Hawaiʻi receives about $2.1 million in federal Title X funding. It goes to clinics for services like birth control, cancer screenings, and testing and treatment for sexually transmitted diseases.
However, President Donald Trump’s administration withheld these funds from the state to ensure that grantees comply with recent executive orders – particularly those banning diversity, equity and inclusion.
“The freeze immediately halted critical resources from being distributed, putting access at risk for patients who want and need time-sensitive health care services,” said Amy Moy, co-CEO of Essential Access, which administers the Title X program in Hawaiʻi.
About two years into Trump’s first term, Hawaiʻi lost its funding because of what was called a “gag order” on providers. It did not allow clinics giving any referrals or offering abortion services to receive Title X funding.
In 2022, President Joe Biden reinstated the program’s funding to the state.
Moy explained that this time is different because the funds were withheld with no warning. They were informed the day before the funding period was supposed to start on April 1.
“There was no time to prepare,” she said. “There was no time to address any specific gaps that may be felt at the provider level and therefore could potentially impact patient access.”
While seven states, including Hawaiʻi, have lost all of their Title X funding, 16 other states have been impacted.
Essential Access reported that Title X funding served about 13,000 patients in 2024, although Moy thinks it is likely more than that because they implemented a new data collection system.
Health care providers that once received Title X funding are impacted in different ways
Hawaiʻi Island Community Health Center received about $300,000 a year.
“This is going to disproportionately impact young women,” said Medical Director Chris Piel.
“We use a lot of this funding to test for infections and treat infections, provide contraception to teens, and just do confidential visits for teens who would otherwise not have access to sexual health.”
Piel and other providers emphasized that one of the main reasons Title X funding is so important is that it provides confidential health care services for those who cannot use insurance: teenagers who need STD testing or treatment but cannot safely use a parent’s insurance, or a married person who may not be able to safely use their spouse’s insurance.
Some clinics that received Title X funding are the only ones that provide family planning services in their areas, like the Waianae Coast Comprehensive Health Center. It also received about $300,000 a year from Title X.
Pat McKenzie, its senior director of clinical initiatives and response, explained that without Title X funding, people who could access free care may need to pay.
“What will happen there is people won't come in for STD tests. People won't come in for early pregnancy testing. People won't be able to afford to come in and get birth control,” she said.
“They talk about, oh, you can get birth control pills now at the pharmacy – you know, you don't even need a prescription. But it can be anywhere from $50 to $70 a pack. That's not doable. That's just not doable.”
McKenzie added that these services do more than just impact the individual patient receiving the care.
“It's not just affecting individuals. It will affect the economics of the entire family,” she told HPR. “So we're going to have to figure out how to continue to service our communities. And it's gonna be tough, but that's what we're dedicated to doing.”
Planned Parenthood’s Kahului Health Center was also a recipient of about $150,000 from Title X funding. About 65% of the Kahului clinic’s patients in 2024 were served using Title X funding.
Providers are calling on the state to fill the gap
House Finance Chair Kyle Yamashita said in a statement that lawmakers are putting money aside to offset reductions in federal funding – but it may not be enough to cover all the needs.
“Given the evolving situation, we are taking a measured approach to respond cautiously rather than react impulsively,” he wrote.
“In the House draft of the budget, we allocated funding to offset potential reductions in federal support in the coming months. However, these resources may not be sufficient to cover all emerging needs, requiring difficult decisions in the months ahead. We remain committed to monitoring developments, assessing their impact, and working with the Senate and the Administration to identify costs and develop strategies to ensure the people of Hawaii continue to have uninterrupted access to essential core services.”
U.S. Sens. Brian Schatz and Mazie Hirono also wrote a letter to the U.S. Department of Health and Human Services urging it to reinstate Title X funding to Hawaiʻi.
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