We often write about Federally Qualified Health Centers (FQHCs), in part because we often work for them in part because FQHCs illustrate many challenges facing other nonprofits. This post discusses a service that FQHCs could provide but mostly choose not to—a common circumstance among certain classes of nonprofits, like foster family agencies and substance abuse treatment providers.
To understand the dilemma, you have to know that the Health Resources & Services Administration (HRSA) funds FQHCs under Section 330 of the Public Health Services Act and FQHCs are sometime referred to as “Section 330 providers.” While FQHCs do collect copays and most take insurance, a large chunk of their funding comes directly and indirectly (via Medicaid) from the feds. FQHCs are mandated to provide “integrated full life-cycle care” (HRSA-lingo here), including reproductive health/family planning services. Still, many of our FQHC clients are skittish about promoting these services and are consequently reluctant to seek other grants to support family planning.
Thus, FQHCs have effectively ceded the huge pot of Title X family planning grants ($288 billion in 2016) to specialized family planning clinics, which are mostly but not exclusively operated by local affiliates of Planned Parenthood. While Planned Parenthood provides great women’s reproductive and related preventative health care, with an emphasis on low-income women and girls, unlike FQHCs, their clinics do not provide full life-cycle care.
From what we can tell, FQHCs and Planned Parenthood clinics seem to operate in a symbiotic, but parallel manner, in which both stay out of each other’s turf (if you have even more specialized knowledge about this situation, feel free to leave a comment). There are about 650 Planned Parenthood clinics, which serve about 2.5 million women annually with family planning services (this does not include abortions). In contrast, there are about 1,400 FQHCs, which serve about 17 million patients annually, and these numbers are growing rapidly due to the expansion of Medicaid under the ACA. More than 50% of FQHC patients are women, so let’s call it 9 million. FQHCs serve many more women than Planned Parenthood, but readers would never know this from the media.
While I don’t know this for sure, one presumes this is because, bureaucratically speaking, there are at least two parts to Planned Parenthood that are structured separately: the family planning side, which is touted by progressives, and the abortion side, which is demonized by some conservatives. The nascent FY ’18 federal budget battle between the Trump administration/Republicans and Democrats is being fought partially over Title X funding. The media usually obfuscates the Tile X grant aspect, focussing instead on the much more sensational issue of Planned Parenthood funding.
I assume that, if Congress passed legislation making Planned Parenthood ineligible for Title X (unlikely but possible), other providers, like FQHCs, would start applying for Title X grants. In other words, no matter what happens, as far as I know, there are no proposed cuts to Title X (again, if you have specialized knowledge, leave a comment). It’s just a question of which agencies will provide Title X funded services and how those agencies will link with Planned Parenthood, which presumably would continue as the nation’s main abortion provider.
I know the potential competition between FQHCs and Planned Parenthood clinics is a big issue for Planned Parenthood, as Title X provides more or guaranteed funding to keep the lights on—a concern for all nonprofits. This basic issue was confirmed by several interesting pieces I found and that the Alan Guttmacher Institute published (it’s more or less the research affiliate of Planned Parenthood).* For example, this article makes the curious argument that FQHCs couldn’t expand to provide family planning service now being provided by Planned Parenthood:
FQHCs are an integral part of the publicly funded family planning effort in the United States, but it is unrealistic to expect these sites to serve the millions of women who currently rely on Planned Parenthood health centers for high-quality contraceptive care.
As a grant writer, I admire the carefully crafted but entirely specious reasoning, which reminds me of our needs assessments, I’m pretty confident that FQHCs would have no trouble picking up the slack and the Title X grants—if they wanted to. We have some FQHC clients with over 40,000 patients, and at that size they can begin to resemble something larger than a community clinics. At the moment, they’re mostly reluctant to tangle with Planned Parenthood—but, again, they could.
And they might.
* The Guttmacher Institute is a great source, albeit one with a point of view, for studies and data relating family planning, teen pregnancy, and the like. We sometimes use their citations in writing needs assessments. If you’re curious about research organizations with a point of view, Daniel Drezner’s book The Ideas Industry is good.