For tens of thousands of West Virginians, the federal government’s family planning program pays for free and low-cost reproductive health care like contraceptives and tests for sexually transmitted infections at health clinics across the state.
But many of the clinics’ administrators and providers worry that some of this access will soon be in jeopardy.
In July, West Virginia Department of Health and Human Resources officials who administer the federal program for over 120 West Virginia clinics told local health care workers that they are changing how the money is disbursed.
Starting this fall, all clinics that receive funds from DHHR’s Title X grant will have to go through a competitive application process to stay in the program. Previously, private health centers and county health departments that provide the care had a simple contract with the state and were reimbursed after providing reproductive health services.
In some rural counties, the local health department is the only federal family planning clinic. Because the state is making the change with little notice or support, many local health care workers said they think those clinics, often understaffed, are at-risk of losing this crucial funding.
If that happens, thousands of West Virginians could lose reliable access to reproductive health care.
“We are definitely worried about our patients,” said Crystal Simpson, a nurse at the Wyoming County Health Department.
A complicated transition
The federal government’s family planning program is designed to help people who can’t access the resources otherwise — often folks who don’t have insurance, are under 18, live in areas with doctor shortages or immigrated to the U.S.
Despite being underfunded by Congress for over a decade, the program successfully delivered reproductive health care to over 1.6 million Americans in 2021. Almost 32,000 of them were West Virginians, over half of whom were living below the federal poverty line.
Some of the money goes to DHHR-funded clinics in areas where the next clinic might be over a dozen miles away, places like the Hardy County Health Department.
“If we can’t get the money, we can’t do the program”
Nikita sutherland, Nurse at Hardy County Health Department
Nikita Sutherland, a nurse at the department, said the Hardy County program sees hundreds of people every year — often immigrants and refugees who have come to work at the chicken plant in Moorefield. Many don’t have health insurance or own cars, leaving the program as the only option for affordable birth control pills and STI screenings.
When Sutherland first heard that DHHR was going to soon fund programs through a competitive grants model, she worried about Hardy County.
“If we can’t get the money, we can’t do the program,” she said.
The rural local health department only has six full time employees. Bill Ours, the department’s administrator, said requiring them to apply for a competitive grant without outside help would be extremely difficult.
“Everybody here already has three, four, five jobs,” he said.
West Virginia’s current reimbursement system is an outlier
In a letter to its family planning program clinics, DHHR said the change was necessary to follow rules for the grant. In an email to Mountain State Spotlight, a spokesperson for DHHR clarified that the currently-used reimbursement system was flagged as not fulfilling federal financial requirements in a 2021 review.
She acknowledged that the change may result in some clinics losing funding, and that the department would try to increase training and support for those who remain. She said DHHR will fund local agencies that have the capacity to provide family planning care and meet financial reporting requirements.
“It remains a strong priority for us to maintain access to birth control and other modalities to help people plan their families,” said Matthew Christiansen, the state health officer.
Most other states require health clinics to submit a grant application to get family planning funds. Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, said DHHR adjusting their funding model made sense.
To her, the agency switching to a grants model by itself doesn’t mean funds will become less accessible to rural West Virginians. It could, in fact, be a change that increased the quality of reproductive health services.
“They do have the opportunity, I think, to make the application process as straightforward as possible,” she said. “To support people, as we will, to prepare their applications.”
But many family planning clinic employees say that DHHR has not done much to ease the transition. In an email, a spokesperson for the agency said it has provided and will continue to provide support to West Virginia family planning clinics as they make the transition. She cited a series of town hall meetings the department hosted and some data it sent clinic administrators as two of their key efforts.
Sutherland and Ours participated in one of the town hall meetings. So did Amber Hedrick, the Pendleton County Health Department administrator. Like Hardy County, Pendleton is the only clinic in its county that participates in the federal family planning program.
All three health workers left the meetings with the same fears: small, rural clinics could lose their funds when the grant system starts in April 2024. None of them remember DHHR officials saying they would make it easy to apply for and keep their funds.
“I did not hear anyone say they would assist us in the grant process,” Hedrick said.
DHHR officials told them the agency’s plan is to give clinics only 30 days to write and submit an application and to require administrators to apply for the competitive grant every year.
“If they’re really moving toward a full competition every [year], I think that’s unreasonable,” Coleman said.
In an email, a spokesperson for DHHR said administrators planned to release the application in early October, and that they were considering extending the application period beyond 30 days.
Most states require applications. How is that going in Nebraska?
Making federal family planning funds widely available to small rural residents is something Joanna Murray thinks about constantly. She’s the executive director of Nebraska Family Planning, the only group in her state that receives a Title X grant.
“A really important, super important grant,” Murray said. “Especially for a state like ours, a rural community.”
When the nonprofit was founded and won its grant in 2019, its leadership decided to implement a model in which health centers would have to apply for funds. That model allowed it to support a network of health centers across Nebraska, including many in rural areas.
The key, Murray said, was using the grants model as a way for centers to tell her organization what they need. From there, everyone can work together to make sure the clinics are supported.
“We’re trying to say ‘let’s build the resources you need for your community,’” she said.
As West Virginia prepares to switch to a competitive grants funding model, Murray said it’s important to be thoughtful with the process.
As many states, including West Virginia and Nebraska, have enacted abortion bans, access to reliable reproductive health resources is and will only become more important. And to Murray, making sure small clinics don’t lose their ability to provide that care is crucial.
“That’s why you have to really go slow in this model,” she said.
This story has been updated with information provided by DHHR after publication in response to previous questions from Mountain State Spotlight.
Correction: An earlier version of this story misidentified Clare Coleman. She is the president and CEO of the National Family Planning and Reproductive Health Association.