Background

Since the late 1970s, states have attempted to impose abortion-related restrictions on the use of public funds for family planning services. Many of these attacks are rooted in the flawed assertion that funds allocated for family planning services are “fungible” and free up other funds that providers might use to pay for abortion services. In reality, publicly supported family planning providers are generally underfunded, and funding that supports or reimburses for other reproductive health services do not transfer to abortion services. Most early attempts to exclude abortion providers from receiving state funds were struck down by courts that specifically rejected the fungibility argument.

However, in the intervening decades, states have become more successful in enacting public funding restrictions. For example, states have made providers’ eligibility for state funding contingent on meeting certain conditions, such as not offering abortion services, even if such services are provided without the use of state funds. Increasingly, states are seeking to deny funds even to entities that do not provide abortions but offer counseling on or referral for abortion. And a number of states now allocate funds through a priority system that either disadvantages or wholly excludes safety-net health centers affiliated with clinics that provide abortion. These restrictions typically apply to state family planning funds or federal family planning funds that pass through the state treasury.

The latest wave of policy threats to family planning funding emerged in the summer of 2015 with the public release of a series of deceptive videos seeking to discredit Planned Parenthood. Since then, several states have attempted to prohibit abortion providers generally, or Planned Parenthood affiliates specifically, from receiving any public funds that pass through the state treasury, including federal grants such as Title X funding.

Some states have gone so far as to end their joint state-federal Medicaid family planning expansion programs in favor of entirely state-funded “spin-off” programs. These state-funded programs cover many of the same services as the Medicaid family planning expansions, but exclude providers that offer abortion services.

Other states are now seeking to prevent safety-net health centers from receiving other types of public funds intended to address a wide range of public health concerns, such as infant mortality, STIs, breast and cervical cancer, and domestic and sexual violence.

Highlights

Restrictions on Family Planning and Other Types of Public Funds*

State

Bars funds to:

Gives lowest priority to private reproductive health–focused providers when distributing family planning funds

Planned Parenthood

Abortion providers

Entities that contract or are affiliated with an abortion provider

Entities that counsel or refer for  abortion

Private reproductive health–focused providers

Restrictions on Title X funds (9 states)

Arizona†​

       

 

 

Kansas

       

X

 

Kentucky

         

X

Louisiana

 

     

Mississippi

 

X

X

     

Nebraska

 

X

 

X

   

Ohio

         

X

Oklahoma

       

X

 

South Carolina

         

X

Tennessee

         

X

Wisconsin

 

X

X

     

TOTAL

 

3

2

1

2

4

Restrictions on state family planning funds (15 states)

Arizona

 

X

X

     

Arkansas

 

X

X

X

   

Colorado

 

X

       

Indiana

 

X

       

Iowa

 

X

X

     

Kentucky

       

X

 

Louisiana

 

     

Michigan

 

X

 

X

   

Mississippi

 

X

X

     

Missouri

 

X

X

   X

X

 

North Carolina

 

X

       

Ohio

 

Ψ

 

Ψ

   

Oklahoma

       

X

 

South Carolina

         

X

Tennessee

         

X

Texas

 

X

X

   

X

Wisconsin

 

X

X

X

   

TOTAL

 

11

7

4

3

3

Restrictions on Medicaid participation (1 state)

Alabama

         

Arizona

 

       

Arkansas

X

         

Florida

 

       

Indiana

 

       

Kansas

         

Louisiana

       

Mississippi

 

     

Texas

 

     

TOTAL

1

         

Established Medicaid spin-off program for family planning services (3 states)

Iowa

 

X

X

     

Missouri

 

X

X

     

Texas

 

X

X

     

TOTAL

 

3

3

     

Restrictions on other types of public funds (12 states)

Arizona

 

X

X

     

Arkansas

 

X

X

X

   

Indiana

 

X

       

Kentucky

       

X

 

Louisiana

 

     

Mississippi

 

X

X

     

Missouri

 

X

X

     

Nebraska

 

X

 

X

   

North Carolina

 

X

       

Ohio

 

X

 

X

   

Oklahoma

       

X

 

Texas

 

X

X

   

X

Wisconsin

 

X

X

X

   

TOTAL

 

10

6

4

2

1

Temporarily enjoined by court order; policy not in effect.

▼ Permanently enjoined by court order; policy not in effect.

* Other public funds include funding for services such as breast and cervical cancer screening, STI testing and treatment, and sex education.

† Title X funds administered by Wisconsin are subject to restrictions on and abortion providers and affiliates. These restrictions do not apply to Title X funds administered by independent agencies. Arizona has a similar law that requires the state to apply for Title X funds and if granted, excludes private reproductive health–focused providers from receiving the funds. Wisconsin also limits Medicaid reimbursement for prescription drugs to the acquisition cost and limits the dispensing fee, which reduces the amount providers can receive for services.

‡ Private reproductive health–focused providers are excluded through a priority system.

Ψ In Ohio, a law prohibits the allocation of family planning funds to organizations that provide abortions, counseling or referrals, unless those activities are physically and financially separate from family planning services.