Fact Sheet: State Alternatives to Abortion Funding

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

OVERVIEW

• As of March 2023, sixteen (16) 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 Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Minnesota, Missouri, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas and Wisconsin.
  • One state, West Virginia, is expected to initiate an A2A program soon.
  • An additional state, Tennessee, has a pledge from its governor to allocate funds to the state’s pregnancy centers.

• 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 anticipated to use a management agency once its program is in place.

• 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.[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 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 their own standards for operations, impose criteria for using funds, establish invoicing procedures, and conduct trainings 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, Pennsylvania.

• West Virginia is anticipated to use a management agency once its program is in place.

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

All remaining states that provide funding (Arkansas, Kansas, 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. 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.[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: $4.5 million (FY22-23, beginning on July 1, 2022),[13] (proposed to continue through FY23-24 at same amount)[14]
• State Uses TANF funding for PHOs?: No. Special appropriation from general budget[15]
• Florida also proposed to allocate $70 million to fund fatherhood programs, and $35.5 million to support adoptive and foster families for FY23-24[16]
• Florida Senate Bill 300 proposes to increase funding to $25 million in recurring funds for future years. The bill is currently pending in the Florida legislature.[17]

Georgia

• Name of Program: Positive Alternatives for Pregnancy and Parenting Grant Program[18]
• Funding Amount: $2 million[19]
• State Uses TANF funding for PHOs?: No

Indiana

• Name of Program: Indiana Pregnancy and Parenting Support Services Program
• Funding Amount: $4.5 million (FY22-23 allocation)[20]
• State Uses TANF funding for PHOs?: Yes

Iowa 

• Name of Program: More Options for Maternal Support (MOMS) Program[21]
• Funding Amount: TBD[22]
• State Uses TANF Funding for PHOs?: No

Kansas

• Name of Program: Pregnancy Maintenance Initiative (PMI)[23]
• Contract Agency: none, state contracts directly with providers[24]
• Funding Amount: $338,846 (FY22)[25]
• State Uses TANF funding for PHOs?: No. Kansas provides a direct funding allocation by statute.[26]

Louisiana

• Name of Program: Alternatives to Abortion Services Program[27]
• Funding Amount: $1,033,013 (allocated from July 1, 2018 through Sept. 30, 2022).[28]
• State Uses TANF funding for PHOs?: Yes

Minnesota

• Name of Program: Positive Alternatives to Abortion[29]
• Contract Agency: none, Minnesota Department of Health contracts directly with providers[30]
• Funding Amount: $3,357,000 (awarded annually 2021-2025)[31]
• 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.[32]

Missouri

• Name of Programs: Missouri provides funding in two ways, the Alternatives to Abortion Awareness Program (AAAP)[33] 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.[34]
• Funding Amount: $8.66 million[35]
• 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)[36]
• Funding Amount: $6.9 million (FY23)[37]
• State Uses TANF funding for PHOs?: No

North Dakota

• Name of Program: Alternatives to Abortion Services[38]
• Funding Amount: $600,000 plus $1.5 million (one-time Covid relief) for biennium 2021-2023[39]
• State Uses TANF funding for PHOs?: Yes[40]
• North Dakota Senate Bill 2129 proposes funding PHOs for $1,600,000 for the biennium budget of FY23-24.[41] The bill is currently pending with the North Dakota House Judiciary Committee.[42]

Ohio

• Name of Program: Ohio Parenting and Pregnancy Program[43]
• Contract Agency: None. Ohio Department of Job and Family Services contracts directly with PHOs.
• Funding Amount: $1,500,000 (allocated annually for FY22 & FY23)[44]
• State Uses TANF funding for PHOs?: Yes[45]

Oklahoma

• Name of Program: Choosing Childbirth Program[46]
• Funding Amount: $7 million[47]
• State Uses TANF funding for PHOs?: No. Law designed to fund through legislative appropriations.[48]

Pennsylvania

• Name of Program: Real Alternatives[49]
• Funding Amount: $7.263 million[50]
• State Uses TANF funding for PHOs?: Yes[51]

Tennessee

• While nothing official has been announced in Tennessee, Governor Bill Lee pledged to provide $100 million to pregnancy centers to “serve mothers, fathers, and families during a crisis pregnancy.”[52]
• Name of Program: TBD
• Funding Amount: $100,000,000 (anticipated)
• State Uses TANF funding for PHOs?: TBD

Texas

• Name of Program: Texas Alternatives to Abortion Services Program[53] (official) or Alternatives to Abortion, A2A (unofficial)[54]
• Funding Amount: $100,022,732 (FY22-23)[55]
• State Uses TANF funding for PHOs?: No[56]

West Virginia

• West Virginia passed HB 2002, which creates PHO funding.[57] It awaits the governor’s signature.
• Name of Program: Pregnancy Counseling Program: Mothers and Babies Pregnancy Support Program[58]
• Funding Amount: Funds will be distributed via a management agency based on a fee per service agreement[59]
• State Uses TANF funding for PHOs?: No

Wisconsin

• Name of Program: Pregnancy Counseling Program[60]
• Funding Amount: $69,100[61]
• 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.”[62]
• In June of 2022, a significant number of Wisconsin Assembly members asked Governor Tony Evers to fund PHOs for $10 million.[63] Evers summarily rejected the request, asserting that the centers do not have medical personnel. A survey of Wisconsin PHOs by Charlotte Lozier Institute and CareNet 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.[64]

[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_of_2022_IGS.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] “FY23-24 Framework for Freedom Budget.” Gov. Ron DeSantis. Available at: http://frameworkforfreedombudget.com/web%20forms/Bill/BillText.aspx (Accessed 8 Mar. 2023).

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

[16] “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).

[17] The Florida Senate. Senate Bill 300. Available at: https://www.flsenate.gov/Session/Bill/2023/300 (Accessed 20 March 23).

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

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

[21] Iowa H.J. 945, pgs. 70-73. Available at: https://www.legis.iowa.gov/legislation/BillBook?ga=89&ba=HF2578 (Accessed 8 Mar. 2023).

[22] Ibid.

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

[24] “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 3 Mar. 2023).

[25] Ibid.

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

[27] 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).

[28] LIFT Louisiana. 2020. Available at: https://drive.google.com/file/d/1Q6dN75DHTWvBwWLcYBw3MeHIEay0zZJg/view (Accessed 3 Mar. 2023).

[29] “2022 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 3 Mar. 2023).

[30] Ibid.

[31] 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 Mar. 2023).

[32] “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).

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

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

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

[36] 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).

[37] 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).

[38] https://www.nd.gov/dhs/services/abortionalternative/ (Accessed 3 Mar. 2023).

[39] More information may be requested of the North Dakota Department of Human Services, Alternatives to Abortion program: https://www.nd.gov/dhs/services/abortionalternative/ (Accessed 3 Mar. 2023).

[40] “Alternatives to Abortion Services.” ND.gov. Available at: https://www.nd.gov/dhs/services/abortionalternative/ (Accessed 3 Mar. 2023).

[41] North Dakota SB 2129 (2023). Available at: https://www.ndlegis.gov/assembly/68-2023/regular/documents/23-0136-02000.pdf (Accessed 3 Mar. 2023).

[42] North Dakota State Legislative Page for DC 2129 (2023). Available at: https://legiscan.com/ND/bill/SB2129/2023. (Accessed 3 Mar. 2023).

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

[44] 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 Mar. 2023).

[45] Ibid.

[46] 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).

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

[48] 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.

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

[50] Ibid.

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

[52] Tennessee Governor Bill Lee. 2023 State of the State Address. Available at: https://www.tn.gov/governor/sots/2023-state-of-the-state-address.html (Accessed 20 Mar. 2023)

[53] “Alternatives to Abortion Report for Fiscal Year 2022.” Texas Health and Human Services. Available at: https://www.hhs.texas.gov/sites/default/files/documents/alternatives-abortion-fy2022-rider68.pdf  (Accessed 3 Mar. 2023).

[54] Ibid.

[55] Ibid.

[56] Ibid.

[57] West Virginia HB 2002. Available at: http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=2002&year=2023&sessiontype=RS&btype=bill

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

[59] Ibid.

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

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

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

[63] 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).

[64] 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