© 2024 University of Missouri - KBIA
Play Live Radio
Next Up:
0:00
0:00
0:00 0:00
Available On Air Stations

With elections looming, Missouri providers worry about reproductive healthcare funding

Michelle Trupiano works on her office in Jefferson City on Friday, Oct. 18, 2024.
Tadeo Ruiz Sandoval
/
KBIA
Michelle Trupiano works on her office in Jefferson City on Friday, Oct. 18, 2024.

For decades, low-income Missourians have accessed reproductive health care through a federal grant awarded to the state. But Missouri’s recipient is unsure of the funding’s future.

The Missouri Family Health Council is the sole grantee of Title X, the only federal fund dedicated to sexual health and family planning. The fund covers services like cancer screenings, STI prevention and care as well as contraceptives among other things.

“The goal of Title X is to provide equitable and accessible family planning services to everybody who needs them,” said Michelle Trupiano, the council’s executive director. "And so, it works as a grant funded program.”

The funding is highly coveted and there are currently 86 grantees around the country. Once the money is awarded to them through an application process, those grantees then fund their provider network.

That network then uses the money to subsidize their clinics’ procedures, staffing or materials needed to provide healthcare services for low-income patients.

“We always say reproductive and sexual health is health care. You don't separate the body into different pieces,” Trupiano said. “It is a basic part of health care.”

The fund has been provided by the government for over 50 years. But over the past eight, the rules surrounding it have changed.

During the Trump administration, the Department of Health and Human Services issued a Final Rule that amended how Title X worked.

Title X grantees were not allowed to refer patients to abortion services or provide counseling regarding abortion. Instead, the new rules mandated grantees refer pregnant patients to prenatal care.

Clare Coleman is the CEO of the National Family Planning and Reproductive Healthcare Association (NFPRHA). A group that helps all applicants of Title X funding work through the process.

The Missouri Family Health Council is the state's sole Title X grantee. It serves a network of 55 clinics across t
Tadeo Ruiz Sandoval
/
Tadeo Ruiz Sandoval
The Missouri Family Health Council is the state's sole Title X grantee. It serves a network of 55 clinics across the state.

“In the Trump administration, that rule forbade providers from responding to a patient,” Coleman said. “You could not include information about abortion in those options.”

These rules led some providers to stop using Title X funds, and many who withdrew didn’t get Title X funding again until 2022.

In 2018, there were 99 recipients, which decreased to 72 by the end of the administration’s term.

According to the Office of Population Affairs, the number of patients seen dropped from nearly 4 million people in 2018 to 1.5 million people in 2020.

Those rules were reversed by the Biden administration. And Tyriesa Howard , a social work and public health assistant professor at Washington University in St. Louis, says under a Kamala Harris administration, we could see more protections for Title X.

“Vice President Harris actually advocates for federal protections of abortions rights," Howard said. "So, from my understanding, her administration also backs broader access to contraceptives and would seek to safeguard Title X funding for family planning services.”

With new rule changes, grantees had to compete multiple times by complying with the rule.

“We were competitive three times in those four years,” Bré Thomas, CEO of Affirm Arizona, its state grantee, said. “They made us re-compete, they changed the rules and made us compete again.”

A quilt of T-shirts adorns Michelle Trupiano's office wall on Friday, Oct. 18th, 2024.
Tadeo Ruiz Sandoval
/
Tadeo Ruiz Sandoval
A quilt of T-shirts adorns Michelle Trupiano's office wall on Friday, Oct. 18th, 2024.

Affirm Arizona was part of litigation twice against the federal government over roadblocks put in place for the applications and Title X rule changes.

“For us, it was absolutely tumultuous, difficult and hard,” Thomas said.

With a new administration change, those rules were repealed and reverted back to its original form. However, one thing remained the same. The funding itself.

For a decade, the federal fund has remained at around $285 million. Which advocates say hasn’t kept pace with inflation or rising medical costs.

“The cost of providing care has gotten much more expensive,” said Stephanie LeBleu, the Title X project director of Every Body Texas, the state’s Title X grantee. “The cost of contraceptive methods are increasing kind of constantly.”

The Missouri Family Health Council receives $5 million a year that it distributes to its 55-clinic network. Trupiano said the organization has been asked to include more clinic sites across Missouri, but it simply doesn’t have enough money to do so.

“We know that there are a lot more places across the state that we would love to be Title X providers if there was more funding available to do so,” Trupiano said.

It’s an experience reciprocated by Thomas, who said this static fund has already made things difficult in Arizona.

“We’re a growing state and even back then we didn’t have enough money to meet this need,” Thomas said. “We continue to not be able to meet the need and there’s more people here and expenses go up.”

But some don’t approve of the way their tax dollars are used.

For Bonnie Lee, member of pro-life group, Team P.L.A.Y, Title X shouldn’t go to abortion-care organizations like Planned Parenthood. While the fund doesn’t cover abortion procedures, it’s money they can use for other operations.

“Tax dollars without a person’s ability to direct where that money goes to, should not be funding any business that does abortion, is associated with abortion or promotes abortion,” Lee said.

The Biden administration has proposed to allocate $390 million to Title X in its 2025 presidential budget. Congress will have to decide by late December.

And while the funding hasn’t moved, the rule reversion has helped some providers come back. There are now 86 grant recipients.

“We did lose some providers,” Trupiano said. “Those providers were able to come back into the project. And we saw an increase in patients after the change and rules back in 2021.”

While the election’s result leaves Title X’s rules in the air, Trupiano said the Missouri Family Health Council will adapt to continue funding healthcare.

CORRECTION: An earlier version of this story stated Stephanie LeBleu was the executive director of Every Body Texas. She is actually the group's Title X project director.

Tadeo Ruiz Sandoval is a Senior in the Missouri School of Journalism from Mexico City. He's a reporter and producer for KBIA.
Related Content