For health clinics that rely on federal funding through Title X, April 1 is one of the most important days of the year: It’s when the grant program’s annual funds are typically renewed.
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Clinics rely on the money to provide reproductive health services — such as birth control, cancer screenings, wellness exams and HIV testing — to more than 2.8 million people, many of whom are low-income, uninsured or underinsured.
But this year, the Trump administration delayed the standard application process for new grants. So clinics across the country are worried that the money they need will not become available Wednesday.
Typically, the federal government opens the application process for Title X grants in the fall and gives clinics months to submit their requests. Instead, the Health and Human Services Department began accepting applications March 13 and gave clinics just a week to submit.
Clinics were expected to use their awards from last year by Tuesday, though they can request permission from the government to roll over remaining funds.
“I’ve never, ever, ever seen such a short turnaround between applications’ being due and the funding deadline,” said Clare Coleman, CEO of the National Family Planning and Reproductive Health Association, an advocacy group for Title X clinics.
Coleman said she was not aware of any clinics that had received their annual awards as of Tuesday afternoon.
“Typically, the government takes between 70 and 90 days to look at the applications,” she said.
Andrew Nixon, a spokesperson for HHS, did not answer a question about whether Title X funds would be distributed on time Wednesday and instead sent a statement about the grant application process for next year.
“HHS, through the Office of the Assistant Secretary for Health, will issue new fiscal year 2027 Notices of Funding Opportunity (NOFOs) for the Title X program matched with agency priorities,” the statement said.
Coleman said HHS has the option to tell clinics that it will reimburse any expenses incurred during the waiting period before funding arrives. However, it has not yet done so. Nixon did not answer a question about whether the agency will offer reimbursements.
The Title X program was enacted in 1970, under President Richard Nixon, with bipartisan support. By making contraception available to families regardless of their incomes, the program aimed to reduce unintended pregnancies. It has expanded to include fertility services, breast and cervical cancer screenings and tests and treatment for sexually transmitted infections.
Clinics offer services on a sliding scale based on family size and income. Families who make 100% of the federal poverty level or less — around $33,000 for a four-person household — qualify for free care. Federal law prohibits clinics that take the funding from denying care to patients who cannot afford it.
Brian Haile, CEO of the Neighborhood Health network in the Nashville, Tennessee, area, said he has been working on contingency plans for its 12 clinics, assuming new funding will not arrive this week.
“What we’re trying to figure out is how much can we dip into our savings account to pay for in hopes that we get reimbursed,” Haile said.
Neighborhood Health largely serves people of color and those living below the poverty line. Demand for Title X services has gone up this year, Haile said, since increased insurance premiums prompted some people to opt out of Affordable Care Act plans.
If Neighborhood Health has to make temporary cuts because of a lack of operating funds, Haile said, it might force payroll reductions for staffers or clinics might start charging patients small sums for insulin, which is usually provided at no out-of-pocket cost.
If that happens, he said, “April 1 is going to be a really cruel April Fools’.”
Other clinics are optimistic that they can keep services running as usual in the short term if funding is delayed.
Ruth Richardson, president and CEO of Planned Parenthood North Central States — which operates clinics in Iowa, Minnesota, Nebraska, North Dakota and South Dakota — said the organization plans to maintain low or no costs for Title X services for as long as possible.
“We would be continuing to honor that Title X sliding scale fee for at least the next month or so and then having to kind of re-evaluate” if funding is held up beyond that, Richardson said.
Before Title X grant applications opened up this month, Senate Democrats implored HHS Secretary Robert F. Kennedy Jr. in a letter to award the funding on time, warning of “catastrophic” health consequences. A coalition of Democratic governors followed up last week with a letter emphasizing the importance of meeting the April 1 deadline.
Disruptions to Title X funding are not new, however. Last year, the Trump administration temporarily withheld funding for nearly a quarter of Title X grants serving an estimated 842,000 patients. HHS restored the grants in December, about eight months after the National Family Planning and Reproductive Health Association sued it to challenge the funding freeze. The group voluntarily dismissed the suit in January.
President Donald Trump’s budget request for 2026 proposed axing all $286 million appropriated for the Title X program, but Congress included it in the funding bill that passed this year.
“These are all essential health care services that people need,” Richardson said. “It is much more cost-effective to invest proactively in the Title X program than to pay the cost of the downstream consequences.”
HHS awarded five-year grants in 2022 to support more than 4,000 clinics, which are entering their final year of the grant cycle. Title X recipients are still required to reapply for funding every year.
During Trump’s first term, his administration barred Title X clinics from providing abortion care or abortion referrals, which prompted roughly 1,000 clinics to leave the program. The regulations were reversed during the Biden administration, and the current Trump administration has not revisited the restrictions.
“The Title X program, at least for the last decade, has been targeted politically in many ways,” Coleman said. “It has not received an increase in its annual congressional funding for 11 straight fiscal years. There have been repeated attempts by members of Congress to eliminate the program entirely.”
Nevertheless, she said, “the program survives, and we believe the program will continue to survive.”