A group of 128 Democratic members of Congress are calling on the federal government to prevent a funding shortfall for reproductive health clinics in two weeks.
The letter, first shared with NPR, was drafted by the House Democratic Women's Caucus and Reproductive Freedom Caucus and sent to Health Secretary Robert F. Kennedy Jr. on Monday. "We call on HHS to immediately award a one-year full funding extension to all current Title X grantees as the funding process cannot be effectively executed before their funding runs out on March 31," the letter says.
Free services for birth control, cancer screening
The role Title X plays in keeping communities healthy is practically invisible, explains Rep. Sharice Davids, D-Kan., one of the House members who helped gather co-signers to the letter. "When someone's going in because they need birth control or cancer screenings or STI testing, everyday people aren't like, 'Thank goodness for Title X,'" she notes.
Despite the low-profile, she says, Title X (as in the number 10) is incredibly important. The program, which was signed into law by President Nixon in 1970, helps health centers provide birth control and sexually transmitted infection treatment and testing to people without health insurance. For low income patients, the services are free. Title X does not pay for abortion care.
Title X grants go to public health departments and nonprofit reproductive health clinics around the country. Every year, the federal government asks for a budget and a variety of data from grantees before giving them the next year of funding.
Those applications usually open in the fall, says Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, a membership group that represents Title X grantees. "What happened this year, for the first time in my experience — and I've been working on this for 27 years — that guidance never came out and an application never got released," she says.
"Laughable" timeline
When HHS missed its deadline of Dec. 31, "trepidation, concern, real fear" grew among recipients, Coleman says. Last week, a group of Democratic senators sent a letter to Secretary Kennedy asking for a one-year extension for Title X grantees and noting that the guidance had not yet been released.
The applications were ultimately opened on Friday evening, with a deadline of this coming Friday, giving grantees one week to respond with all the requested information instead of the usual three or four months. It's a timeline that Coleman calls "laughable."
According to a senior HHS official who asked NPR not to use their name because they were not authorized to speak to the media, the Title X team includes 10 staffers, who will have seven business days to review dozens of grant applications from around the country.
If the staff or grantees can't manage that, the funding might not go out on April 1 as scheduled. Even a short gap can "lead to consequences, things we can't undo" including health centers cutting hours, staff, or services, explains Coleman.
"This isn't over," she says. "The money needs to go out on time."
She supports the call from members of Congress to issue a one-year extension for current grantees. "That'd be great," she says. "There are ways to do this that are much less onerous, much more straightforward."
President Trump proposed defunding Title X in his 2026 budget proposal. His administration also withheld 22 Title X grants for most of 2025 before reversing course in the face of a lawsuit brought by Coleman's organization. And during the October federal shutdown, the Trump administration fired the entire staff that administers Title X at HHS; those staff members were un-fired as part of the deal to end the shutdown.
In the end, the bipartisan budget that Trump ultimately signed in February kept funding for Title X steady, Coleman notes.
HHS did not respond to a request for comment about the potential for Title X recipients to have a funding gap. The Office for Management and Budget did not respond to multiple requests for comment from NPR about the reason for the delay in application information for grantees.
Project 2025 link
Title X funding is mentioned in Project 2025, a document OMB Director Russell Vought helped shape when he was at Heritage Action for America, the advocacy and lobbying arm of the Heritage Foundation.
"The Title X family planning program should be reframed with a focus on better education around fertility awareness and holistic family planning," the document stated, adding that grantees should also be required to provide information "about the importance of marriage to family and personal well-being."
Coleman says the delays in the normal funding process have caused "anxiety and needless drama" to health centers that provide this care across the country, although she emphasizes that care for patients remains available, and has not yet been affected by the administrative delays.
Rep. Davids says easy and affordable access to birth control and STI testing are basic services that patients have come to expect. When it comes to the Title X funding issues, she says, "I think the more people hear about this, the more, frankly, outraged we're going to see people being about this."
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