Author: Grace Hall

Continued Uncertainty in Title X Funding for Family Planning Services

The Title X Family Planning Program has been a major part of reproductive health care in the United States for over 50 years. It was established in 1970 when Congress passed the Public Service Act, and it remains the only federal program focused entirely on family planning and preventative health services. The program is run by the Office for Population Affairs within the United States Department of Health and Human Services, and it provides funding to a wide network of public and nonprofit clinics across the country. With an annual budget of approximately $286.5 million, Title X has served around 195 million people over its history,  making it a critical part of our country’s health care safety net. 

Title X clinics offer a variety of important services, especially for people who might not otherwise have access to care. These services include birth control (both FDA-approved methods and natural family planning), pregnancy testing and counseling, help for people who are trying to become pregnant, STI testing and treatment, and other pre-pregnancy health care. One of the most important aspects of Title X is that it provides care regardless of a person’s income, insurance status, location, or immigration status. Because of this, Title X often serves as a first point of contact within the health care system for many low-income individuals. 

According to the FPAR 2023 report, Title X served 2.8 million people, which was a 7% increase from the previous year. The program also plays a big role in providing STI and HIV testing, as well as cancer screenings. Most people who use Title X services are low-income; about 60% have incomes below the Federal Poverty Line (FPL), and another 23% are just above the FPL. These services are vital for people who may not be able to afford care. In addition to providing services, Title X helps set a standard for quality of care and healthy equity.

Despite its history and importance, Title X is currently facing uncertainty. Under the current Trump administration, several changes could seriously impact the program. In Trump’s 2026 budget proposal, there was an effort to defund Title X. Additionally, $65.8 million in funding was withheld from some of the program’s grants, affecting clinics that rely on that money to operate. 

Things became more complicated in late 2025, when HHS told clinics that new guidelines would be coming. Usually, clinics have several months (three to four) to prepare for changes, but this time they were given only one week to respond after the new guidance was released on March 13, 2026. The updated rules removed earlier requirements that focused on maintaining high-quality family planning standards and promoting equity and inclusion. These changes have raised concerns among providers about the future direction of the Title X program. 

At the same time, funding for Title X is set to expire on April 1, 2026, and the new guidance was released only one week ago. Normally, the funding review process takes months and involves a careful evaluation of each clinic’s services and plans. The delay has left many clinics unsure about what will happen next. Clare Coleman, a leader representing many Title X providers, has pointed out that there has been little to no explanation from the Trump administration, which only adds to the confusion. 

If funding is not continued, the effects on services could be serious. Many clinics may have to cut back services or even close, and patients who previously received free or low-cost care may suddenly have to pay out of pocket. This could lead to individuals skipping important health services like birth control, STI testing, or cancer screenings. There is also concern that policies from Trump’s previous presidency could return, including rules that removed over 1,000 clinics from the program because of their connection to abortion services. 

Overall, the future of the Title X program seems uncertain at best. These recent funding issues and policy changes have created stress and fear in both patients and providers. A program that has helped millions of people access health care is now facing challenges that could limit its ability to continue working. 

The Telehealth Cliff: Implications of Expiring COVID-19 Waivers

During the COVID-19 public health emergency, the U.S. government enacted a series of telehealth waivers that significantly expanded access to remote healthcare services. These changes were designed to address barriers to care during a time when in-person medical visits carried heightened risks of infection. By relaxing long-standing restrictions and broadening the scope of telehealth, policymakers ensured that millions of patients could continue receiving essential medical care. However, because many of these waivers were temporary, the nation does face a policy crossroad as expiration deadlines approach.

Prior to the pandemic, telehealth under Medicare was restricted by geographic and originating site limitations. Patients typically had to be in a rural area and physically present at a medical facility to access telehealth services. The COVID-19 era waivers removed these restrictions, allowing patients to receive telehealth services from the comfort of their own homes and in any location. This shift significantly expanded access, particularly for vulnerable populations, including the elderly, individuals with mobility challenges, and those living in underserved areas.

The waivers also expanded the scope of providers eligible to deliver telehealth services. Physical therapists, occupational therapists, speech-language pathologists, and audiologists were temporarily authorized to bill for telehealth services. Federally Qualified Health Centers (FWHCs) and Rural Health Clinics (RHC) were permitted to serve as distant site providers, further expanding the pool of available telehealth practitioners. Behavioral health care received significant support as well, with relaxed requirements for in-person visits and broader acceptance of telehealth for mental health treatment.

One of the most transformative flexibilities was the inclusion of audio-only telehealth visits. Recognizing that not all patients had access to reliable broadband or video technology, regulators allowed providers to conduct visits via telephone. This proved particularly valuable for low-income and rural patients, helping to close the care delivery gaps.

Prescribing of controlled substances via telehealth also saw temporary adjustments. The Drug Enforcement Administration (DEA) relaxed requirements for in-person visits before issuing prescriptions, which allowed patients to continue receiving critical medications for conditions such as ADHD, anxiety, and opioid use disorder.

As the public emergency wound down, Congress took steps to extend many of these waivers. The American Relief Act of 2025 extended telehealth flexibilities through March 31, 2025, while the Full-Year Continuing Appropriations and Extensions Act pushed the deadline to September 30, 2025. Yet, unless further action is taken, and right now none has, these waivers are set to expire, which creates what some policy experts call a “telehealth cliff.”

If these waivers expire without replacement, access to telehealth will narrow significantly. Medicare patients may once again be limited to receiving telehealth only in rural areas and from specific originating sites, reducing the ability to access care from home. Audio-only visits would no longer be reimbursed, excluding patients without video technology. Non-physician providers may lose the ability to conduct telehealth visits, shrinking the range of available services. Additionally, the more flexible rules for prescribing controlled substances remotely would tighten, requiring more in-person visits.

Now that the expiration date has passed, critical questions about the future of telehealth remain. Supporters argue that the waivers demonstrated telehealth’s effectiveness and necessity, especially in addressing disparities in access to care. They emphasize that removing these flexibilities would disproportionately harm patients in rural, underserved, and low-income communities. Policymakers have responded by introducing proposals such as the Telehealth Modernization Act, which would extend many of these flexibilities through 2027.

The telehealth waivers enacted during the COVID-19 pandemic represented a historic transformation of the US health care system. They expanded access, reduced barriers, and highlighted the potential of telehealth as a permanent feature of modern care delivery. Yet, now with the expiration day has passed, the nation must decide whether to preserve these gains or return to a more restrictive system. The outcome will shape the accessibility, equity, and effectiveness of healthcare for millions of Americans.

NIH: A Freeze on Funding and Answers

The National Institutes of Health (NIH) is part of the United States Department of Health and Human Services (HHS). It consists of twenty-seven organizations known as Institutes and Centers. The NIH aims to foster creative discoveries and innovative research strategies; develop, maintain, and renew scientific human and physical resources to prevent disease; expand the knowledge base in medical and related sciences to enhance the nation’s economic well-being; and exemplify and promote the highest levels of scientific integrity, public accountability, and social responsibility. Although each Institute and Center has its own research agenda, they all receive their funding directly from Congress. 

The NIH allocates the majority of its $48 billion budget to medical research. A significant portion of this funding is awarded to universities, medical schools, and other institutions to conduct extramural research through grants. One major category supported by the NIH is cancer research, which receives approximately $8 billion annually. Since President Trump took office on January 20, 2025, he and his administration have implemented substantial cuts to federal health agencies. His administration, as of last week, has sent termination notices to thousands of federal health workers, including those at the NIH, which anticipates a loss of 1,200 employees. 

In addition to cuts affecting federal employees at the NIH, the Trump administration has stalled grant authorization and funding. The NIH cannot consider new grant applications because President Trump has blocked it from posting new notices in the Federal Register, a requirement before any federal meeting can be convened. As a result, the agency had to cancel planned meetings to review thousands of grant applications. Due to the freeze, the NIH has reportedly stalled over 16,000 applications, all competing for approximately $1.5 billion in NIH grant funding. An anonymous committee member who reviews grant funding meetings states that even though the freeze remains in place, “applications still come in, and essentially they go into a black hole, and nothing can be done with them.” In addition to workforce cuts, the Trump Administration has hit the NIH with a cap of 15% on the rate they pay for the indirect cost of medical research. This is much lower than many other federal institutions get to maintain buildings and equipment.

Anjee Davis, the CEO of Fight Colorectal Cancer, expresses her fear regarding employee cuts and a funding freeze: “We are scared that these blanket mandates could erase decades of progress in the fight against cancer. This isn’t about politics. It’s about protecting the advancements we’ve fought so hard to achieve in cancer care and research over the past two decades.” Dr. Celine Gounder, CBS News Medical Contributor, explained that the NIH is “how we end up with new drugs and other advancements in medicine.” CBS further explains that while there are immediate impacts from the freeze and firings, concerns grow among individuals that there are both immediate and long-term worries about a slowdown in biomedical research and potential delays in drug approvals. Davis and her company surveyed patients currently being treated for colorectal cancer, and 75% of respondents indicated they were worried that these government actions would delay their care and hinder new research into their cancer. 

While the funding freeze is new, and the federal workforce cuts at healthcare agencies are even newer, there is not much to say to ease the fear and anxiety felt by individuals, more specifically cancer patients. It is very concerning regarding the immediate impact on health care and public health and the longer-term implications for whether we will maintain our leadership in the health space. 

Biden-Harris Addressing the Maternal Health Crisis

In the United States, there are approximately 22 maternal deaths for every 100,000 live births. The rate of maternal deaths in the United States is more than double, almost nearly triple the rate for any other first-world/high-income nation. Many of these pregnancy-related deaths occur during the postpartum period. The postpartum period is days 1- 42 after the baby’s birth and ends around the time a mother’s body nearly returns to pre-pregnancy state. The postpartum time is critical because it lays the foundation for long-term health for the mother and baby. 

The American College of Obstetricians and Gynecologists (ACOG) explains that postpartum care for both the mother and the baby must become an ongoing process, not just a single encounter the mother gets before she leaves the hospital and one more visit at her six-week check-in. ACOG further implements that postpartum care should evolve over six weeks. Starting within the first three weeks postpartum, a mother should have a visit to address acute postpartum issues. After the 3-week check-in, postpartum care should include ongoing care as needed, which includes a comprehensive women’s exam and a transition into women’s care after pregnancy. 

Although many doctors and health agencies acknowledge the correlation between high maternal deaths and lack of postpartum care, the US still has the highest maternal death rate. In June 2022, the Biden-Harris Administration addressed the Maternal Health Crisis in our country. In their address, Vice President Kamala Harris explains that the systematic barriers and failure to recognize, respect, and listen to patients of color have meant that Black and American Indian/Alaska Native (AI/AN) women experience a greater share in maternal mortality than their counterparts. VP Harris goes on to extend that the Biden-Harris administration is committed to cutting the rates of maternal mortality and morbidity, reducing disparities in maternal health outcomes, and improving the overall experience of pregnancy, birth, and postpartum across the country. 

In July 2024, nearly two years after implementation, VP Harris announced that there had been key accomplishments from the administration’s effort to combat maternal mortality and morbidity. Starting off, their administration has created the first-ever baseline federal health and safety requirements for maternal emergency and obstetric services in hospitals. These new standards ensure that hospitals have the protocols and supplies for obstetrical emergencies, and if hospitals are unable to perform during the emergencies, they have procedures to transfer patients to other facilities. Second, the administration has expanded postpartum Medicaid coverage from two to twelve months, which ultimately provides lifesaving coverage to thousands of new moms. Extending has given postpartum moms the ability to seek doula care, and some states can cover the services. In addition to having designated hospitals, VP Harris launched the Newborn Supply Kit Pilot Project, which distributes kits with essential supplies to families. Supplies include diapers, baby lotion, baby socks, blankets, and wipes. The goal of this program is to reduce time, stress, and the burden on new parents to obtain supplies immediately needed. 

Specifically looking at the United States hospital system, the administration has also created “Birthing Friendly” Hospitals. These hospitals are designated to describe high-quality maternity care. To earn the designation of “birthing friendly,” hospitals have to participate in statewide or national perinatal quality improvement programs and implement evidence-based quality interventions in their hospital to improve maternal health. 

On August 27th, 2024, it was released that the U.S. Department of Health and Human Services (HHS) announced more than $558 million in additional funding to improve maternal health. $440 million of their projected funding is to expand evidence-based maternal, infant, and early childhood home visiting services across the country. $118.5 million of their funding comes from the CDC to aid in building the public health infrastructure to better identify and prevent pregnancy-related deaths. 

As we pass the two-year mark on the Biden-Harris administration’s maternal mortality and morbidity project, it is safe to say the U.S. has made great strides in moving towards lowering its maternal death rate. There are still many areas that need work and change, but it is safe to say necessary changes to alter and protect the mothers of the U.S. are being made.