Health clinics throughout the state, including dozens in Western Pennsylvania, are among those impacted by federal funding cuts to a program that directs millions of dollars to help low-income people access family planning services.

Pennsylvania is the third-highest recipient of Title X funding nationally, having received $13.5 million last year, according to the Office of Population Affairs, which is housed within the U.S. Department of Health and Human Services (HHS).

"The withholding of Title X funding impacts approximately 50 clinical sites in Western Pennsylvania," said Alicia Schisler, executive vice president and chief of strategy at Adagio Health, a Pittsburgh-based nonprofit. She said eight of those are Adagio Health Medical offices located primarily in rural areas in Western Pennsylvania.

Adagio Health serves 34,000 people across 23 Pennsylvania counties, per the Office of Population Affairs, and it has been a Title X recipient since 1971. Last year, it received $5.6 million in aid, which not only includes contraceptive services and STI screening, but cancer screening and infertility services.

Title X, established in 1970 as part of the Public Health Service Act, is a competitive grant program that funds family planning services, cancer- and domestic violence screening, testing for sexually transmitted infections and birth control access at clinics across the country. Organizations apply every five years for funding.

HHS officials said in a March 31 letter to Converge Inc., a Mississippi provider, that the freeze was needed to evaluate whether the targeted organizations are in compliance with current executive orders. The organization posted its letter online.

The federal funding freeze will hit differently across the country. Texas and New York receive the most Title X funding, followed by Pennsylvania, while states such as Utah have very few.

Adagio Health announced in a press release that, effective April 1, its Title X family planning funding was being withheld. The organization declined to provide a copy of its HHS letter to the Post-Gazette for review.

Four health care organizations in Pennsylvania — AccessMatters, Adagio Health Inc., Family Health Council of Central Pennsylvania and Maternal and Family Health Services — received Title X grant funds for fiscal year 2024.

Neither AccessMatters, which services the Philadelphia area, nor Family Health Council of Central Pennsylvania immediately responded to requests for comment.

Schisler, at Adagio Health, said in a phone interview that ramifications from the freeze have been immediate, with some birth control options currently unavailable at some of the organization's clinics.

"Title X plays a critical role in promoting healthier moms and babies by providing access to comprehensive family planning and preventive health services," said Schisler in an email.

"If Title X funding is not restored, quickly, in Western Pennsylvania — the impacts will be significant and severe. Women and families in rural communities in Western Pennsylvania will be most significantly impacted."

Title X funds are not used to fund abortions.

At this point, not every grant recipient has had its funding temporarily withheld. Many, including numerous Planned Parenthood affiliates, are bracing for freezes as letters are sent to those impacted.

Each Title X grant includes "subrecipients," which may receive a portion of the funding.

Per a December 2024 Title X directory, Pennsylvania has about 75 subrecipients, including eight Pittsburgh sites: Allies for Health + Wellbeing, Planned Parenthood of Western Pennsylvania, The Midwife Center for Birth and Women's Health, the University of Pittsburgh's pediatrics department and UPMC's Children's Hospital of Pittsburgh, Magee Women's Hospital, Presbyterian Shadyside and St. Margaret Hospital.

Planned Parenthood of Western Pennsylvania said in a statement Wednesday it was one of the subrecipients partially impacted by the cuts.

"Title X funds make it possible for us to administer care to more than 4,700 patients annually on a no-fee or sliding fee scale, making PPWP's services affordable to anyone in need," the statement said. The organization said the cuts will limit access to care like pregnancy tests, birth control, or cancer screenings.

The freezing of already awarded funds is unprecedented, said Rebecca Simmons, an assistant professor in the Division of Family Planning at the University of Utah, specializing in contraceptive access.

Last year, she and her colleagues published a study in the journal Contraception that examined the impact of the first Trump administration's rule imposed in 2019 that impacted grant eligibility. Among the factors was whether organizations offered abortion referrals.

Some organizations, including Planned Parenthood affiliates, temporarily pulled out of the program.

Simmons' team found the average number of services provided through Title X recipients nationwide dropped by 16% and STI testing was stunted as a result of the change, which the Biden administration rescinded in 2021.

"Title X really serves low-income folks," said Simmons. "These clinics are already operating on a very narrow margin.

"To believe you have these funds available, and to not be given those funds, it does quite a different thing to your budget and plan than applying for a program you didn't get into. These folks are going to need to scramble really hard, or even close down sites or services basically overnight in order to be in the black."

In Pennsylvania, the situation is expected to impact rural women, some of whom use programs that receive funding from Title X as their sole health care provider.

"Most of the 23 counties we serve in Western Pennsylvania, with the exception of Allegheny and Erie — are rural," Schisler said. "Our patients are primarily women who don't have any insurance or who are underinsured."

She said Adagio's goal is to figure out how to comply with related executive orders to get its funding reinstated. In 50 years of participating in the program, Adagio has always complied with federal requirements, she said.

Typically, federal administrations provide a 30- to 90-day window to allow grantees and subrecipients to shift services to comply with changes when a new president is elected, said Simmons.

HHS gave grantees 10 days, according to the Converge Inc. letter.

"I'm not sure whether some of these places are going to be able to do this within the time frame," Simmons said. "It's just dependent on what the administration really wants to see."

Without Title X, some clinics may be unable to access reduced-cost drugs or health care services, like intrauterine devices — making services cost-prohibitive for many.

The contraceptive patch and Depo-Provera shot are enormously expensive, and clinics can order those drugs and medications for pennies on the dollar, said Simmons.

Lauren Kokum, director of affiliate communications for Planned Parenthood Federation of America, said in an email Wednesday that the organization expects the Trump administration to notify each of the 40 Planned Parenthood affiliates participating in the program. That could impact about 300 health centers nationwide, more than half of all of the organization's health centers, she said.

At least nine affiliates have received direct confirmation from the Trump administration that they are under investigation and their funding is being withheld, said Kokum.

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