JOHNSON CITY, Tenn. (WJHL) — Family planning advocates had a gut check moment a couple of weeks ago when they learned the federal government was suspending Tennessee’s Title X funding, which totaled $7.5 million in fiscal 2023 — primarily over the state’s decision not to inform pregnant clients that abortion is one possible option.
Those advocates breathed a sigh of relief — albeit with some questions in mind — upon learning that Gov. Bill Lee had recommended $7.5 million in recurring annual state funding starting in July and $1.875 million to fund health department family planning April 1 through June.
“The fact that this funding is being proposed at the amount that Title X funding was taken previously and that it will continue to recur is wonderful news and an absolute relief,” A Step Ahead Foundation Executive Director Maggie Wood told News Channel 11 Wednesday.
A Step Ahead Tri-Cities works closely with regional health departments, which traditionally provide a variety of Title X-funded birth control options and other family planning to low and moderate-income people.
Wood called the services “incredibly important to the health of our state for a myriad of reasons.”
She said most A Step Ahead clients can’t afford birth control or family planning and that about 15 to 20% get referred to the health departments because they’re eligible for those services.
“Ensuring that these critical resources continue to be available at free or relatively no cost is an important part of that and the Title X funding, which will now be the state funding, is a critical part of that equation,” Wood said.
What happened with the feds?
Tennessee is the only state known to be deemed out of compliance with Title X requirements and according to an official, is still discussing potential next steps with its attorney general.
Lee spokesperson Jade Byers pulled few punches in describing the action and the importance of the funding.
“The federal government is denying Tennessee funding that has supported critical maternal and family care for thousands of Tennesseans for decades,” Byers wrote in an email to News Channel 11.
“As we discuss next steps with the Attorney General’s office, Governor Lee will fulfill his commitment to serving families by proposing to amend the state budget to include state dollars to fill the void caused by the federal government’s decision.”
Lee’s recommendation, which will become final if it survives the budget process, came after a weeks-long back and forth between Tennessee’s Department of Health and the federal Department of Health and Human Services (HHS) over Tennessee’s “nondirective counseling” approach for pregnant clients.
In a March 1 letter to TDH head Dr. Ralph Alvarado and the head of the family planning program, Yoshie Darnall, federal officials cited the state’s policy on “Pregnancy Test Conducted in a Family Planning Visit.”
That policy said, “Patients with positive pregnancy test must be offered the opportunity to be provided information and counseling regarding all options that are legal in the state of Tennessee.”
DHS wrote that such wording doesn’t comply with Title X requirements for what it calls “nondirective options counseling and referrals,” saying counseling and referral must be offered for pregnancy termination — which is no longer legal in Tennessee other than very narrow exceptions.
Alvarado replied March 13, writing that the state believed the nondirective policy did comply with what he described as “broad and undefined language” in the Title X regulation. He wrote that the state didn’t “construe the phrase ‘pregnancy termination’ to include every possible method of ‘pregnancy termination,’ including abortion.”
DHS wrote back March 20, saying that abortion referrals must be provided on request of clients, that Tennessee’s approach wasn’t compliant, and that continuing funding after March 31 was “not in the best interest of the government.”
The last letter from TDH to DHS came March 31. It referenced several other points of alleged non-compliance involving policies on infant care, foster care and adoption, saying those had not changed since DHS approved Title X funding last October.
In the letter, Darnall and TDH Deputy Commissioner for Population Health Leslie Meehan asked, “Will OPA continue to recommend contract termination solely because of the Department’s refusal to counsel pregnant women on abortions that are now illegal in Tennessee?”
OPA is DHS’s Office of Population Affairs.
Local legislator fully supports funding
State Rep. Rebecca Alexander (R-Jonesborough) said the area’s health departments and groups like A Step Ahead provide an essential service.
“If we’re going to maintain our abortion laws in this state we have to provide women with the resources that they need,” Alexander said.
“These groups provide a tremendous amount of care for the women in this area.”
Alexander said it’s the state’s responsibility to fill in those gaps left by Title X cuts, “and I fully believe it (Lee’s amendment request) will be funded.”
In Johnson City Wednesday, Wood reported that some impacts from the April 1 cessation of funding might already have occurred.
She said A Step Ahead staff was having trouble scheduling clients as health departments in Washington, Carter and Sullivan counties “are all currently out of the Nexplanon arm implant, and we have reason to believe this is directly due to the Title X funding change.”
She said referring clients to the free services helps A Step Ahead make its grant and private funding go further.
The organization sometimes supplements pregnancy prevention costs for people who don’t qualify for affordable options. Sometimes it drives people who have no transportation. Whatever its role, the money isn’t endless.
“Really the most important thing is that access to preventative birth control remains for everyone in our community,” Wood said.
“I mean it’s just so integral and it’s just so important that everybody in our community be able to walk into a clinic, walk into a health care provider and say ‘this is my body, these are my health care concerns, this is my situation, this is the type of family I want to grow or not,’ and to be able to access the tools to live that life for them, the life that they’re choosing easily, and on their own terms.”
“We’re relieved that this funding will be able to help us do this work that we’re doing to try to ensure that for our community.”