Title X is the United States’ only federal program dedicated to providing comprehensive family planning services to low-income individuals, particularly those who have no insurance or are underinsured.1 Established in 1970 under the Public Health Service Act, the Title X program facilitates access to a wide range of affordable services, including contraceptive methods, pregnancy testing and options counseling, and STI testing. Under federal law, the Title X program does not fund abortion care and never has.2
Title X is funded by federal grants administered by the US Department of Health and Human Services through the Office of Population Affairs and implemented through competitive grants to a range of public health agencies and nonprofit organizations.
The program serves a diverse array of communities through a network of health care providers, including federally qualified health centers, public health departments, hospitals and community-based clinics. A core feature of Title X is its emphasis on person-centered care, an approach in which providers respect and respond to individuals’ preferences, needs and values.3 The program requires grantees to ensure that services are culturally competent, accommodate diverse populations and address health disparities. This broad reach aims to ensure equitable access to care, including for underserved populations.
By addressing financial and systemic barriers, Title X fills a critical gap for individuals who may not be able to access Medicaid, private insurance or other sources of subsidized care, thereby playing an essential role in advancing public health and health equity.
Who Title X Serves
- Income-based eligibility: Title X supports clinics and providers to deliver services at no cost for individuals with incomes at or below 100% of the federal poverty level. For those with incomes between 101% and 250% of the federal poverty level, services are offered on a sliding fee scale. Individuals earning above 250% of the federal poverty level are charged fees that reflect the “reasonable cost of providing services,” as determined by the provider.2
- Uninsured or underinsured individuals: Title X providers and facilities serve as essential providers of affordable reproductive health care for uninsured individuals, as well as those with limited or inadequate insurance coverage. These clinics also support underinsured individuals, whose health plans may not comprehensively cover family planning services.4
- Young people: People younger than 18 are eligible for Title X services, and confidentiality is a key part of the program. Parental consent is not required for adolescents to access services, ensuring that young people can receive the care they need.2,5
- Immigrants: Non-US citizens are not automatically disqualified from receiving Title X services.6 Title X clinics are able to serve undocumented immigrants as well, though eligibility may vary by state and clinic.7
The Title X program served 2.8 million people from a wide range of backgrounds in 2023.
| Income level | % of users | No. of users |
| ≤100% federal poverty level (FPL) | 60 | 1,661,000 |
| 101–250% FPL | 23 | 644,000 |
| >250% FPL | 9 | 257,000 |
| Unknown or not reported | 8 | 211,000 |
| Race | % of users | No. of users |
| White | 52 | 1,450,000 |
| Black/African American | 23 | 632,000 |
| Asian | 2 | 69,000 |
| American Indian/Alaska Native | 1 | 38,000 |
| Native Hawaiian/Pacific Islander | 1 | 38,000 |
| Multiracial | 3 | 76,000 |
| Unknown or not reported | 17 | 470,000 |
| Age | % of users | No. of users |
| <20 | 15 | 413,000 |
| 20–29 | 40 | 1,117,000 |
| ≥30 | 45 | 1,242,000 |
Note: Numbers rounded to nearest thousand.
Source: Killewald P et al., 2023 Family Planning Annual Report: National Summary, Washington, DC: OPA, HHS, 2023, https://opa.hhs.gov/sites/default/files/2024-10/2023-FPAR-National-Summary-Report.pdf.
Scope and Benefits of the Title X Program
- Title X funding provides access to contraception to help people avoid pregnancies they do not want and plan and space pregnancies they do want, which decreases the risk of complications like preterm birth and low-birth-weight births.8
- Title X services reach patients who face financial barriers to health care. In 2023, 83% of clients served by Title X–funded clinics had family incomes at or below 250% of the federal poverty level ($75,000 for a family of four), with 60% qualifying for free services because they had incomes at or below 100% of the federal poverty level.9 Among all Title X clients, 27% were uninsured, while 67% of users with some form of health insurance had public insurance coverage.
- Title X guidelines promote person-centered care. Title X–funded providers offer a wide range of contraceptive methods and allow clients to choose the method that works best for them. In 2023, nearly 73% of female and 58% of male clients adopted or continued a contraceptive method after visiting a Title X–funded clinic.9
- Title X grantees provide essential health services. Title X–funded clinics provide services like cancer screenings, STI and HIV testing, cardiovascular health checks and referrals to primary care providers.10,11 In 2016, 60% of clients sampled in a survey reported that a Title X clinic was their only source of health care in the previous year,4 making the program critical for improving overall health for low-income patients.
- Title X services have proven health benefits, including contributing to reductions in rates of STIs12 and mitigating the risk of cancer by providing cervical cancer screenings for more than 430,000 people in 2023.9
- Title X services are cost-effective, saving $7 in Medicaid-related expenses for every dollar spent.13 These savings include costs associated with prenatal, delivery and infant care avoided through family planning.