Fact Sheet: State Alternatives to Abortion Funding

Originally published on June 28, 2022, this paper was updated on October 13, 2023, and again on February 25, 2025.

OVERVIEW

• As of February 2025, 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, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, West Virginia, and Wisconsin.

• Seventeen 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.

• Eleven 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.)

• Four 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, and Ohio.
  • One state, North Dakota, funds its A2A program through its state Medicaid program instead of TANF.
  • One 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 FY24.
  • 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.

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.

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.^[6] 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 2020.^[7]

INVOICING AND PAYMENT PROCEDURES IN DIRECT STATE FUNDING

Often states require providers to invoice for reimbursement for services rendered, either directly to the state or through their contract agency, often referred to as a “fee-for-service” arrangement. West Virginia, for example, operates under a fee-per-service arrangement.^[8] Other states, such as Kansas (for the Pregnancy Maintenance Initiative),^[9] do not require invoicing but do require some form of reporting and/or audit.

Typically, providers can invoice for a wide range of services, from medical services to counseling sessions to educational classes to material assistance.^[10] Some states, such as Florida,^[11] allow invoicing for medical services, while others that rely on TANF finding do not .^[12]

STATE-BY-STATE SUMMARY OF DIRECT STATE FUNDING

Arkansas

• Name of Program: Pregnancy Resource Center Grant^[13]
• Funding Amount: $2 million (FY24-25, began July 1, 2024)^[14]
• State Uses TANF funding for PHOs?: No. Special appropriation from general budget^[15]

Florida

• Name of Program: Florida Pregnancy Support Services Program
• Funding Amount: $29.5 million^[16]
• State Uses TANF funding for PHOs?: No. Special appropriation from general budget^[17]

Georgia

• Name of Program: Positive Alternatives for Pregnancy and Parenting Grant Program^[18]
• Funding Amount: $2,033,112.06 (distributed in FY24)^[19]
• State Uses TANF funding for PHOs?: No

Indiana

• Name of Program: Indiana Pregnancy and Parenting Support Services Program
• Funding Amount: $4 million FY24-25 allocations
  • $4 million for Real Alternatives^[20]
• State Uses TANF funding for PHOs?: Yes^[21]

Iowa

• Name of Program: More Options for Maternal Support (MOMS) Program^[22]
• Funding Amount: $1 million (for FY23-24)^[23]
• State Uses TANF funding for PHOs?: No

Kansas

• Name of Program: Pregnancy Maintenance Initiative (Kansas had two funding programs for 2023-2024, but has now gone to one (PMI) for 2024-2025^[24])
• Funding Amount: $338,846^[25]
• State Uses TANF funding for PHOs?: No. Kansas provides a direct funding allocation by statute.^[26] 

Louisiana

• Name of Program: Louisiana Pregnancy and Baby Care Initiative^[27]
• Funding Amount: $1,054,054 (allocated for FY24)^[28]
• State Uses TANF funding for PHOs?: Yes

Missouri

• Name of Programs: Missouri provides funding in two ways, the Alternatives to Abortion Public Awareness Program (AAPAP)^[29] is a special appropriation funded by statute; and the Alternatives to Abortion Services Program (AASP). The AAPAP is run by the Missouri Department of Social Services (DSS). Funds are spent by DSS to advertise the Program. PHOs receive the money and can be found via a county search on a website.^[30]
• AAPAP Funding Amount (FY24): $275,000^[31]
• AASP Funding Amount: $8,658,561 million in FY24; Governor recommends same amount in 2025.^[32]
• State Uses TANF funding for PHOs?: Yes, as part of the AASP grant only.

North Carolina

• Name of Program: Unnamed but funded through a legislative directive to the North Carolina Department of Health and Human Services, Division of Public Health^[33]
• Funding Amount: $7,750,000 (FY24)^[34]
  • $6,250,000 to Carolina Pregnancy Care Fellowship d/b/a LifeLink Carolina
  • $1,500,000 to Human Coalition
• State Uses TANF funding for PHOs?: No

North Dakota

• Name of Program: Alternatives to Abortion Services^[35]
• Funding Amount: $1,000,000^[36]
• State Uses TANF funding for PHOs?: No. Allocation from General funds of ND Treasury

Ohio

• Name of Program: Ohio Parenting and Pregnancy Program^[37]
• Funding Amount: $13,535,000 (allocated annually for FY23)^[38]
• State Uses TANF funding for PHOs?: Yes^[39]

Oklahoma  

• Name of Program: Choosing Childbirth Program^[40]
• Funding Amount: $17,640,000 over the course of three years^[41]
• State Uses TANF funding for PHOs?: No. Law designed to fund through legislative appropriations.^[42]

South Carolina

• Name of Program: Unnamed but funds “Pregnancy Crisis Centers”
• Funding Amount: $2,400,000 (FY23-24)^[43]
• State Uses TANF funding for PHOs?: No. Funded by statutory allocation.^[44]

Tennessee

• Name of Program: Crisis Pregnancy Provider Support Grants^[45]
• Funding Amount: $20,000,000^[46]
• State Uses TANF funding for PHOs?: No. Funded by the Department of Finance and Administration.^[47

Texas

• Name of Program: Thriving Texas Families Program^[48]
• Funding Amount: $140,000,000 ($70 million each for FY24 & FY25)^[49]
• State Uses TANF funding for PHOs?: No. Funded through general appropriations under the Texas Health and Human Service Program^[50]

Utah

• Names of Programs: Prolife Utah Support Life Program, Utah Pregnancy Resource Center Support Life Program, UT SB 147 “Adoption Revisions”^[51]

• • Prolife Utah Support Life Program
    • Funding amount: $200,000 (FY24-25)^[52]
    • State uses TANF funding for PHOs?: No
  • Utah Pregnancy Resource Center Support Life Program
    • Funding Amount: $200,000 (FY24-25)^[53]
    • State uses TANF funding for PHOs?: No
  • UT SB 147 “Adoption Revisions”
    • Funding amount: $245,000 (FY24-25)^[54]
    • State uses TANF funding for PHOs?: No

West Virginia

• Name of Program: Pregnancy Counseling Program: Mothers and Babies Pregnancy Support Program^[55]
• Funding Amount: $3,000,000 (from October 1, 2024 through September 30, 2025)^[56]
• State Uses TANF funding for PHOs?: No. Funded by statutory allocation.^[57]

Wisconsin

• Name of Program: Pregnancy Counseling Program^[58]
• Funding Amount: $69,100^[59]
• State Uses TANF funding for PHOs?: No. 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 is for groups that neither “provide abortion services” nor have affiliates that “provide abortion services.”^[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 28 Oct. 2024).

[4] S.B. No. 257, Gen. Assem. Reg. Sess. (N.C. 2017). (Accessed 28 Oct. 2024).

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

[6] Pub. L. 104–193, 110 Stat. 2105

[7] “Temporary Assistance for Needy Families.” Center on Budget and Policy Priorities. 1 Mar. 2022. pg. 2. Available at: https://www.cbpp.org/sites/default/files/atoms/files/7-22-10tanf2.pdf. (Accessed 28 Oct. 2024).

[8] See “How do Pregnancy Help Organizations receive program funding?”, West Virginia Mothers & Babies Support Program: FAQ. Available at: https://www.wvmothersandbabies.org/faq/ (Accessed 17 Dec. 2024).

[9] Grants awarded annually. See Kansas Office of Revisor of Statutes, 65-1,159a, https://www.ksrevisor.org/statutes/chapters/ch65/065_001_0159a.html (Accessed 17 Dec. 2024).

[10] See, e.g., “What services and goods qualify for reimbursement?” https://www.wvmothersandbabies.org/faq/ (Accessed 17 Dec. 2024).

[11] See “Resources for Healthy Pregnancies: Florida Pregnancy Support Services.” floridahealth.gov. Available at: https://www.floridahealth.gov/programs-and-services/womens-health/pregnancy/prenatal-care.html?utm_source=  (Accessed 17 Dec. 2024).

[12] See “Q17: Which funding restrictions apply to benefits and services provided pursuant to goals three and four of TANF?”, Q & A: Use of Funds, U.S. Department of Health and Human Services, Office of the Administration for Children & Families. Available at: https://www.acf.hhs.gov/ofa/faq/q-use-funds?utm_source=  (Accessed 17 Dec. 2024). “Section 408(a)(6) is the only restriction on the use of the “grant” in section 408 that applies to benefits and services that are not ‘assistance.’ This provision precludes the use of Federal TANF funds for any medical services other than … family planning services.”

[13] “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).

[14] Arkansas SB 64 (2024). Available at: https://legiscan.com/AR/text/SB64/id/2989772 (Accessed 28 Oct. 2024).

[15] Ibid.

[16] Florida HB5001 FY24-25 Budget. Available at: https://www.flsenate.gov/Session/Bill/2024/5001/BillText/er/PDF (Accessed 28 Oct. 2024).

[17] Ibid.

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

[19] “Annual Report O.C.G. A.§ 31-2A-31 (Fiscal Year 2024) Positive Alternatives for Pregnancy and Parenting Grant Program.” Available at: https://dph.georgia.gov/document/document/lrg-ocgass-31-2a-31-annual-report/download (Accessed 18 Jan 2025).

[20] Indiana HB 1001, 2023, pg. 56. Available at: https://legiscan.com/IN/text/HB1001/id/2794292 (Accessed 28 Oct. 2024).

[21] The Indiana Pregnancy and Parenting Support Services Program. Real Alternatives. 31 July 2024. Available at: https://www.realalternatives.org/wp-content/uploads/2024/09/2024.07-IN-Data.pdf (Accessed 24 Oct. 24).

[22] 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)

[23] Ibid.

[24] Kansas HB 2789 sought to increase the funding to $4 million for the pregnancy compassion program from July 1, 2024, and continue in that amount annually thereafter. The bill died in the House Committee on Health and Human Services on April 30, 2024.

[25] “The Governor’s Budget Report, State of Kansas: Fiscal Year 2024, Vol. 1.” Kansas.gov. pgs. 271 & 279. Available at: https://budget.kansas.gov/wp-content/uploads/FY2024_GBR-Vol1-UPDATED-02.27.2023.pdf (Accessed 24 Oct. 2024).

[26] K.S.A. 65-1,159a. Available at: https://www.ksrevisor.org/statutes/chapters/ch65/065_001_0159a.html (Accessed 28 Oct. 2024).

[27] See “Fiscal Note.” Louisiana Legislative Fiscal Office. 26 Mar. 2024. Available at: https://legis.la.gov/legis//ViewDocument.aspx?d=1358082 (Accessed 28 Oct. 2024). This replaces the old program known as the “Alternative to Abortion Services” program, which was created by La. Admin. Code tit. 67, § III- 5569. 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 28 Oct. 2024).

[28] Ibid.

[29] MO Rev Stat § 188.335. Available at: https://law.justia.com/codes/missouri/2011/titlexii/chapter188/section188335/ (Accessed 28 Oct. 2024).

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

[31] MO HB 11 (2023). pg. 29. Available at: https://documents.house.mo.gov/billtracking/bills241/hlrbillspdf/0011H.05T.pdf (Accessed 28 Oct. 2024).

[32] The Missouri Budget. Fiscal Year 2025. State of Missouri. 24 Jan. 2024. pg. 243. Available at: https://oa.mo.gov/sites/default/files/%2BFiscal_Year_2025_Executive_Budget_UPDATED_3.4.2024_%28web%29.pdf (Accessed 28 Oct. 2024).

[33] House Bill 1033, May 7, 2024. Available at: https://www.ncleg.gov/Sessions/2023/Bills/House/PDF/H1033v1.pdf (Accessed 20 Feb 2025).

[34] North Carolina HB 259 2023, pgs. 281-282, Available at: https://www.ncleg.gov/Sessions/2023/Bills/House/PDF/H259v7.pdf (Accessed 28 Oct. 2024).

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

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

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

[38] 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).

[39] Ibid.

[40] 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).

[41] Notice of Funding Opportunity. Choosing Childbirth Act Funding. Oklahoma State Department of Health. Available at: https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/family-health/fsps/CCB%20NOFO%202024%20Final.pdf (Accessed 28 Oct. 2024).

[42] 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.

[43] South Carolina General Appropriations Bill FY 2024-2025 H. 5100. Sec. 33.II.2, “Pregnancy Crisis Centers“ available at: https://www.scstatehouse.gov/sess125_2023-2024/appropriations2024/tap1a.htm#s33 (Accessed 14 Nov 2024).

[44] Ibid.

[45] 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).

[46] Ibid.

[47] Ibid.

[48] 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).

[49] 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).

[50] Id. at 50.

[51] “Budget of the State of Utah and Related Appropriations: Fiscal Years 2024 and 2025.” Legislative Fiscal Analyst. Revised September 2024. Pgs. 444 & 448. Available at: https://le.utah.gov/interim/2024/pdf/00003198.pdf (Accessed 14 Nov. 2024).

[52] Ibid., pg. 444.

[53] Ibid.

[54] Ibid., pg. 448.

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

[56] Interview with Jeannette Entsminger. President and CEO of the West Virginia Pregnancy Center Coalition. 28 Oct. 2024.

[57] Ibid.

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

[59] 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.

[60] Id. at 54.