on them.
But we need more people tounderstand what's at stake.
I always say that Title X isthis silent program.
For decades, Title X has beenquietly protecting our
communities.
And because it's been here forso long, I don't think a lot of
people even realized what it wasor how much it did.
(26:28):
But now is the time foreveryone to pay attention.
We all need to pay attentionbecause if we don't act, the
consequences are going to ripplefor years.
We know that there are going tobe more untreated infections.
There are going to be more latestage cancers.
There are going to be moreunplanned pregnancies, more
preventable deaths.
(26:48):
More people are going to fallthrough the cracks.
And so that's why I'm sograteful for this opportunity
today, for this platform,because we need multiple voices
talking about this.
We need multiple peopleadvocating about this.
And we need our Title X fundingrestored.
We need it now.
Thank you so much for thisopportunity.
(27:10):
Again, I am truly grateful.
Amy (27:14):
I'm Amy Moy, co-CEO at Essential Access Health, and our
organization advancesreproductive equity and
champions high quality,equitable access to sexual and
reproductive health care forall.
We have been a Title X granteesince the program was
(27:34):
established about 55 years agoby Congress with bipartisan
support.
And we have been the proudTitle X grantee in the nation
with the largest Title X systemin the country.
Our California providernetwork, which we have been the
grantee for the state since theprogram was established, has
(27:58):
over 60 healthcare organizationsin our network.
And we have the privilege andhonor of being able to serve as
the Title X grantee in the stateof Hawai'i ever since 2022.
Collectively, the Hawai'i andCalifornia Title X networks
provide care to over 500,000patients at more than 300
(28:22):
healthcare sites.
The Trump administration'sdecision to withhold our Title X
awards for California andHawai'i was unlawful and
unprecedented and causedimmediate harm.
The impact that we felt overthe last three months when no
Title X funds have been comingto Essential Access Health or
(28:45):
the extensive provider networkwe support has been devastating.
There have been difficultdecisions to be made around our
staffing structure and we knowthat the healthcare
organizations that we fund havehad to similarly look at what
(29:05):
decisions need to be made ifthese funds were not released.
We know that more than ninetypercent of the Title X funding
that is received in the Hawai'iand California provider network
supports their critical staffinginfrastructure.
And without Title X funds, ourTitle X network providers have
(29:30):
reported that there would be areduction in the health care
workforce.
And we know that many serviceareas in Hawai'i and California
were already facing providershortages and contraceptive
deserts.
Many of the Title X providersalso use those funds for
community outreach and educationthat links patients to care.
(29:54):
And without Title X funding, alot of those activities were
halted and there was a need toconsider either eliminating in
full or drastically reducingsome of that programming.
We also know that Title X fundsare critical in ensuring access
(30:15):
to care, particularly for thosewho face barriers to getting to
a health center.
Title X funds can supportmobile clinics to do outreach in
underserved populations andneighborhoods without a brick
and mortar health center.
Title X funds also supportextended clinic hours and teen
(30:39):
clinic hours for patients thatmight have difficulty coming
during some regular nine to fivehours.
They support transportation toclinics.
So, these funds are so criticalto ensure and support the
delivery ofhigh quality sexual and reproductive health services. The funding also supports provider training and supports to make sure that access to best practices and the highest quality care is available for patients who rely on Title X-funded health centers and Title X funding for care.
While we are greatly relievedthat now with the release of
(31:19):
funding for essential access forour Title X award, that release
of funding is a necessary andoverdue step, but it doesn't
erase the harm that was causedby this arbitrary, illegal, and
immediate withholding of thecritical resources in the first
place.
And while we're greatlyrelieved that we will be able to
(31:40):
get these vital funds out tothe field, and we are going to
be working as hard as we can toget these vital funds out as
quickly as possible, we knowthat also this may be a
temporary reprieve.
We also know that thewithholding of Title X funding
didn't happen in a vacuum, thatwhile the release of Title X
(32:03):
awards for California andHawai'i is a glimmer of hope and
good news for the providers andpatients who rely on this
critical funding source, we knowthat this is also coinciding
with other threats and actionsthat are creating
distress, duress, and disruptions to accessing time-sensitive sexual and reproductive health care, particularly for patients with lower incomes, including the sweeping reconciliation bill that was just signed into law that slashes Medicaid, targets trusted providers, and takes away health care from an estimated 17 million people.
(32:31):
And we also know that studiesshow that more than 70% of
family planning services isactually covered by Medicaid.
(32:52):
So, cuts to Medicaid, trustedproviders being carved out and
unable to be able to providecritical care for patients that
rely on Medicaid for coverage ofthese vital health services
is also going to be devastatingto the family planning system.
(33:14):
And we also know that while therelease of some of the family
planning dollars is a relief forthe moment, and we know that
the process by which it waswithheld was wrong.
And the administrationbasically did the wrong thing,
the wrong way.
These actions also come againsta backdrop of other
(33:36):
unprecedented and ongoingattacks and the future of Title
X and also access tocontraception remains at risk
nationwide.
We know that there's thepotential for new program
regulations that may hinder andput a question around what
(33:57):
services may be provided orcovered under the Title X
program, what entities may beeligible for Title X funding in
the future, and just the scopeand breadth of the program is in
question under thisadministration and Congress.
The president's budget proposalincluded elimination of the
(34:20):
Title X program completely.
And we are also waiting to seehow Congress moves forward with
their appropriations process tosee how Title X funding is going
to be handled in theirappropriation process for fiscal
year 25 to 26.
So, the withholding of funds isone piece that was and
(34:43):
continues to be something thatwe did not expect for its
unprecedented nature, kind ofmidstream funding being
withheld, released for some, notfor others without clear
process or indication and awithholding of funds without any
cause or ability to be able tomake any potentially needed
(35:06):
action that might be needed forcorrective action.
And we are just moving forwardwith these funds as best as we
can now, while also being verythankful that state legislative
leaders in California andHawai'i and under the leadership
of Governors Newsom and Greenrecognize the important role
(35:29):
that family planning servicesplay in our individual, family,
and community health andwell-being, as well as our
economic security.
And they move forward with howhaving an allocation for state
investments in these vitalservices to be able to support
the family planning providersafety net over the coming year,
(35:52):
as well as being able tosupport the patients that rely
on services that they need thatwe know are time sensitive,
including contraception, STIprevention and treatment, and
even cancer screenings.
I think moving forward, what weare hoping is that we will be
able to communicate with ourcongressional leaders, continue
(36:16):
to hopefully have dialogue withthis administration, as well as
state leaders and our communitypartners about the value of
Title X and how critical it isto continue to protect this
vital program and ensure thatpatients can get the family
planning care they need when andwhere they need it from the
(36:39):
providers that they trust intheir local communities.
I think it's also important tonote that the health centers and
many organizations that aredirect Title X grantees, it's
not only Title X.
Many of these healthcareorganizations receive multiple
federal grants because of thepiecemeal nature of our federal
(37:03):
funding system, our healthcaresystem.
You have the big behemoth ofMedicaid that is covering, and
it varies, of course, by state,the number of people and their
income eligibility, but coveringsome level of direct service
for many folks with lowerincomes, but then we know that
(37:25):
Medicaid rates and reimbursementrates do not cover the full
cost of providing care.
And we know that not everybodyis eligible to receive Medicaid
across the country who may be inneed of support and care that
may be otherwise unaffordable tothem.
So, what is happening now withthe cuts to Medicaid, the
(37:49):
threats and withholding of TitleX funding, it's also on top of
withholding of benefits, RyanWhite [HIV/AIDS] funding or
other critical funding sourcesthat make up, that are the
patchwork of our healthcaredelivery system.
And what we're seeing acrossthe board is not only at this
(38:10):
time our funds being abruptlywithheld with some level of
notification, some funding andnotices of award are just being
delayed and not even without anynotice or justification or
reason.
Just for example, the CDCreleased some notice of awards
(38:35):
for HIV prevention for a programperiod that was set to start
June 1.
There was no notice, there wasno indication of when or if
these notices of awards werecoming.
So these are just two examplesin a broader healthcare system,
also with patients and providerssuffering the stress of of
(38:56):
worrying about will ICE agentsarrive at their health centers?
Is this a safe place to go?
Will patients still come to getthe care that they need?
All of these things arehappening at once and it's
somewhat of a perfect storm outthere.
So, while maybe some healthcenters could navigate some
(39:19):
level of instability with TitleX funding, Title X funding
alone, it's that it's also...
and for some, it's absolutelydevastating if they don't have
other sources of resources tohelp provide these care, but
it's also happening on top ofall of the other things.
One other thing to note is evenwhen notices of awards are
(39:43):
granted and there's technicallymoney for organizations in the
grants management system, wealso have heard across the board
delays in being able to drawdown the funding that's been
awarded.
And so, the consistency andreliability of this funding is
(40:03):
just not existent.
And this has really real-worldimplications as you mentioned
when it comes to keeping doorsopen keeping inventory of
contraceptive methods on theshelf and available, keeping
staff.
And then we know that there arehealthcare shortages.
(40:24):
So when we have these momentsof crisis, we have a breakdown
of the system that gets harderand harder to rebuild.
This is a time of...
and it does seem to be somewhatinteresting...
for the folks that still havetheir funding being withheld,
not having any specific clearguidelines or timelines for
(40:49):
having to receive it, it'sawful.
Our hearts are with colleaguesthat are continuing to have the
funding.
But I do think that this hasbeen a wake-up call for a field
that since 1970 has largelyrelied on this funding stream,
that it's really time to thinkdifferently, to show up
(41:11):
differently, to focus energy inother ways, to think about if
the goal is making sure thatpeople have access to the family
services they want and need.
What are the other ways that wecan do that?
Because, you know, this kind ofcycle of the pendulum shifting
(41:32):
when it comes to these federalfunds, it's just, it's no way to
live.
You know, we need to kind of bethinking bigger and beyond
that.
Title X and also be thinkingabout when we have moments when
the Title X federal funding isat risk, when the purpose and
intent of the program is beingthreatened and could be reshaped
(41:58):
in a way that is not inalignment with the purpose and
intent of the program by whichCongress established in statute.
We also have to be thinkingabout the future, that while
Title X is a critical resource,We also know it was created in
1970.
There are ways that we can andshould be thinking about this
(42:19):
program differently to meet amodern healthcare system, to
really meet the needs ofpatients and providers.
And so, I think it's alsoimperative and incumbent on the
field as well as in those whocare about family planning
services to be thinking about: how do we minimize risk in this (42:36):
undefined
moment?
How do we maximize Title Xfunding and protect it for as
long as we can, while alsoenvisioning and being prepared
for a moment in time knowing thecyclical nature of these things
when we can hopefully envisionand shape a stronger program.
Jennie (43:02):
Okay, y'all.
I hope you enjoyed hearing fromthe Title X providers.
I'm so grateful to NFPRHA forhelping us put this episode
together.
They gave us a great collectionof providers from all over the
country to talk about theirissues.
I'm just so grateful for NFPRHAfor that help and to all of the
providers who stood up to telltheir stories.
So, thank you all.
And with that, don't forget tocheck out our merch store.
(43:25):
The link is in the show notes.
Otherwise, you can find us onBonfire by searching for "rePROs
Fight Back." And with that, Iwill see everybody next week.
[music outro] If you have anyquestions, comments or topics
you would like us to cover,always feel free to shoot me an
email.
You can reach me at jennie@reprosfightback.com or you can
(43:46):
find us on social media.
We're at rePROs Fight Back onFacebook and Twitter or
@reprosfb on Instagram.
If you love our podcast andwant to make sure more people
find it, take the time to rateand review us on your favorite
podcast platform.
Or if you want to make sure tosupport the podcast, you can
also donate on our website atreprosfightback.com.
(44:07):
Thanks all!
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