The family planning services program, officially known as Title X (pronounced “Title Ten”), is a federally funded program that provides reproductive health care on a sliding fee scale to people with low incomes. Established in 1970 as part of the Public Health Service Act, it remains the only federal grant program dedicated solely to family planning and related preventive health services. If your household income falls below the federal poverty level, services are completely free. For incomes between 101% and 250% of the poverty level (roughly $27,750 to $69,375 for a family of four), fees are discounted based on what you can afford.
What Title X Clinics Actually Provide
Title X clinics offer a broad range of reproductive and preventive health services, not just birth control. A typical visit can include contraceptive counseling, a physical exam, and your choice of contraceptive method. Beyond that, clinics provide screening and testing for sexually transmitted infections, pregnancy testing and counseling, and basic infertility services.
Preventive cancer screenings are also a core part of the program. For cervical cancer, clinics follow national screening guidelines: Pap smears every three years starting at age 21, with the option of combined Pap and HPV testing every five years for people aged 30 to 65. Clinical breast exams are offered as well, typically annually for those 40 and older and every three years for those in their 20s and 30s. These screenings catch problems early in populations that might otherwise skip them due to cost.
Clinics also provide education, counseling, and referrals. If a service falls outside what the clinic can handle directly, staff connect patients with other providers or programs.
How the Sliding Fee Scale Works
The cost structure is straightforward. Title X projects are required by law to use a sliding fee scale based on the federal poverty level guidelines, which are updated each year. There are three tiers:
- Below 100% of the federal poverty level: No charge for any covered service.
- 101% to 250% of the poverty level: Discounted fees based on your income. The higher your income within this range, the more you pay, but it’s still below full cost.
- Above 250% of the poverty level: You can still be seen at a Title X clinic, but you’ll generally pay the full fee or use your insurance.
You do not need health insurance to be seen. You do not need to be a U.S. citizen. Title X clinics serve anyone who walks in, regardless of immigration status, age, or sex.
Who Runs These Clinics
The program is administered at the federal level by the Office of Population Affairs (OPA) within the U.S. Department of Health and Human Services. OPA awards grants to a network of public and private organizations, including state and local health departments, community health centers, Planned Parenthood affiliates, hospital-based programs, and other nonprofit agencies. These grantees then operate clinic sites in their regions.
The network spans all 50 states, the District of Columbia, and several U.S. territories. To find a clinic near you, OPA maintains a searchable directory at reproductivehealthservices.gov, where you can enter your location and see nearby Title X-funded providers.
Confidentiality Protections
Title X has strong confidentiality requirements built into its federal regulations. Patient information is protected, and clinics cannot share details of your visit without your consent. This applies to all patients, including teenagers.
The question of whether minors can access services without parental consent has been a point of legal dispute. Federal regulations have historically prohibited Title X clinics from requiring parental consent or notifying parents when a minor seeks services. A 2022 federal court ruling in Texas challenged part of this policy, but the regulation remains in effect across the rest of the country. Title X-funded projects are required to encourage family involvement in minors’ decisions, and they must provide counseling to young people about resisting coercion into sexual activity. All providers must also comply with state laws on reporting child abuse, molestation, and sexual assault.
What Title X Does Not Cover
Title X funding cannot be used for abortion services. This restriction has been in place since the program’s creation. Clinics can provide nondirective counseling about all pregnancy options, including referrals, but the grant money itself cannot pay for abortion procedures.
The program is also not a substitute for comprehensive health insurance. It covers family planning and closely related preventive care, but not primary care, chronic disease management, or emergency services. Many Title X clinics do help patients enroll in Medicaid or marketplace insurance plans if they qualify, effectively serving as a gateway to broader coverage.
How to Access Services
Getting care through the program is simpler than most people expect. You can search for a nearby clinic through the OPA’s online locator at reproductivehealthservices.gov, which lists every Title X-funded site in the country. Most clinics accept walk-ins or offer same-week appointments. Bring proof of income if you have it (a pay stub or tax return), though clinics typically accept self-reported income as well. No referral from another provider is needed, and no insurance card is required to be seen.