Missouri state health agency seeks control of Title X funds that go to Planned Parenthood

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(Missouri Independent) – Missouri’s state health department has applied to oversee federal family planning funds, a move reproductive health advocates fear would give the state power to cut off funding for providers who refer patients for abortion services.

During his confirmation hearing late last month, former Department of Health and Senior Services Director Donald Kauerauf’s testimony focused on his views on masks and the COVID-19 vaccine. But lost among his answers was the fact that DHSS had recently applied to oversee federal Title X funds, a national grant program that covers family planning services for low-income individuals.

Asked whether he believes the state should rely on federal funding to implement public health programs, Kauerauf said: “Rely? No. We need to seek every funding opportunity possible. We just recently submitted in an application for Title X funding so that we could have control over the funding that comes into this state.”

The application marks the third funding cycle that DHSS has applied to oversee the funds. The state health department first applied in 2018 and again in 2019, under former President Donald Trump’s administration, according to Politico. It was denied both times.

The Missouri Family Health Council Inc. (MFHC) has been the sole grantee of Title X funding for the last 40 years. 

Michelle Trupiano, the nonprofit’s executive director, said that while she couldn’t speak to the state’s intentions for applying, her concern is that the state would limit the providers who can access the funds.

“Anytime that they are trying to limit providers, that has a very negative impact on the overall safety net,” Trupiano said, “And at the end of the day, the care that patients receive.”

A spokeswoman for DHSS confirmed Wednesday that the agency applied to oversee the funds. Tara Broido, a spokeswoman for the U.S. Department of Health and Human Services declined to comment on applicants but said the agency will announce which entities will receive funds for the next 5-year period when awards are made in the spring.

Samuel Lee of Campaign Life Missouri said he welcomed the department applying again for the funds.

“In attempts to defund Planned Parenthood in Missouri, Title X has always been ‘Well, what do we do about this?’” Lee said. “And there’s no easy way to do it, because it doesn’t go through the state.”

The news of DHSS’ application comes amid renewed efforts by lawmakers and the state to limit access to abortion and reproductive health services.

In October, President Joe Biden’s administration rolled back rules issued under former President Trump that barred providers who refer abortion services from receiving the federal dollars. As a result, Planned Parenthood affiliates in Missouri rejoined the Title X program after leaving in light of the Trump-era rule.

Before the rule reversal could go into effect, Missouri joined a coalition of 11 other states in a lawsuit led by Ohio to block it. A judge ruled against the states last month, and last week a federal judge rejected the states’ request that the new Biden administration rules be paused while their appeal of the ruling is considered.

From 2018 to 2019, Planned Parenthood of the St. Louis Region and Southwest Missouri, served 14% of all Title X clients in Missouri, according to MHFC.

Yamelsie Rodríguez, the president and CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a statement Monday that she was confident the Biden administration would reject DHSS’ application — like it was twice before under the Trump administration.

“It’s no secret the Missouri Department of Health and Senior Services has a disturbing history when it comes to sexual and reproductive health care including tracking women’s menstrual cycles and weaponizing inspection reports to further its political agenda,” Rodríguez said. “DHSS’ Title X application is just another attempt to do more of the same — dismantle access to Planned Parenthood, which plays an outsized role in Missouri’s safety net program.”

In the Missouri legislature, bills filed by state lawmakers aim to restrict public funds from going toward abortion providers or their affiliates — and some rely on a definition of “public funds” that include federal grants or payments received by the state. Another bill would set up a hierarchy by which the Title X funds must be issued if overseen by DHSS.

“If they can get control and this law passes, then that sets up a very interesting situation,” Lee said, “where the state would be required as a matter of law to not disperse these funds — in essence to Planned Parenthood because they’re the only organization that operates an abortion facility in the state.”

Title X funds are issued in a variety of ways. Some states’ health departments, like Kansas, receive the funds to distribute while other states’ Title X dollars are administered through providers and nonprofits. In 2011, a judge blocked enforcement of a Kansas law that aimed to stop the flow of Title X dollars to Planned Parenthood.

MFHC currently administers Title X funds to 16 providers who operate 59 clinic sites, and typically has been awarded roughly $5 million annually, Trupiano said.

Ultimately, Trupiano said there is more need than there is available services.

“We need all providers, all funding sources working together in order to support patients,” Trupiano said, “and make sure that no matter where somebody lives, no matter their zip code, they have access to the full range of services.”

DHSS’ attempt to oversee the Title X funds, follows new emergency regulations enacted last year that allow the state health department, which inspects and licenses abortion facilities, to share info on inspection violations with the Department of Social Services, which could then sanction facilities by barring Medicaid payments. Planned Parenthood previously called on the Biden administration to intervene.

The state health department has faced scrutiny for its attempts to regulate abortion providers before, and an administrative law judge ruled in 2019 that DHSS had wrongfully denied a St. Louis Planned Parenthood its license. During a hearing on the dispute, former DHSS Director Randall Williams’ testified that he maintained a spreadsheet to track women’s menstrual cycles who had visited the Planned Parenthood location in an attempt to investigate failed abortions.

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Tessa Weinberg


Tessa Weinberg covers education, health care, and the legislature. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She most recently covered state government in Texas for The Fort Worth Star-Telegram.

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