A coalition of 128 House Democrats has urged the Department of Health and Human Services to avert an impending funding shortfall for reproductive health clinics, saying action is needed before current Title X awards expire on March 31.
The letter, drafted by the House Democratic Women’s Caucus and the Reproductive Freedom Caucus and sent Monday to HHS Secretary Robert F. Kennedy Jr., asks the department 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.”
Rep. Sharice Davids (D-Kan.), who helped gather co-signers, stressed that Title X’s contributions are often unseen but essential. When people seek birth control, cancer screenings or STI testing, “everyday people aren’t like, ‘Thank goodness for Title X,'” she said. Created by Congress in 1970, Title X helps health centers provide contraception and testing and treatment for sexually transmitted infections to people without insurance; services are free for low-income patients. The program’s funds do not pay for abortion care.
Title X grants go to public health departments and nonprofit reproductive health clinics across the country. Under the usual schedule, grantees submit budgets and data each year before receiving the next year’s awards; applications typically open in the fall. Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, said that in her 27 years with the field, guidance never came out and an application was not released on schedule — a first.
When HHS missed a Dec. 31 deadline for guidance, Coleman said recipients reacted with “trepidation, concern, real fear.” Democratic senators also wrote to Secretary Kennedy last week urging a one-year extension and calling attention to the delay in issuing guidance.
HHS opened applications on Friday with a deadline the following Friday, leaving grantees only one week to prepare materials that typically take three or four months. Coleman called that schedule “laughable.” A senior HHS official, speaking on background, told NPR the team handling Title X has about 10 staffers, who would have seven business days to review dozens of applications from around the country.
If HHS staff or grantees cannot meet the truncated timeline, funding may not be distributed on April 1 as planned. Coleman warned that even a short lapse could force clinics to cut hours, staff or services, producing harms that can’t easily be undone. She backed congressional calls for a one-year extension, saying there are less burdensome ways to manage the process.
The current uncertainty follows years of political pressure on the program. The Trump administration proposed eliminating Title X in its 2026 budget and withheld 22 Title X grants for much of 2025 before reversing course after a lawsuit brought by NFPRHA and the ACLU. During an October federal shutdown, the administration fired the HHS staff that administers Title X; those employees were later rehired as part of the shutdown resolution. A bipartisan budget signed in February kept Title X funding level.
HHS and the Office of Management and Budget did not respond to NPR requests for comment about the potential funding gap or the delay in issuing application guidance.
Project 2025, a conservative policy plan associated with Heritage Action and with input from OMB Director Russell Vought when he was at that group, also addresses Title X. The plan recommends reframing the program to emphasize fertility awareness and “holistic family planning” and suggests grantees be required to provide information “about the importance of marriage to family and personal well-being.”
Coleman said the drawn-out and delayed funding process has created “anxiety and needless drama” for health centers, though she emphasized that patient care has so far continued uninterrupted. Rep. Davids said easy, affordable access to birth control and STI testing are basic services people expect, and she predicted growing public outrage as awareness of the funding problems spreads.
Photo credit: Ed Zurga/AP (Rep. Sharice Davids)