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How Changes To Title X Are Affecting Wyoming's Family Planning Clinics

Catherine Wheeler
Teton County Health Department

Gillette Reproductive Health is like any other doctor's office. There are people waiting, a TV is playing, and there are stacks of magazines.

But this clinic is a Title X clinic, and Julie Price is its executive director. She said Title X clinics provide reproductive health care for low-income and uninsured people, though people with insurance can also go there.

Price said these clinics provide services like HIV testing, cancer screenings and more.

"The services people come in for are well women exams, or STD testing and treatment, or clinical breast exams or mammograms, or whether they want to see if they're pregnant. We'll do a lot contraceptive care. So what we say is we can teach how to get pregnant or not to get pregnant," Price said.

There are 11 Title X clinics in Wyoming, and they are all under the umbrella of the Wyoming Health Council. The non-profit is the state's sole Title X grantee, meaning it's responsible for distributing the federal dollars to the clinics around the state.

Earlier this year, the U.S. Department of Health and Human Services handed down new regulations that Title X clinics have to follow if they want to keep their grant funding.

Rob Johnston, executive director of the Wyoming Health Council, said the new rules limit what staff can say to clients who might be looking for an abortion.

"In most of our clinics we have [registered nurses] or others providing these kinds of services. And now that type of conversation is being restricted to licensed professionals such as physicians, physician assistants, nurse practitioners, what have you," Johnston said.

Title X funds have never paid for abortions. They can just only provide information for women for the next steps of a pregnancy, whether that's prenatal care or a different option.

But with the new rule, only a doctor, physician assistant or nurse practitioner can be the one to give pregnant women a list of options for any sort of further health care. The list could include an abortion provider, it just can't be acknowledged as such.

Johnston said that is problematic in Wyoming, where those people are sometimes only in the office a couple of times a week.

"It's really restricting what can happen on those other three days and it may mean that people have to make appointments months in advance, which could complicate what their needs are," he said.

He said that if certain staff are not able to directly help with referrals, it adds extra hoops pregnant women have to jump through to look for the right provider for them.

Because of all this the Kaiser Family Foundation says more than 900 family planning or reproductive health clinics, which includes Planned Parenthood clinics, have left the Title X program.

That includes one in our state.

"We made the decision, along with our advisory council and with staff, that it doesn't serve our patients well to not be able to provide complete medical care," said Jodie Pond, director of health for the Teton County Health Department. Teton's health department oversees the Teton County Family Planning Clinic.

Pond said of the $38,000 the clinic received from the program, it would have to spend about $8,000 of it hiring someone to help with the paperwork and data they are required to provide in the program.

"It's also been very unstable for the last few years, where it should have been a three-year grant and we've had to write a grant application every six months," she said.

Pond said there were aspects of the program that benefited the clinic. She said it kept them organized, but in the end, it just didn't help them in the ways they wanted it to.

She said in their county, she's confident they'll raise the money to continue their program.

Pond said her staff has committed to continuing all of the clinic's services and acknowledges that Teton County's clinic is in a different position than other clinics in the state.

"We have the support of our county health department and the infrastructure here, and again a lot of Title X clinics are stand alone, so they have rent to pay and lights to turn on. So they don't have, I guess I'd say, the luxury to be able to say, 'you know, we can't do this because of this regulation,'" she said.

Rob Johnston with the Wyoming Health Council said clinics in other counties may face challenges.

"If they want to continue to provide these services, to be honest, they aren't in a financial position to find other funding for those services to reach the clients who have been historically served by them," he said.

In talking to some of the other clinics around the state, those clinics haven't even thought about leaving because Title X funding is the cornerstone of the budget.

Johnston said now his focus is on making sure the remaining clinics are in compliance with the new rules while also maintaining the same services.

He said part of the changes to Title X also include separating family planning clinics from other kinds of health providers, especially if the clinics are associated with local public health departments.

"They're talking about physical location in a building, they're talking about if you have shared electronic health records, whether you have a shared billing system, those kinds of things. And for many of those clinics they do. Now that is not the case for our stand-alones, but for those co-located with public health, that could become an issue," he said.

Johnston said his organization has to submit its action plan on how to do that by March 2020, though some of the details of the changes are still unclear.

Have a question about this story? Contact the reporter, Catherine Wheeler, at cwheel11@uwyo.edu.

Catherine Wheeler comes to Wyoming from Kansas City, Missouri. She has worked at public media stations in Missouri and on the Vox podcast "Today, Explained." Catherine graduated from Fort Lewis College with a BA in English. She recently received her master in journalism from the University of Missouri. Catherine enjoys cooking, looming, reading and the outdoors.
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