The Appropriations Committee heard testimony Feb. 5 on proposed changes to the use of Title X funding that would impact disbursement to health clinics that also provide abortion services.
Nebraska receives funds from the federal Title X program, which are used to subsidize reproductive and preventive health services, including the diagnosis and treatment of sexually transmitted diseases, cancer screenings and family planning services. Federal grant funds dispersed by the state through the program cannot be used to perform abortions.
A provision included in LB944 as part of Gov. Pete Ricketts’ mid-biennium budget proposal would prohibit federal Title X funds from being be paid or granted to an organization that performs, assists, provides counseling in favor of or refers for abortion services. An otherwise qualified organization that is affiliated with, but objectively independent from, such an organization—which the bill defines as legal, physical and financial separation—would not be disqualified from receiving funds under the bill.
Bo Botelho, chief operating officer for the state Department of Health and Human Services, testified in support of the provision, saying that it would ensure all pregnancy counseling at Title X facilities is neutral and non-directive.
The change would not necessarily reduce access to reproductive healthcare for low-income Nebraskans, he said, as long as facilities maintain objective independence between any abortion services provided and their Title X activities. He cited a recent state audit that indicated Title X funds had been used for abortion services, in violation of federal and state law.
“The proposed [change] is needed to ensure program integrity through enhanced clarification,” Botelho said. “At this point in time we do not foresee a decrease in available services because of the proposed language. The department believes that other organizations would step forward should current grantees choose not to participate.”
Marion Miner, associate director of pro-life and family for the Nebraska Catholic Conference, also supported the change, which he said would bring state law into compliance with the express will of Congress in regard to Title X. The clear separation requirements in the new language would assure Nebraskans that tax dollars are not being used to fund abortion services illegally, he said.
Sandy Danek, president of Nebraska Right to Life, agreed. Currently, taxpayers have no certainty that Title X funds are not being used for abortion advocacy because of the fiscal “shell game” that can occur within the walls of providers, she said.
“If the abortion providers want to continue to receive Title X funds, for the purpose for which they are intended, they only have to act in good faith to comply with the stipulations set forth in this language,” Danek said.
Julie Reno, former Title X manager for DHHS, testified against the funding change. Reno, who retired in December, said the audit issues referenced by the department were coding errors—a common issue in the medical field—made by an inexperienced staffer at Planned Parenthood of the Heartland. The situation was remedied, she said, and was not a cause for concern to federal auditors.
Title X, which Reno said served 55,000 Nebraskans in 2016, has been in place since 1970 and the state has never had compliance issues with the federal government, she said. Any of the facilities currently providing services in the state likely would be forced to close if they were to lose funding under the proposal, she said.
“They all struggle, all the time, to keep their heads above water,” Reno said.
Jeff Tracy, director of the Community Action Health Center in Gering, also testified against the proposal on behalf of the Health Center Association of Nebraska. Five of the state’s seven community health centers receive Title X grant funds, he said, and are required by federal law to provide information and counseling to pregnant women regarding prenatal care and delivery, infant care, foster care or adoption and pregnancy termination.
Upon request, they also must provide referrals, he said, including referrals for abortion services. As a result, the bill’s language could be viewed as being in direct contradiction to federal regulations, he said, and could prevent entities from qualifying as Title X providers.
“Our concern with LB944 as drafted is that, potentially, all existing Title X clinics could lose funding depending on how certain aspects of the language are interpreted,” Tracy said. “The elimination of even one provider would severely limit access to reproductive health care.”
Sofia Jawed-Wessel, assistant professor of public health at the University of Nebraska-Omaha, agreed. If a Nebraska provider were to lose Title X funding, she said, those grant dollars would not automatically transfer to another facility in the state. Grant funds are distributed based on the number of people an entity serves that obtain Title X reproductive services, she said, and reallocation of those funds to the state by the federal government would not happen immediately, nor be guaranteed.
“We want to make sure that Nebraskans have the ability to get these services as soon as possible,” Jawed-Wessel said.
The committee took no immediate action on the proposal.