In 2017, Republican lawmakers sneaked a provision into the state budget designed to strip Planned Parenthood of funding meant to serve low income patients.
The law directed the Arizona Department of Health Services to apply for Title X grant dollars under the federal Public Health Safety Act. State health officials are required to argue that the state “is best suited to receive and distribute” those federal dollars to eligible agencies.
But when the Health Department was finally awarded Title X funding, the agency spent only a fraction of the grant.
DHS was given $906,000 to spend between September 2018 and March 2019.
Of that, they spent just $88,000, leaving $818,000 in unspent federal dollars that should have gone to services for low income patients.
Meanwhile, Arizona Family Health Partnership had no trouble spending its portion of federal dollars. The nonprofit group, which has received most, if not all, of the Title X funds allocated to Arizona since 1983, was awarded $2.72 million during the same seven-month period.
They spent every penny, according to Arizona Family Health Partnership CEO Brenda Thomas.
Arizonans made up about 1 percent of all Title X patients in 2017.
That’s 36,402 people, mostly women, who could otherwise not afford to seek medical care. Of those patients, more than 22,000 were uninsured.
Had Arizona Family Health Partnership received all the Title X grant money, it’s likely that the $818,000 DHS didn’t manage to distribute would have been spent on birth control and other family planning services for low-income Arizonans.
That includes Planned Parenthood, which received a portion of the $2.72 million the nonprofit was awarded in that seven-month period. The remaining dollars went to county health departments and other providers.
Had the state received the full portion of the Title X grant, no dollars would have been distributed to Planned Parenthood.
In 2017, President Trump overruled an Obama administration order that prohibited states from denying Title X funds to certain organizations, as long as they’re capable of providing family planning services.
Republican lawmakers, backed by Cathi Herrod and the Center for Arizona Policy, an influential anti-abortion lobbying group, seized Trump’s order as an opportunity to divert Title X funds away from Planned Parenthood.
In order to do that, the state needed to get its hands on the Title X grant, said Sen. J.D. Mesnard, then speaker of the House of Representatives.
“It’s been no secret that the Legislature, the Republicans here, are not fans of funding the No. 1 abortion provider in the country,” the Chandler Republican said in 2017. “We have, as much as we’ve been able to do, [tried] to divert funds to other health care providers that aren’t abortion providers… This is consistent with that philosophy.”
Herrod said at the time that it would be typical for a state agency to apply for the funding and dismissed the idea that Planned Parenthood relies on the funds.
“Planned Parenthood is not the only game in town, and taxpayers should not be forced to pay for abortions – even indirectly through paying other expenses at abortion clinics,” Herrod said in a 2017 statement. “Planned Parenthood of Arizona currently receives a fraction of Title X funding – losing it would hardly be crippling.”
Planned Parenthood Arizona receives about 18 to 20 percent of their annual revenue from Title X dollars, according to spokeswoman Tayler Tucker. But, Tucker said Planned Parenthood Arizona serves 53 percent of Title X eligible patients.
Both state and federal laws already preclude the use of tax dollars for elective abortions, and no Title X money can be used for abortions either.
Under the 2017 law, the state’s health services agency must distribute the grant money first to state or county-owned health care facilities, then to hospitals and federally qualified health centers, rural health clinics, and health care providers that offer required primary health services as listed in federal law.
DHS officials blamed the unspent federal dollars on location and timing.
The Health Department’s share of Title X dollars could only be spent in five rural counties: Mohave, Santa Cruz, Yuma, Apache and Cochise. None of those counties currently have Title X providers, the most obvious candidates for the grant money, said Sheila Sjolander, assistant director of prevention services for DHS.
Sjolander said the state would have had to help start local Title X programs in a short period of time in order to spend the remaining $818,000.
“Title X is a very structured highly regulated program,” Sjolander said. “It makes it really hard to start up a new service in a rural area in a very short period.”
Although there are no current Title X providers in those five counties, county health departments could have applied for the funds as long as they used them for their intended purpose.
None did, according to Sjolander.
Given the short timeframe in which to spend grant dollars, Sjolander said she understands why county health departments didn’t apply for the money.
“I probably wouldn’t have applied either,” Sjolander said.
She said the ability to apply and the capacity to implement the program are two different things.
The $88,000 the department did spend was for staff and development of the program during the seven-month time period, which was unusually short, Sjolander said.
Sjolander said the state is developing a plan to spend the remaining $818,000 on one-time purchases like supplies and training, but that has to be approved by the federal government, and Sjolander said the department is still waiting for that to happen.
Had Arizona Family Health Partnership been awarded the money granted to DHS, it’s likely that at least some patients in those five rural counties would have been served. Thomas said her nonprofit has worked in some of the five counties previously, but none on a consistent year-to-year partnership. Most of the nonprofit’s rural work has been in Mohave County, where it continues to allocate money.
Moving forward, Arizona Family Health Partnership will focus on providing services in counties with unmet needs, Thomas said.
For the next three years, the nonprofit will have plenty of funding to do just that.
Arizona Family Health Partnership was given 100 percent of Arizona’s recent Title X grant funding, while DHS received none. Thomas said the grant, which is $5.2 million per year, is not enough money to fund all the rural counties, but that the nonprofit is working to finalize contracts that would extend services in two counties.
Thomas said the competition for Title X funding has soured her nonprofit’s relationship with DHS. Thomas had previously had conversations about Title X funds with state health officials, and said she later felt duped into helping the state directly compete for grant dollars with her organization.
“It’s harder to be a good partner with people you know you have to compete with,” she said.
While the state’s recent applications for Title X funding have been a motivator for Thomas’ organization, the state’s involvement goes against the spirit of Title X funding as outlined by the federal government in the 1980s, Thomas said.
She said when multiple groups were receiving the grants in 1983, Arizona Family Health Partnership, which was called Arizona Family Planning Council then, was agreed upon by the groups to serve as an “outside government entity” that would distribute the funds.
“They made that decision so it (Title X dollars) couldn’t be politicized,” Thomas said.
As for DHS, Sjolander said state health officials will continue to apply for Title X funding according to state law.
If DHS is awarded funding in the future, officials expect they’ll be given longer than seven months to spend the grant money, enough time to avoid the issues that led to unspent dollars in 2018 and 2019, she added.
Sjolander would not speculate why the department was not granted any of the funds after their most recent application.
Reporter Ben Giles and Capitol Media Services contributed to this report.