Fact Sheet: State Alternatives to Abortion Funding

Originally published on June 28, 2022, and has been updated on October 13, 2023.

OVERVIEW

• As of September 2023, eighteen (18) states have authorized some form of alternatives to abortion (A2A) funding to life-affirming Pregnancy Help Organizations (PHOs), which typically include pregnancy centers, adoption agencies, maternity homes and life-affirming social service agencies.
  • These states include Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Minnesota, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Wisconsin, and West Virginia.
  • In 2024, Kansas will have two A2A funding programs: its traditional program called the “Pregnancy Maintenance Initiative,” and a newly established Alternatives to Abortion program.

• Fourteen (14) of these states actively distribute funds to PHOs or contract agencies for PHOs.[1]
  • In Wisconsin, all funding is provided to the Medical College of Wisconsin,[2] which is not considered a typical PHO.

• Ten (10) states have traditionally used one or more contract agencies to assist in distributing funding or managing the state’s program. (See below for more detail.)
  • West Virginia is using a management agency as of October 1, 2023.

• At least five (5) states distribute a portion of their TANF (Temporary Assistance for Needy Families) funding to PHOs. (See below for more detail.)
  • These states include Indiana, Louisiana, Missouri, Ohio, and Pennsylvania.
  • One (1) state, North Dakota, funds its A2A program through its state Medicaid program instead of TANF.
  • One (1) state, North Carolina, funds its A2A program through the federal Title V Maternal and Child Health Services Block Grant, which was enacted through the Social Security Act of 1935.[3]
    • In 2017, North Carolina enacted a Special Appropriations Bill, which provides additional PHO funding, a portion of which is appropriated to Carolina Pregnancy Care Fellowship, for durable medical equipment, training, and administration; and a portion of which is appropriated to fund a “two-year continuum of care pilot program” to Human Coalition for its clinic in Raleigh.[4] This program has continued through FY23.
  • Missouri has a non-TANF budget appropriation of $75,000 in the current fiscal year for raising awareness of Missouri’s Alternatives to Abortion Program.[5] These funds are used by the State to support the work of PHOs and are not distributed directly to PHOs.

• Eleven (11) states require providers to invoice for reimbursement for services rendered, either directly to the state or through their contract agency.
  • These states are Florida, Georgia, Indiana, Louisiana, Minnesota, Missouri[6], North Carolina, North Dakota, Pennsylvania, Texas, and Wisconsin.
  • Two (2) states do not require invoicing but do require some form of reporting/audit. Kansas (for the Pregnancy Maintenance Initiative) and Ohio distribute funds in accordance with each state-imposed schedule.

MANAGEMENT OF FUNDS

Management of funds varies from state to state. Some states engage one or more “contract management agencies” (“Agencies”) to administer their program. Others use their own state employees to administer the funds and work directly with PHO grantees.

While the degree of responsibility placed on an agency varies from state to state, typically the agency is charged with receiving and distributing funds and selecting its subgrantees. They may also be allowed to set standards for operations, impose criteria for using funds, establish invoicing procedures, and conduct training or audits.

As of 2023, seven (7) states used only one Agency to administer/manage funding. These states are Florida, Georgia, Indiana, North Carolina, North Dakota, Oklahoma, and Pennsylvania.

• West Virginia is using a management agency as of October 1, 2023
• Kansas has two programs. The Pregnancy Maintenance Initiative is managed by the state. The Alternatives to Abortion program is using a management agency.

Three (3) states have historically used more than one Agency to administer funding. Louisiana has used two agencies, Missouri has used nine agencies, and Texas has used four agencies.

All remaining states that provide funding—Arkansas, Kansas (for the Pregnancy Maintenance Initiative) Iowa, Minnesota, Ohio, and Wisconsin—work directly with PHO grantees.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES IN A2A FUNDING

States that extend funding to pro-life providers often do so under their Temporary Assistance for Needy Families (TANF) Program. TANF is a block grant program, which has provided a combined total of $16.5 billion each year to states since its creation by the U.S. Congress in 1996 through the Personal Responsibility and Work Opportunity Act.[7] Such monies are not limited to PHO funding but are used to fund a variety of state programs. States are permitted to use federal TANF funds to support their own programs but are required to subsidize the programs with their own state dollars, a requirement known as the “Maintenance of Effort” (MOE). Collectively, states spent approximately $15 billion in MOEs in 2018.[8]

INVOICING AND PAYMENT PROCEDURES IN DIRECT STATE FUNDING

Eleven (11) states require providers to invoice for reimbursement for services rendered, either directly to the state or through their contract agency. West Virginia’s program, which will be active October 1, 2023, will also require invoicing, bringing the total up to twelve (12). Kansas (for the Pregnancy Maintenance Initiative) and Ohio do not require invoicing but do require some form of reporting and/or audit.  In these two states, funds are requested and distributed in accordance with each state’s-imposed schedule.

Typically, providers can invoice for a wide range of services from counseling sessions to educational classes to material assistance and even for issuing referrals to community resources. Some states, such as Florida, allow invoicing for medical services, while others, such as Texas, do not.[9]

STATE -BY-STATE SUMMARY OF DIRECT STATE FUNDING

Arkansas

• Name of Program: Pregnancy Resource Center Grant[10]
• Funding Amount: $1 million (FY22-23, beginning on Jan. 1, 2022)[11]
• State Uses TANF funding for PHOs?: No. Special appropriation from general budget[12]

Florida

• Name of Program: Florida Pregnancy Support Services Program
• Funding Amount: $25 million in recurring funding[13]
• State Uses TANF funding for PHOs?: No. Special appropriation from general budget[14]
• Florida also proposed to allocate $70 million to help fund fatherhood programs, and $35.5 million to support adoptive and foster families for FY23-24[15]

Georgia

• Name of Program: Positive Alternatives for Pregnancy and Parenting Grant Program[16]
• Funding Amount: $2 million[17]
• State Uses TANF funding for PHOs?: No

Indiana

• Name of Program: Indiana Pregnancy and Parenting Support Services Program
• Funding Amount: $8 million FY23-25 allocations
  • $7 million for Real Alternatives
  • $1 million for the Telecare Women’s Clinic Pilot Program-FY23-24 only[18]
• State Uses TANF funding for PHOs?: Yes

Iowa

• Name of Program: More Options for Maternal Support (MOMS) Program[19]
• Funding Amount: $1 million (for FY23-24)[20]
• State Uses TANF funding for PHOs?: No

Kansas

• Name of Programs (Kansas has two funding programs):
  • Alternatives to Abortion[21]
    • Funding Amount: $2 million[22]
    • State Uses TANF funding for PHOs?: No. Kansas provides a direct funding allocation by statute.
  • Pregnancy Maintenance Initiative (PMI)
    • Contract Agency: none, state contracts directly with providers[23]
    • Funding Amount: $677,692[24]
    • State Uses TANF funding for PHOs?: No. Kansas provides a direct funding allocation by statute.[25]

Louisiana

• Name of Program: Alternatives to Abortion Services Program[26]
• Funding Amount: $1,260,000 (allocated for FY22 and proposed FY23)[27]
• State Uses TANF funding for PHOs?: Yes

Minnesota

• Name of Program: Positive Alternatives to Abortion[28]
• Funding Amount: $3,357,000 (awarded in FY22)[29]
• State Uses TANF funding for PHOs?: No
• Minnesota Governor Tim Walz’s proposed budget for the FY 2024-25 biennium calls for defunding the Positive Alternatives to Abortion grant program.[30]

Missouri

• Name of Programs: Missouri provides funding in two ways, the Alternatives to Abortion Awareness Program (AAAP)[31] is a special appropriation funded by statute; and the Alternatives to Abortion Services Program (AASP). The AAAP is run by the Missouri Department of Social Services (DSS). Funds are spent by DSS to advertise the Program. PHOs receive the money and are listed on a website.[32]
• Funding Amount: $8.66 million[33]
• State Uses TANF funding for PHOs?: Yes, as part of the AASP grant only.

North Carolina

• Name of Program: Maternal and Infant Health Grant (MIHG)[34]
• Funding Amount: $6.9 million (FY23)[35]
• State Uses TANF funding for PHOs?: No

North Dakota

• Name of Program: Alternatives to Abortion Services[36]
• Funding Amount: $1,000,000[37]
• State Uses TANF funding for PHOs?: No. Allocation from General funds of ND Treasury

Ohio

• Name of Program: Ohio Parenting and Pregnancy Program[38]
• Contract Agency: None. Ohio Department of Job and Family Services contracts directly with PHOs.
• Funding Amount: $13,535,000 (allocated annually for FY23)[39]
• State Uses TANF funding for PHOs?: Yes[40]

Oklahoma  

• Name of Program: Choosing Childbirth Program[41]
• Funding Amount: $3 million[42]
• State Uses TANF funding for PHOs?: No. Law designed to fund through legislative appropriations.[43]

Pennsylvania

• Name of Program: Real Alternatives[44]
• Funding Amount: $7.263 million (FY22-23)[45]
• State Uses TANF funding for PHOs?: Yes[46]
• Pennsylvania Governor Josh Shapiro plans to discontinue the Real Alternatives program effective December 31, 2023[47]

Tennessee

• Name of Program: Crisis Pregnancy Provider Support Grants[48]
• Funding Amount: $20,000,000[49]
• State Uses TANF funding for PHOs?: TBD

Texas

• Name of Program: Thriving Texas Families Program[50]
• Funding Amount: $140,000,000 ($70 million each for FY24 & FY25)[51]
• State Uses TANF funding for PHOs?: No. Funded through general appropriations under the Texas Health and Human Service Program[52]

West Virginia

• Name of Program: Pregnancy Counseling Program: Mothers and Babies Pregnancy Support Program[53]
• Funding Amount: Funds will be distributed via a management agency based on a fee per service agreement[54]
• State Uses TANF funding for PHOs?: Funded by statutory allocation.[55]

Wisconsin

• Name of Program: Pregnancy Counseling Program[56]
• Funding Amount: $69,100[57]
• State Uses TANF funding for PHOs?: Wisconsin provides a statutory mandate for the Wisconsin Department of Health Services (WDHS) to award grants from the appropriations. Statutory grant of funds for pregnancy counseling for groups that neither “provide abortion services” nor have affiliates that “provide abortion services.”[58]
• In June of 2022, a significant number of Wisconsin Assembly members asked Governor Tony Evers to fund PHOs for $10 million.[59] Evers summarily rejected the request, asserting that the centers do not have medical personnel. A survey of Wisconsin PHOs by Charlotte Lozier Institute and Care Net pregnancy centers showed the centers have 196 total paid staff members, 23 percent of whom were licensed medical professionals, as well as 848 total volunteers, of whom 16 percent were licensed medical professionals.[60]

[1] Wisconsin distributes to one organization, which does not meet the definition of a Pregnancy Help Organization.

[2] Bureau Director of Community Health Promotion, Division of Public Health. Letter to Jeanneane Maxon [16 Sept. 2020].

[3] Pub. L. 74-271. Available at: https://www.ssa.gov/history/35act.html (Accessed 3 Mar. 2023).

[4] S.B. No. 257, Gen. Assem. Reg. Sess. (N.C. 2017).  (Accessed 3 Mar. 2023).

[5] MO HB 11 (2017).  (Accessed 3 Mar. 2023).

[6] Missouri also appropriates funds to advertise its program, but PHOs do not see that money.

[7] Pub. L. 104–193, 110 Stat. 2105

[8] “Temporary Assistance for Needy Families.” Center on Budget and Policy Priorities. 6 Feb. 2020. Available at: https://www.cbpp.org/sites/default/files/atoms/files/7-22-10tanf2.pdf. (Accessed 3 Mar. 2023).

[9] Often states that fund PHOs through their TANF Block Grant do not allow funding for medical services. States that fund through non-TANF methods often allow funding for medical services and/or equipment.

[10] “Pregnancy Resource Center Grant.” Arkansas Department of Finance and Administration. Available at: https://www.dfa.arkansas.gov/intergovernmental-services/grant-programs/pregnancy-resource-center-grant (Accessed 3 Mar. 2023).

[11] Arkansas Act 187 of 2022. Available at: https://www.dfa.arkansas.gov/images/uploads/intergovernmentalServicesOffice/Act187.pdf  (Accessed 3 Mar. 23).

[12] Ibid.

[13] Florida HB5001 FY22-23 Budget. Available at: https://www.flsenate.gov/Session/Bill/2022/5001/BillText/er/PDF (Accessed 3 Mar. 2023).

[14] S.B.2500, 2017, Sec. 445 Leg., Reg, Sess. (Fla. 2017).  (Accessed 3 Mar. 2023).

[15] “Fathers’ Day comes early as DeSantis signs bill to support Florida’s dads.” Miami Herald.11 April 2022. Available at: https://www.miamiherald.com/news/politics-government/state-politics/article260312955.html (Accessed 8 Mar. 2023), and Florida HB 7065 (2022). Available at: https://www.flsenate.gov/Session/Bill/2022/7065/BillText/er/PDF (Accessed 8 Mar. 2023).

[16] GA Code 31-2A-31. https://codes.findlaw.com/ga/title-31-health/ga-code-sect-31-2a-31.html (Accessed 3 Mar. 2023).

[17] More information may be requested of the Georgia Department of Public Health. https://dph.georgia.gov/ (Accessed 3 Mar. 2023).

[18] Indiana HB 1001, 2023, pg. 56. Available at: https://legiscan.com/IN/text/HB1001/id/2794292  (Accessed 7 June 2023).

[19] Iowa Dept. of Health and Human Services. Request for Proposal. More Options for Maternal Support (MOMS) Program. Pg. 3.Available at: PROC|DAS Bidding Opportunities | Iowa Department of Administrative Services (Accessed 14 Sept. 2023)

[20] Ibid.

[21] KS House Bill 2429 (2023).  Available at: https://kslegislature.org/li/b2023_24/measures/documents/hb2429_00_0000.pdf (Accessed 18 Sept. 2023).

[22] KS HB 2184 2023, pgs. 28. Available at: https://kslegislature.org/li/b2023_24/measures/documents/hb2184_enrolled.pdf (Accessed 7 June 2023).

[23] “Pregnancy Maintenance Initiative Program Annual Report FY22.” Kansas Department of Health and the Environment. 1 Jan. 2023 Available at:https://www.kdhe.ks.gov/DocumentCenter/View/5345/Annual-Report-2022—Pregnancy-Maintenance-Initiative-PDF?bidId=#:~:text=65%2D1%2C159a%3A%20Stan%20Clark,Maintenance%20Initiative%20Program%20(PMI).&text=State%20General%20Funds%20(SGF)%20totaling,Fiscal%20Year%20(SFY)%202022. (Accessed 7 June. 2023).

[24] KS HB 2184 2023, pg. 86. Available at: https://kslegislature.org/li/b2023_24/measures/documents/hb2184_enrolled.pdf (Accessed 7 June 2023).

[25] K.S.A. 65-1,159a.  Available at: https://www.ksrevisor.org/statutes/chapters/ch65/065_001_0159a.html (Accessed 3 Mar. 2023).

[26] La. Admin. Code tit. 67, pt. III, § 5569. Available at: https://casetext.com/regulation/louisiana-administrative-code/title-67-social-services/part-iii-family-support/subpart-15-temporary-assistance-for-needy-families-tanf-initiatives/chapter-55-tanf-initiatives/section-iii-5569-alternatives-to-abortion-services-program (Accessed 3 Mar. 2023).

[27] Louisiana Department of Children and Families. “Fiscal Year 2023 Executive Budget Review.” pg. 33 16 Mar. 2022.  Available at: https://house.louisiana.gov/housefiscal/DOCS_APP_BDGT_MEETINGS/DOCS_APPBudgetMeetings2022/FY%2023%20Children%20and%20Family%20Services.pdf (Accessed 21 Sept. 2023).

[28] MN Stat. 145.4235 Available at: https://www.revisor.mn.gov/statutes/2020/cite/145.4235 (Accessed 21 Sept. 2023).

[29] Minnesota Department of Health. “2021 – 2025 Positive Alternatives Grant Awards with Programs or Services.” Jan. 2021. Available at: https://web.archive.org/web/20210808110441/https://www.health.state.mn.us/docs/people/womeninfants/positivealt/paagrantees202125.pdf . (Accessed 21 Sept. 2023).

[30] “Governor’s 2024‐25 Biennial Budget Recommendations, General Fund.” Available at: https://mn.gov/mmb-stat/documents/budget/operating-budget/gov-rec/jan23/jan23-general-fund-summary-report.pdf  (Assessed 3 Mar. 2023).

[31] MO Rev Stat § 188.335. Available at: https://law.justia.com/codes/missouri/2011/titlexii/chapter188/section188335/ (Accessed 3 Mar. 2023).

[32] https://dss.mo.gov/fsd/a2a (Accessed 3 Mar. 2023).

[33] More information may be requested of the Missouri Department of Social Services, Alternatives to Abortion Program: https://dss.mo.gov/fsd/a2a/  Also see, Bayless, K.  “Missouri Banned Abortion. Why is it spending millions to promote alternatives to the procedure.” The Kansas City Star.  3 July 2023.  Available at; https://www.kansascity.com/news/politics-government/article277059568.html  (Accessed 21 Sept. 2023).

[34] Maternal and Child Health Services Title V Block Grant: FY 2022 Application/ FY 2020 Annual Report.” 31 Aug. 2021.  Human Resources and Services Administration. 31 Aug. 2021. Available at: https://mchb.tvisdata.hrsa.gov/Admin/FileUpload/DownloadStateUploadedPdf?filetype=PrintVersion&state=NC&year=2022  (Accessed 3 Mar. 2023).

[35] North Carolina SB 105 2021, pgs. 232-234 Available at: https://www.ncleg.gov/Sessions/2021/Bills/Senate/PDF/S105v7.pdf (Accessed 3 Mar. 2023).

[36] https://www.hhs.nd.gov/cfs/alternatives-abortion-services  (Accessed 3 Mar. 2023).

[37]North Dakota SB 2129 (2023). Available at: https://legiscan.com/ND/text/SB2129/2023 (Accessed 3 Mar. 2023).

[38] Ohio Revised Code Annotated §5101.804. Available at: http://codes.ohio.gov/orc/5101.804 (Accessed 3 Mar. 2023).

[39] Ohio Governor Mike DeWine, Executive Order 2022-09D. 29 Apr. 2022.  Available at: https://content.govdelivery.com/attachments/OHIOGOVERNOR/2022/08/09/file_attachments/2240331/Signed%20EO%202022-14D.pdf  (Accessed 3 Mar. 2023).

[40] Ibid.

[41] HB1703, Okla. Stat. tit. 63, § 1-740.15; Available at: http://webserver1.lsb.state.ok.us/cf_pdf/2017-18%20ENR/hB/HB1703%20ENR.PDF (Accessed 3 Mar. 2023).

[42] Oklahoma SB 1043, Sec. 4 (2023), Available at: http://webserver1.lsb.state.ok.us/cf_pdf/2021-22%20ENR/SB/SB1043%20ENR.PDF (Accessed 21 Sept. 2023).

[43] HB1703, Okla. Stat. tit. 63, § 1-740.15; Available at: http://webserver1.lsb.state.ok.us/cf_pdf/2017-18%20ENR/hB/HB1703%20ENR.PDF (Accessed 3 Mar. 2023), at 2.

[44] Real Alternatives, “Our Mission,” Available at: https://www.realalternatives.org/about-us/ (Accessed 3 Mar. 2023).

[45] Ibid.

[46] “History.” Real Alternatives. Available at: https://www.realalternatives.org/https-wp-content-uploads-2019-06-history-2019-pdfhistory/ (Accessed 3 Mar. 2023).

[47] Miller, C. “Shapiro terminates state funding for Real Alternatives anti-abortion centers in Pa.” Pennsylvania Capital-Star. 4 Aug. 2023. Available at: https://www.penncapital-star.com/government-politics/shapiro-terminates-state-funding-for-real-alternatives-anti-abortion-centers-in-pa/ (Accessed 21 Sept. 2023).

[48] Tennessee Governor Bill Lee.  “Gov. Lee’s Full ‘Tennessee: Leading the Nation’ Agenda Passes.” Press Release. 23 April 2023. Available at: https://www.tn.gov/governor/news/2023/4/23/gov–lee-s-full–tennessee–leading-the-nation–agenda-passes.html (Accessed 21 Sept. 2023).

[49] Ibid.

[50] The Thriving Texas Families Program continues Texas’ previous Alternatives to Abortion Program. See Texas SB 24, Sec. 54.002. (2023). Available at: https://capitol.texas.gov/tlodocs/88R/billtext/pdf/SB00024F.pdf#navpanes=0 (Accessed 21 Sept. 2023).

[51] Texas HB 1 (2023), D.1.2 “Alternatives to Abortion.” Available at: https://capitol.texas.gov/tlodocs/88R/billtext/pdf/HB00001F.pdf#navpanes=0 (Accessed 21 Sept. 2023).

[52] Id. at 50.

[53] West Virginia HB 2002. Available at: https://www.wvlegislature.gov/Bill_Text_HTML/2023_SESSIONS/RS/bills/hb2002%20sub.pdf (Accessed 3 Mar. 2023).

[54] Ibid.

[55] Ibid.

[56] Wis. Stat. Ann. § 253.08. Available at:  https://docs.legis.wisconsin.gov/statutes/statutes/253/08 (Accessed 3 Mar. 2023).

[57] Community Health Promotion, Wisconsin Division of Wisconsin Department of Public Health. Letter to Jeanneane Maxon [16 Sept. 2020]. Updated funding information may be obtained by contacting the Wisconsin Department of Public Health.

[58] Id. at 54.

[59] Fannon, E. “GOP lawmakers ask Gov. Evers for $10M to aid pregnancy centers.” CBS 58. Available at: https://www.cbs58.com/news/gop-lawmakers-ask-gov-evers-for-10m-to-aid-pregnancy-centers (Accessed 8 Mar. 2023).

[60] Charlotte Lozier Institute. Pregnancy Center State Impact Report: Wisconsin. Available at: https://lozierinstitute.org/wp-content/uploads/2023/01/Final-2019-Wisconsin-State-Impact-Report.pdf