Fact Sheet: State Alternatives to Abortion Funding

This fact sheet may be viewed as a PDF: Fact Sheet: State Alternatives to Abortion Funding

OVERVIEW

• Fourteen (14) states authorize 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 Florida, Georgia, Indiana, Kansas, Louisiana, Minnesota, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas and Wisconsin. (See below for more detail.)
• One (1) additional state, Arkansas, will be starting an A2A funding program this year (2022).[1]
• Thirteen (13) of these states actively distribute funds to PHOs or contract agencies for PHOs.[2]
  • In Wisconsin, all funding is provided to the Medical College of Wisconsin,[3] 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.)
• At least six (6) 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, Pennsylvania, and Texas.
  • 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.[4]
    • 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.[5]
  • 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.[6] 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[7], North Carolina, North Dakota, Pennsylvania, Texas, and Wisconsin.
  • Two (2) states do not require invoicing but do require some form of reporting/audit. Kansas and Ohio distribute funds in accordance with each state’s imposed

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 sub-grantees. They may also be allowed to set their own standards for operations, impose criteria for using funds, establish invoicing procedures, and conduct trainings or audits.

As of 2020, seven (7) states used only one Agency to administer/manage funding. These states are Florida, Georgia, Indiana, North Carolina, North Dakota, Oklahoma, Pennsylvania

Three (3) states have historically used more than one Agency to administer funding. Louisiana uses two agencies (as of 2020), Missouri uses nine agencies (as of 2020), and Texas uses two agencies.

All remaining states that provide funding (Kansas, 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.[8] 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.[9]

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. However, Kansas 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.[10]

STATE -BY-STATE SUMMARY OF DIRECT STATE FUNDING

Arkansas

• New for 2022
• Details: TBD
• Anticipated Funding Amount- $1 million[11]

Florida

• Name of Program: Florida Pregnancy Support Services Program
• Funding Amount: $4.5 million (FY22-23, beginning on July 1, 2022)[12]
• State Uses TANF funding for PHOs?: Special appropriation from general budget[13]

Georgia

• Name of Program: Positive Alternatives for Pregnancy and Parenting Grant Program[14]
• Funding Amount: $2 million[15]
• State Uses TANF funding for PHOs?: No

Indiana

• Name of Program: Indiana Pregnancy and Parenting Support Services Program
• Funding Amount: $2.25 million (FY19-20 allocation)[16]
• State Uses TANF funding for PHOs?: Yes

Kansas

• Name of Program: Pregnancy Maintenance Initiative (PMI)[17]
• Contract Agency: none, state contracts directly with providers[18]
• Funding Amount: $338,846 (FY18)[19]
• State Uses TANF funding for PHOs?: Kansas provides a direct funding allocation by statute.[20]

Louisiana

• Name of Program: Alternatives to Abortion Services Program[21]
• Funding Amount: $1,033,013 (allocated from July 1, 2018 through Sept. 30, 2022).[22]
• State Uses TANF funding for PHOs?: Yes

Minnesota

• Name of Program: Positive Alternatives to Abortion[23]
• Contract Agency: none, Minnesota Department of Health contracts directly with providers[24]
• Funding Amount: $3,357,000 (awarded annually 2021-2025)[25]
• State Uses TANF funding for PHOs?: No

Missouri

• Name of Programs: Missouri provides funding in two ways, the Alternatives to Abortion Awareness Program (AAAP)[26] 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.[27]
• Funding Amount: $8.66 million[28]
• 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)[29]
• Funding Amount: $15.6 million. (allocated over two years – FY21-23).
• State Uses TANF funding for PHOs?: TBD under new budget

North Dakota

• Name of Program: Alternatives to Abortion Services[30]
• Funding Amount: $600,000 plus $1.5 million (one-time Covid relief) for biennium 2021-2023[31]
• State Uses TANF funding for PHOs?: Yes[32]

Ohio

• Name of Program: Ohio Parenting and Pregnancy Program[33]
• Contract Agency: None. Ohio Department of Job and Family Services contracts directly with PHOs.
• Funding Amount: $1,500,000 (allocated annually for FY22 & FY23)[34]
• State Uses TANF funding for PHOs?: Yes[35]

Oklahoma

• Name of Program: Choosing Childbirth Program[36]
• Funding Amount: $7 million[37]
• State Uses TANF funding for PHOs?: Law designed to fund through legislative appropriations.[38]

Pennsylvania

• Name of Program: Real Alternatives[39]
• Funding Amount: $7.263 million[40]
• State Uses TANF funding for PHOs?: Yes[41]

Texas

• Name of Program: Texas Alternatives to Abortion Services Program[42] (official) or Alternatives to Abortion, A2A (unofficial)[43]
• Funding Amount: $100,022,732 (biennium 2022-2024)
• State Uses TANF funding for PHOs?: Yes[44]

Wisconsin

• Name of Program: Pregnancy Counseling Program[45]
• Funding Amount: $69,100[46]
• 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.”[47]

[1] https://www.usnews.com/news/best-states/arkansas/articles/2022-03-03/arkansas-lawmakers-ok-1m-for-pregnancy-resource-centers#:~:text=Arkansas%20lawmakers%20have%20voted%20to,women%20from%20getting%20an%20abortion.&text=March%203%2C%202022%2C%20at%206%3A02%20p.m.&text=LITTLE%20ROCK%2C%20Ark.

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

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

[4] Pub. L. 74-271. Available at: https://www.ssa.gov/history/35act.html (Accessed 6 Oct. 2020).

[5] S.B. No. 257, Gen. Assem. Reg. Sess. (N.C. 2017).

[6] MO HB 11 (2017).  (Accessed 28 Nov. 2018).

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

[8] Pub. L. 104–193, 110 Stat. 2105

[9] “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 6 Oct. 2020).

[10] 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.

[11] DeMillo, Andrew.  “Arkansas Lawmakers OK $1M for Pregnancy Resource Centers. Associated Press. U.S. News & World Report. 3 Mar. 2022. Available at: https://www.usnews.com/news/best-states/arkansas/articles/2022-03-03/arkansas-lawmakers-ok-1m-for-pregnancy-resource-centers#:~:text=Arkansas%20lawmakers%20have%20voted%20to,women%20from%20getting%20an%20abortion.&text=March%203%2C%202022%2C%20at%206%3A02%20p.m.&text=LITTLE%20ROCK%2C%20Ark. (Accessed 3 May 2022).

[12] Florida HB5001 FY22-23 Budget. Available at: https://www.flsenate.gov/Session/Bill/2022/5001/BillText/er/PDF (Accessed 10 May 2022).

[13] S.B.2500, 2017, Sec. 445 Leg., Reg, Sess. (Fla. 2017).

[14] GA Code 31-2A-31. https://codes.findlaw.com/ga/title-31-health/ga-code-sect-31-2a-31.html

[15] More information may be requested of the Georgia Department of Public Health. https://dph.georgia.gov/

[16] Real Alternatives, “Our Mission,” Available at: https://www.realalternatives.org/about-us/ (Accessed 3 May 2022).

[17] Kansas Department of Health and the Environment. Email to Jeanneane Maxon [26 April 2020].

[18] Kansas Department of Health and the Environment. Email to Jeanneane Maxon [29 May 2018].

[19] Ibid.

[20] K.S.A. 65-1,159a.  Available at: https://www.ksrevisor.org/statutes/chapters/ch65/065_001_0159a.html (accessed 9 Sept. 2020).

[21] La. Admin. Code tit. 67, pt. III, § 5569.

[22] LIFT Louisiana. 2020. Available at: https://drive.google.com/file/d/1Q6dN75DHTWvBwWLcYBw3MeHIEay0zZJg/view (Accessed 3 May 2022).

[23] “2021 Positive Alternatives Grant Program: Supporting Women in Carrying Their Pregnancies to Term and Caring for Their Babies After Birth.” Minnesota Department of Health. Feb. 2022. Available at:  https://www.health.state.mn.us/docs/people/womeninfants/positivealt/pafactsheet.pdf (Accessed 10 May 2022).

[24] Ibid.

[25] Minnesota Department of Health. “2021 – 2025 Positive Alternatives Grant Awards with Programs or Services.” Jan. 2021. Available at: https://www.health.state.mn.us/docs/people/womeninfants/positivealt/paagrantees202125.pdf. (Accessed 3 May 2022).

[26] MO Rev Stat § 188.335. Available at: https://law.justia.com/codes/missouri/2011/titlexii/chapter188/section188335/ (Accessed 9 Oct. 2020).

[27] https://dss.mo.gov/fsd/a2a

[28] More information may be requested of the Missouri Department of Social Services, Alternatives to Abortion Program: https://dss.mo.gov/fsd/a2a/

[29] Maternal and Child Health Services Title V Block Grant: FY 2022 Application/ FY 2020 Annual Report.” 231 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 10 May. 2022).

[30] https://www.nd.gov/dhs/services/abortionalternative/ (Accessed 9 Oct. 2020).

[31] More information may be requested of the North Dakota Department of Human Services, Alternatives to Abortion program: https://www.nd.gov/dhs/services/abortionalternative/

[32] “Alternatives to Abortion Services.” ND.gov. Available at: https://www.nd.gov/dhs/services/abortionalternative/ (Accessed 9 Oct. 2020).

[33] Ohio Revised Code Annotated §5101.804. Available at: http://codes.ohio.gov/orc/5101.804 (Accessed 31 Oct. 2018).

[34] Ohio Governor Mike DeWine, Executive Order 2022-09D. 29 Apr. 2022.  Available at: https://content.govdelivery.com/attachments/OHIOGOVERNOR/2022/04/29/file_attachments/2146220/Signed%20EO%202022-09D.pdf (Accessed 3 May 2022).

[35] Ibid.

[36] 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 31 Oct. 2018).

[37] More information may be requested of the Oklahoma Health Care Authority. https://oklahoma.gov/ohca/individuals/programs/pregnancy-services.html

[38] 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 31 Oct. 2018), at 2.

[39] “About” Real Alternatives. Available at: https://www.realalternatives.org/about-us/#:~:text=Real%20Alternatives%20exists%20to%20provide,support%20services%20throughout%20the%20nation.&text=Real%20Alternatives%20is%20the%20non,Pennsylvania%2C%20Michigan%2C%20and%20Indiana. (Accessed 12 Oct. 2020).

[40] Real Alternatives, “Our Mission,” Available at: https://www.realalternatives.org/about-us/ (Accessed 3 May 2022).

[41] “History.” Real Alternatives. Available at: https://www.realalternatives.org/https-wp-content-uploads-2019-06-history-2019-pdfhistory/ (Accessed 12 Oct. 2020).

[42] “Alternatives to Abortion.” Texas Health and Human Services. Available at: https://hhs.texas.gov/services/health/women-children/alternatives-abortion  (Accessed 12 Oct. 2020).

[43] Ibid.

[44] Ibid.

[45] Wis. Stat. Ann. § 253.08. Available at:  https://docs.legis.wisconsin.gov/statutes/statutes/253/08 (Accessed 10 Sept. 2020).

[46] Community Health Promotion, Wisconsin Division of Wisconsin Department of Public Health. Letter to Jeanneane Maxon [16 Sept. 2020].

[47] Wis. Stat. Ann. § 253.08. Available at:  https://docs.legis.wisconsin.gov/statutes/statutes/253/08 (Accessed 10 Sept. 2020).