Normally by this time of the year, many health organizations are anticipating the arrival of Title X grant funding, which comes from the federal government and is dedicated exclusively to family planning and reproductive health care.
But the U.S. Department of Health and Human Services (HHS) just started the months-long application process on Friday.
Initially, HHS said the grant process would start in November and end in April. Now, applications are due in May and set to be awarded in September -- months after last year's Title X money will have expired. Sixty percent of Title X grants are set to expire on March 31 and the other 40 percent at the end of June.
In the meantime, HHS says grantees can apply for funding to keep clinics running.
The Trump administration said last year that it would reshape Title X. Indeed, the new application eliminates the Obama administration's focus on all forms of contraception and instead emphasizes abstinence programs and natural family planning methods -- both of which haven't traditionally been part of Title X.
Reproductive health advocates worry this might mean less money for organizations like Planned Parenthood that support abortion and other forms of contraception. Title X funding, however, is not allowed to be used to directly fund abortions.
"It is of concern there are no references to contraception and no reference to nationally recognized clinical standards for the provision of high-quality family planning and sexual health care," says Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association (NFPRHA), in a statement.
Planned Parenthood expressed even more concern.
"The Trump-Pence administration is quietly taking aim at access to birth control under the nation’s program for affordable reproductive health care, which 4 million people rely on each year," said Dawn Laguens, executive vice president of the organization, according to Politico. "The last thing anyone wants is for Donald Trump or Mike Pence to weigh in on her sex life -- but this announcement essentially invites them into the bedroom."
Title X has a history of bipartisan support, but it has become more politicized in recent years.
Half of Title X grantees are state health departments -- a fact that Jessica Marcella, vice president of advocacy and communications for NFPRHA, says has protected Title X from huge partisan cuts. The program was signed into law by President Richard Nixon and at the time was championed by President George H.W. Bush -- then a congressman. “We need to make population and family planning household words," he said in 1969. In 2007, his son, George W. Bush, signed the largest increase of Title X funding since the Clinton era.
Fast forward a decade, though, and 13 states have prohibited clinics that provide abortions from receiving Title X money -- despite the fact that no federal money directly pays for abortion services. Nebraska is currently considering becoming the 14th state.
Just before Barack Obama left the White House, he finalized a rule that would prohibit more states from withholding Title X money to centers that provide abortions. President Trump rolled back the rule during his first few months in office.
Reproductive health advocates worry this trend in statehouses might soon be adopted by the Trump administration.
"How far will they go to curtail certain providers?” asks Marcella.
In Texas, where Title X grants are set to expire March 31, the funding delay and uncertainty is already starting to have an impact. Some clinics were planning to stock less of the more expensive -- but also more effective -- forms of contraceptives, like IUDs, says Kami Geoffray, CEO of the Women’s Health and Family Planning Association of Texas, which receives Title X grants and contracts with 100 providers across the state -- ranging from county health departments to rural clinics.
“We’ve had to message our providers that beyond March 31, there’s no guarantee of anything. Depending on the type of provider, that could be catastrophic,” says Geoffray.
Some clinics always have cash reserves; others cannot exist without Title X money, she says.
This is the latest in a string of incidents where the Trump administration has failed to consistently provide funding for vital health programs, including the Children’s Health Insurance Program and the Community Health Center Fund.
"This delay has already caused undue harm," says Marcella. "At the end of the day, our providers are just trying to serve 4 million people across the country -- people who are primarily low-income."