Last week, we told you about sweeping changes to the Title X grant program, the only dedicated source of federal funding for family planning, and now it seems the changes are even more dramatic than initially known.Politico reports that abstinence-only advocate Valerie Huber will make the final decision on which applicants receive the $260 million available in Title X grants, rather than a group of officials who made the decision in previous years. That means a single person controls the nation's family planning budget for the first time since the late 1980s.Before President Trump appointed Huber to a post at the Department of Health and Human Services (the office that oversees Title X) in June 2017, she served as the president and CEO of Ascend, a national organization that promotes abstinence-only sex education until marriage, or what Huber calls "sexual risk avoidance," rather than educate teenagers about contraception. She was the president of Ascend from 2007 to 2017; before that she managed the Ohio Department of Health’s sexual risk avoidance program.In 2016, Huber said in a statement that sex ed normalizes sex among teens. “As public health experts and policy makers, we must normalize sexual delay more than we normalize teen sex, even with contraception," she said. In a 2012 speech, Huber said, "We think it’s very important for teens to know that even if they use a condom or contraception, that doesn’t make sex safe. It doesn’t mean they won’t get pregnant. It doesn’t mean they won’t have an STD." Research has shown time and again that abstinence-only education does not delay the age when teens first have sex, nor does it reduce rates of unintended pregnancies or STDs.Huber is now the acting deputy assistant secretary for the Office of Population Affairs (OPA), a division of HHS. The recent call for grant applications says that the deputy assistant secretary or their designee "will make final award selections." In previous years, final award decisions were made by regional health administrators in consultation with the deputy assistant secretary for population affairs and the assistant secretary for health or their designees. (As in the past, applications will first be reviewed by an independent panel, though the 2018 grant announcement states that "federal staff and an independent review panel will assess all eligible applications.")An HHS spokesperson confirmed the change to Politico, saying "The selection process in the funding opportunity announcement has been updated to reflect that the office head, in this case, the [deputy assistant secretary for population affairs], will make the final selections." The spokesperson also said that HHS has been trying to“streamline administrative function” for Title X since 2013. We've reached out to HHS for comment and will update this post when we hear back.The changes in the call for Title X grants showed that the Trump administration will prioritize applicants that provide primary care services "optimally onsite," as well as groups that promote sexual risk avoidance for teenagers and work with faith-based organizations. Reproductive health specialists that offer the full range of birth control methods tend not to do these things and stand to earn fewer points in the new rating system, making them less likely to earn Title X grants. The grant announcement also de-emphasizes contraception by not mentioning it even once, and removing guidance that applicants should offer all 18 types of FDA-approved contraceptives, including the IUD and implant. Instead, the announcement stresses the inclusion of natural family planning methods.More than 4 million people rely on Title X services every year, the majority of whom are women. Planned Parenthood serves 41 percent of all Title X patients despite only making up 13 percent of the 3,900 Title X clinics in the US.Dawn Laguens, executive vice president of the Planned Parenthood Federation of America, called the decision-making change "outrageous and dangerous" in a statement, adding that "Valerie Huber has pushed to mandate abstinence pledges…It is unprecedented to give decision-making power for millions of dollars in family planning funding to just one individual, let alone someone who promotes abstinence only until marriage.”Updated 3/7/18: An HHS spokesperson provided the following statement about the change in grant approval authority:Since 2013, the Office of the Assistant Secretary for Health’s (OASH) Offices of Population Affairs (OPA) and Grants Management (OGM) have been working to streamline administrative function for the Title X family planning program, to bring it into alignment with all other OASH grant programs. Over the past five years, OASH has been realigning Title X service areas, award start dates, and competitive reviews to more efficiently administer the program. The FY 2018 funding opportunity announcement is the culmination of that effort, synchronizing the entire program into one competition.
Some specific examples of efforts to streamline administrative function:
OASH consolidated the Title X grants expert panel review process from 11 separate offices to the OASH central review function that the other OASH programs were already using. This brought consistency to the reviews and reduced costs by allowing reviews to occur across the entire Title X program rather than region by region.
In 2013, the funding opportunity announcement was changed to reflect shared decision making regarding final award decisions from the Regional Health Administrator (RHA) to RHA with the ASH [assistant secretary for health] and DASPA [deputy assistant secretary for population affairs].
The selection process in the funding opportunity announcement has been updated to reflect that the office head, in this case, the DASPA, will make the final selections. As with the centralized review, this also aligns the Title X program with all other OASH financial assistance award programs. As with all other OASH programs, the program will make final award selections to be recommended to the Grants Management Officer for risk analysis. This change reflects the regulatory requirements for financial assistance awards and was updated in all OASH FY 2018 funding announcements.
Just like previous years, eligible applicants are reviewed by a panel of independent reviewers and are evaluated based on criteria in the Title X regulations. Federal staff also review each application for programmatic and grants management compliance.
Correction 3/7/18: This story has been corrected to reflect that the deputy assistant secretary for population affairs had the authority to make final Title X decisions until the late 1980s, per an HHS spokesperson. It is not the first time since the program's inception in 1970 as previously stated. We regret the error.Sign up for our newsletter to get the best of Tonic delivered to your inbox weekly. 
