Title X Family Planning Clinics: The Income Cutoffs for Free Care and the Sliding-Fee Scale Up to 250% of the Poverty Line

7 min read · Last updated September 28, 2026

Title X of the Public Health Service Act funds a national network of family planning clinics that are required, by federal regulation, to charge low-income patients nothing and to discount everyone else on a sliding scale tied directly to income, up to 250% of the federal poverty line.

In this article

• Who pays nothing, and who gets a discount
• What Title X clinics actually cover
• Confidentiality for minors and for people on someone else’s insurance
• The cutoffs in real dollars
• How to find a funded clinic
• Frequently asked questions

Aleyah is 23, earns $15,800 a year at a part-time retail job, and has no health insurance. When she called a Title X-funded clinic for a routine exam and birth control counseling, the front desk asked for her income before it asked for a card. Because her income put her under the federal poverty line for a household of one, her visit cost her nothing.

Who pays nothing, and who gets a discount

Every organization that accepts Title X grant funding must follow the Code of Federal Regulations (CFR) at 42 CFR 59.5, which sets the pricing rule in two parts. Under subsection (a)(7), a clinic may not charge anything to a patient from a “low-income family,” defined at 42 CFR 59.2 as a family with annual income at or below 100% of the most recent Department of Health and Human Services (HHS) poverty guidelines. Under subsection (a)(8), a clinic must apply a written schedule of discounts, based on ability to pay, for patients above that line, up to 250% of the poverty guidelines. Above 250%, a clinic can charge its regular fee schedule.

An unemancipated minor is assessed on their own resources, not their parents’ household income, when a clinic determines where they fall on the scale. A teenager with no income of their own generally falls at or near the zero-cost tier regardless of what their parents earn.

What Title X clinics actually cover

The federal regulation itself, not just a program summary, spells out the required scope of services. Under 42 CFR 59.5(a)(1), a funded clinic must offer a broad range of medically approved family planning methods and services, including pregnancy testing and counseling, assistance for patients trying to achieve pregnancy, basic infertility services, sexually transmitted infection services, preconception health services, and adolescent-friendly care. HHS’s Office of Population Affairs (OPA) lists breast and cervical cancer screening, human papillomavirus (HPV) vaccination, and human immunodeficiency virus (HIV) prevention medication (PrEP) among the services commonly offered at funded sites.

What Title X funds explicitly cannot pay for is abortion. Federal law, at Section 1008 of the Public Health Service Act, bars using Title X funds for abortion as a method of family planning, and the regulation restates that ban directly. A clinic can offer neutral, non-directive counseling on all pregnancy options, including abortion, adoption, and prenatal care, if a patient asks for it, but the procedure itself is not a Title X-funded service.

Confidentiality for minors and for people on someone else’s insurance

Federal rule, at 42 CFR 59.10(b), bars a Title X-funded clinic from requiring parental consent or notification before serving a minor. This protection is one of the program’s oldest and most consistently litigated features. Following a March 2024 Fifth Circuit Court of Appeals ruling in Deanda v. Becerra, HHS’s Office of Population Affairs issued guidance stating it will not enforce this specific confidentiality protection in Texas, and will not enforce it in the rest of the Fifth Circuit (which also covers Louisiana and Mississippi) where doing so would conflict with that state’s own law. HHS says it continues to enforce the protection everywhere else in the country. If you are a minor outside the Fifth Circuit, this protection applies to you directly under federal rule.

For adults covered under someone else’s insurance plan, such as a parent’s or spouse’s policy, the practical concern is usually whether a claim will generate an insurance statement the policyholder can see. Because the sliding-fee rule ties cost directly to your own income rather than your household’s coverage, many people in this situation qualify for free or steeply discounted cash-pay care at a Title X site specifically so no insurance claim is filed in the first place. Ask the clinic directly whether visiting on a sliding-fee, self-pay basis avoids using your insurance at all.

Household size	100% FPL (pay nothing)	250% FPL (top of discount scale)
1 person	$1,330/month	$3,325/month
2 people	$1,803/month	$4,508/month

The cutoffs in real dollars

The 2026 federal poverty guideline for one person is $15,960 a year, or $1,330 a month, and for two people it is $21,640 a year, or $1,803 a month. Because Title X’s zero-cost threshold sits exactly at 100% of that guideline, a single person earning up to $1,330 a month pays nothing. The top of the sliding-discount scale sits at 250% of the same guideline, which works out to $3,325 a month for one person and $4,508 a month for two. Above those figures, a clinic can charge its standard rate, though many still offer a partial discount as a matter of local practice even where federal rule no longer requires it.

How to find a funded clinic

HHS operates a public clinic locator at reproductivehealthservices.gov, which lists currently funded Title X sites by location. A separate, similar-sounding MyResourceAccess (MRA) program, the health center sliding-fee discount at Federally Qualified Health Centers, runs under a different federal authority (Section 330 of the Public Health Service Act) with its own income rule. Some clinics are funded under both programs at once, but they are legally distinct grants, and a site that is not a Title X grantee will not follow the 100%/250% rule described here.

Frequently asked questions

Do I qualify for free care at a Title X clinic if I have no income at all? Yes. Federal rule requires zero charges for patients from families at or below 100% of the federal poverty guideline, and someone with no income falls well within that threshold. You may still owe a small amount if a specific service involves a third-party payment the clinic is entitled to collect, but core family planning services themselves are not billed.

Does Title X cover abortion? No. Federal law bars Title X funds from paying for abortion as a method of family planning. Clinics can provide neutral counseling on all pregnancy options, including abortion, prenatal care, and adoption, if a patient asks, but the procedure itself is never a Title X-funded service.

Will a Title X clinic tell my parents or my spouse that I was there? Minors have a federal right to confidential services without parental consent almost everywhere in the country. HHS has stopped enforcing that specific protection in Texas after a court ruling, and will not enforce it elsewhere in the Fifth Circuit where it conflicts with a state’s own law. For adults on someone else’s insurance, visiting on a self-pay, sliding-fee basis, which many qualify for, generally avoids generating an insurance statement altogether.

What documents do I need to prove my income for the sliding-fee scale? Most clinics accept a recent pay stub, a tax return, or a simple signed self-declaration of income if you don’t have paperwork on hand. A clinic cannot legally turn you away or charge full price simply because you lack a pay stub. Ask what the specific site accepts before your visit.

Is Title X currently funded and operating normally in 2026? Yes, based on HHS’s own published list of current grant recipients. Funding levels and individual grant awards have shifted in recent years, so if a specific clinic tells you it is not currently accepting Title X patients, use the federal locator to find another funded site nearby rather than assuming the program itself has ended.