Rural county health departments across the state received word from Missouri’s sole grantee for Title X, a reproductive healthcare grant, that the money they rely on for affordable care, was not coming.
The Missouri Family Health Council (MFHC) was expecting year 4 of a 5 year grant for $8.5 million until The U.S. Department of Health and Human Services informed the council and 15 other Title X grantees that the money was being temporarily withheld.
“All the grantees that had their funding withheld were given reasons around potential compliance issues which ultimately were about diversity, equity and inclusion,” MFHC’s executive director, Michelle Trupiano said.
In the past, the council used Title X funds to distribute money across its health network of 52 clinic sites. The money pays for services such as contraception and sexually transmitted disease care. Trupiano said the lack of funding could have devastating consequences for the communities it serves.
Rural counties consider options
Among Missouri’s clinic sites are county health departments that often become the primary medical provider for people in rural communities such as New Madrid, a southeast Missouri town of 15,000 people.
Christi Pipkin is the New Madrid Health Department Administrator. She logged on to a conference call to understand how a loss of Title X cash would affect her area.
“We were told that it was just halted, that it's not completely taken away,” Pipkin said. “So we're in hopes that they change their decision at a later date. We're going to continue providing our services as if nothing has changed.”
Not all county health departments are able to continue as normal, though. Zachary Moser, administrator of the Dent County Health Department in southeast Missouri, says his clinic uses Title X funds to help pay for nurse salaries as well as the cost of supplies for reproductive healthcare procedures.
Title X works on a sliding scale that determines how much a patient will have to pay depending on their income. If a person is beneath the federal poverty level, their care is free and covered by Title X. So losing out on that funding means the people whom the grant helps the most are those who can afford care the least.
If Dent County loses Title X funding, Moser says his department will face tough decisions.
“When that goes away, we'll probably still be able to provide those services, but we're just not going to be able to do them for free,” Moser said. “Which does mean that a lot of people are just not going to be able to afford [care], and they're not going to get those services as a result.”
In the Pemiscot County Health Department, Title X goes towards sexual transmitted disease testing and treatment. Gerri Smith is the health department’s administrator. She said the department is currently looking for a nurse practitioner to join her team and expand care in the community. Title X would help provide funds since the nurse practitioner’s role falls under family planning. However, if the funds were to fall through, hiring said person would have to be reevaluated according to Smith.
“I can say it won’t be a [top] priority because [Title X] does help pay for that person,” Smith said.
Regardless, Smith said her health department will continue to provide care, such as STD testing, without interruption.
Low-income patients could bear the brunt of Title X loss
According to data from the Missouri Family Health Council, nearly 44,000 patients received care through Title X funding in the state last year. Nationally, that number is nearly 4 million.
Because Title X covers a wide range of services, it’s a major source of funding at some clinic sites.
In Springfield, the Ozarks Area Community Action Corporation, or OACAC [Oh-Cack] reported that Title X comprises nearly half of its overall budget.
Jamie Raab is OACAC’s Director of Family Planning. She says this money goes to preventative care like pap smear tests and breast cancer examinations.
“We take that part of our role very seriously, because we want to be able to stop the risk as soon as possible for those patients,” Raab said.
55% of patients OACAC sees are uninsured, so Raab said her patients have a lot riding on Title X’s existence.
“If you're thinking about half of our patients that we see don't have another insurance plan, that makes it very difficult for them to go to some other providers without costly service fees,” Raab said.
For now though, OACAC remains open for patients in need of reproductive care. Raab alongside other health department administrators encourage prospective patients to call their local clinics with any questions they may have regarding Title X.
OACAC is a part of broader conversations with the rest of Missouri’s health network clinics who are talking to one another to prepare contingency plans should Title X leave the state altogether.
Trupiano says the council has not received any guidance from HHS on how to proceed following their decision. Her team formally submitted a response detailing how MFHC provides services on April 10.
“We are going to respond to our notification to provide additional information about our services and the way that we provide them,” Trupiano said. “We hope that there is a swift response from HHS in order to restore this critical funding.”
