A group of 128 Democratic members of Congress is urging the federal government to prevent a looming funding shortfall for reproductive health clinics in two weeks.
The letter, drafted by the House Democratic Women’s Caucus and the Reproductive Freedom Caucus and shared with NPR, was sent Monday to Health Secretary Robert F. Kennedy Jr. It asks 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.”
Rep. Sharice Davids, D-Kan., one of the members who helped gather co-signers, says Title X’s role in keeping communities healthy is largely invisible but vital. When people seek birth control, cancer screenings or STI testing, “everyday people aren’t like, ‘Thank goodness for Title X,'” she says. Still, the program — created by Congress in 1970 — helps health centers provide birth control and sexually transmitted infection testing and treatment to people without health insurance; services are free for low-income patients. Title X funds do not pay for abortion care.
Grants flow to public health departments and nonprofit reproductive health clinics nationwide. Each year grantees must submit budgets and data before receiving the next year’s funding; applications typically open in the fall. Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, says that for the first time in her 27 years of experience, guidance never came out and an application was not released on schedule.
When HHS missed a Dec. 31 deadline, “trepidation, concern, real fear” spread among recipients, Coleman says. Last week, Democratic senators also sent a letter to Secretary Kennedy urging a one-year extension and noting the guidance delay.
On Friday, HHS opened applications with a deadline the following Friday, giving grantees one week to prepare materials that usually take three or four months. Coleman calls that timeline “laughable.” A senior HHS official, speaking on background, told NPR the Title X team includes 10 staffers who would have seven business days to review dozens of applications from across the country.
If staff or grantees cannot meet that schedule, funding might not be distributed on April 1 as planned. Even a short gap can cause consequences clinics can’t undo, including cutting hours, staff or services, Coleman warns. She supports congressional calls for a one-year extension, saying there are less onerous ways to handle the process.
The uncertainty follows years of political pressure. President Trump proposed defunding Title X in his 2026 budget. His administration withheld 22 Title X grants for much of 2025 before reversing course after a lawsuit brought by NFPRHA and the ACLU. During the October federal shutdown, the Trump administration fired the entire HHS staff that administers Title X; those employees were rehired as part of the shutdown resolution. Ultimately, a bipartisan budget signed in February kept Title X funding steady.
HHS and the Office of Management and Budget did not respond to NPR requests for comment about the potential funding gap or why application guidance was delayed.
Title X is also mentioned in Project 2025, a document associated with conservative policy planning that OMB Director Russell Vought helped shape when he was at Heritage Action. The Project 2025 document recommends reframing the program to emphasize fertility awareness and “holistic family planning” and suggested grantees be required to provide information “about the importance of marriage to family and personal well-being.”
Coleman says the delayed funding process has caused “anxiety and needless drama” for health centers, though she emphasizes that patient care remains available and has not yet been affected by the administrative delays. Rep. Davids says easy, affordable access to birth control and STI testing are basic services people expect, and she predicts growing public outrage as awareness of the funding issues spreads.
Photo credit: Ed Zurga/AP (Rep. Sharice Davids)