A September 2019 protest in Cleveland against the Trump administration rule barring Title X-funded family clinics from providing abortion referrals.

Lifting of Title X Gag Rule Could Spur Hundreds of Clinics to Rejoin 340B

Hundreds of family planning clinics that lost their Title X federal grants and 340B eligibility because they opposed a Trump-era rule barring them from providing abortion referrals might return to Title X and 340B soon.

The U.S. Department of Health and Human Services reversed the Trump-era Title X gag rule last week. The reversal takes effect on Nov. 8. The gag rule took effect during the third quarter of 2019.

Rather than abide by the gag rule, hundreds of clinics opted out of Title X, disqualifying them for 340B drug discounts. HHS last month attributed 1.5 million of the 2.4 million decline in patients who sought Title X services between 2018 and 2020 to the Trump administration rule.

“This 2021 regulation will allow for the Title X service network to expand in size and capacity to provide quality family planning services to more clients,” said HHS Assistant Secretary for Health Rachel L. Levine, M.D.

According to Jennifer Lockwood, CEO of 340B consulting firm Ravin Consultants, 921 Title X family planning clinics exited 340B between April 1, 2019, and Jan. 31, 2021. More than 500 exited between the second and fourth quarters of 2019.

“We are unable to determine from OPAIS if these were entirely due to the Title X gag rule, but the analytics of the database undoubtedly show an increase during 2019 of terminations,” Lockwood said.

Colleen Meiman, senior policy adviser to state and regional primary care associations said, “The Biden administration claims that the Trump-era rule caused about 25% of the Title X grantees to drop out of the program, and my guess is that most of those who dropped were Planned Parenthood providers.”

Anula Courtis, CEO of 340B consulting firm 340Best, explained that if a family planning clinic that stopped accepting Title X funds wanted to stay in 340B, it would have had to qualify and re-enroll in 340B as a different kind of covered entity, for example as a federally qualified health center. This would have been long process, and there are just four 15-day 340B enrollment periods per year, she pointed out. Many exiting Title X recipients may have been discouraged from re-enrolling in 340B as something else, Courtis said.

The gag order’s revocation means that clinics should seriously consider returning not only to Title X but 340B, family planning advocates say.

“We are pleased the Biden rule opens the door for health centers to return to Title X allowing them to re-register in the 340B program as family planning providers,” said Audrey Sandusky, spokesperson for the National Family Planning & Reproductive Health Association. “The 340B program provides critical access to contraceptive methods and other important medications that millions of patients rely on from their trusted providers.”

Lockwood agrees that former Title X covered entities should rejoin the program.
“Organizations that lost their eligibility status should highly consider rejoining the 340B program once eligible again,” Lockwood said. “The main reason is to be able to assist with the funding they lost through the grant itself, the 340B savings, and of course now, COVID-19.”