Five Horizons Health Services in Starkville provides sex education and low-cost reproductive health care to Mississippians who might never receive it otherwise – but the federal government is withholding the funds that make the work possible.
Title X, a federal program that has been providing money for family planning services to states for over 50 years, flows through the nonprofit Converge to 91 clinics in Mississippi, including Five Horizons. But the U.S. Department of Health and Human Services on March 31 told Converge it was withholding its funding indefinitely.
The organization’s head said despite complying with the demands of the letter, the funds still haven’t been distributed and she hasn’t been told if or when they will be. The nonprofit had to furlough half of its Title X staff, who will be laid off June 1 if the funding doesn’t come through.
Seven states, including Mississippi, had Title X funds completely withheld, while another sixteen had their funds partially withheld. An estimated 834,000 people nationwide would be affected if the funds are never disbursed, Guttmacher estimates.
Clinics around the state are scrambling to notify patients of cost increases for services like birth control, cancer screening and testing for sexually transmitted infections.
Delta Health Center, which operates 17 safety net clinics covering six counties in the Mississippi Delta, is short $250,000 for family planning services as a result of the funding freeze.
They’re now unable to provide contraception for free as a result of the loss of funds, according to administrator Robin Boyles.
Boyles said Delta Health Center staff always did everything they could to make sure patients could access whatever medication their provider prescribed – regardless of cost. And as a federally qualified health center, they continue to provide services and see patients on a sliding fee scale.
But in the past week, a provider called her to ask if the clinic still had the funds to cover the birth control implant Nexplanon or an IUD for a patient.
Without the Title X dollars to reimburse for the medicine, however, a patient without insurance would have been on the hook $540 for Nexplanon or $371 for a Mirena IUD – two of the most effective forms of contraception.
Those most harmed by the delayed funding will be young adults who received next to no sexual education growing up in Mississippi, says Maggie White, a nurse practitioner at Five Horizons. The clinic sees a lot of patients from Mississippi State University, which educates about 23,000 students a year.
Mississippi allows school districts to adopt one of two types of sexual education curricula: abstinence-only or abstinence-plus. Abstinence-only education promotes abstinence until marriage, while abstinence-plus programs encourage abstinence but include some information about contraception.
“They don’t know anything (about sexual health),” White said. “… They’ll come in for sinus stuff, and then they start asking other questions.”
Title X services include methods for preventing unwanted pregnancy, fertility treatment for helping people get pregnant, testing for STIs and screening for certain kinds of cancer.
In its letter to Converge, the nonprofit that beat out the state Health Department for the federal Title X grant in Mississippi in 2022, the U.S. Department of Health and Human Services alleged that the organization “could be in violation” of the terms of the award and parts of the federal civil rights law. The allegation referenced a 2020 statement the nonprofit made committing to diversity in health care during the wake of the George Floyd protests.
The group sent HHS all the documents it was required, but has not heard back in over a month, said Jamie Bardwell, co-executive director of Converge.
“I have to believe that common sense will eventually prevail,” Bardwell said. “We for sure have done nothing wrong.”
The Title X funding freeze will force Five Horizons to increase the cost of a package of STI tests and treatment from $20 to $120. That’s still comparable to or less than most urgent care facilities, but nurses at the clinic say it will be cost-prohibitive for much of their low-income, younger clientele.
The funding freeze won’t just affect costs – it will also affect accessibility. The only women’s health clinic in Starkville currently has a wait time of two months for a new patient appointment.
Because they serve a largely college-aged population, the providers at Five Horizons are also privy to another trend: Some of the younger patients who are still on their parents’ insurance choose to forgo reproductive care rather than let their parents know they are sexually active.
“Sometimes the college kids will have insurance, but they don’t want to use their insurance because then their parents will figure out what they’re doing, so that was nice that we had that option to not use their insurance to get what they needed,” White said.
Through Title X funding, Five Horizons was able to keep supplies like the Depo-Provera shot – an injection given once every three months to prevent pregnancy – on hand and administer it for free on site to those who were uninsured or chose not to use their parents’ insurance.
Now, McKenzie Russell, the nurse caring for most of the clinic’s Title X patients, says she’ll have to send patients to an offsite pharmacy to pick up birth control – an added obstacle that might put contraception out of reach for some.
Russell, who grew up in Starkville and had her first baby at 16, fears that increased barriers like cost and extra trips will lead to more unintended pregnancies in the community.
She said the clinic has also seen increased rates of abnormal pap smears, which can be a sign of precancerous changes and warrant further testing. The clinic has been offering uninsured patients free pap smears, though that could change if they don’t find another source of funding to cover those costs.
Mississippi has the highest rate of deaths from cervical cancer and the nation’s worst uptake of the vaccine that protects against this cancer.
Meanwhile, the influence of social media on young people has meant that much of the work providers do in well visits is combatting misinformation.
“There was a girl who thought she had syphilis because there was something wrong with her eye,” Russell said. “… They just go down rabbit holes, and we have to bring them back.”
Even if the funding delays don’t result in permanent cuts, the lapse in care could have life-changing consequences for some.
“A month delay may not sound like a huge deal to some people, but when you’re talking about women’s health care, one month could be a huge deal,” said Bardwell. “You could be missing your prescription for birth control, (and) perhaps it results in an unplanned pregnancy. Perhaps you don’t get screened for an STD, STI. Congenital syphilis is very high in Mississippi. These are things that just have a very negative effect for women and their children.”
In the meantime, Converge is expanding telehealth services, as well as launching pop-up clinics around the state. The first one will be June 7 at the Jackson Medical Mall.
“Our number one job since April 1 has been fundraising,” Bardwell said. “Every dollar that we’ve been raising has been to make sure we can still provide care to people in this way.”
The National Family Planning & Reproductive Health Association, represented by the American Civil Liberties Union, filed a lawsuit against the Department of Health and Human Services. The lawsuit argued the agency’s withholding of funds before determining there was a violation of the grant terms is unlawful.
But the lawsuit won’t provide any immediate relief for Mississippi and other affected states – and even if Converge gets the money it was due, Bardwell thinks this won’t be the last time she has to fight for funding under the Trump administration.
“So in our minds, getting our money unfrozen would be a huge positive step, but we by no means think that once that happens we’d be in the clear,” she said. “We imagine there will be multiple hurdles for years on this topic.”
