Changing Course 

Local health department reverses position on family-planning funding.

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After a push from the state, the Memphis and Shelby County Health Department will take on the full amount of Title X funding from the state — a reversal of the position Director Yvonne Madlock took this spring.

In a letter to the Tennessee Department of Health dated April 8th, Madlock stated, "Shelby County does not have the ability to take on the additional, substantial financial cost of operating a larger program or the administrative costs associated with sub-contracting these funds to other potential local providers."

Now the health department will be the sole recipient of $1.3 million in Title X funding, cutting Planned Parenthood and other providers out of a direct funding relationship with the state.

Title X is a federal grant program that provides funding for family-planning services, such as medical exams, birth control, and HIV testing, for low-income and uninsured patients. No Title X money can be used to provide abortions.

In the past, the funding went to local health departments, but those agencies had the option of contracting with private organizations, like Planned Parenthood, to help provide services. Recently, the state health department began pushing county health departments to take on the full Title X funding. Once Nashville-Davidson County agreed to accept all the Title X funding, Madlock felt Memphis was an outlier.

"The last thing we wanted to see were the resources allocated to Shelby County reallocated to another part of the state," Madlock said. "Given that, we decided to reconsider our position."

Madlock said she does have some concerns about her choice.

"We still are not convinced, as a county, that we will be able to afford to be the sole recipient of that entire pile of money," Madlock said. "Because the way in which Title X dollars are earned, the reimbursement level does not cover costs."

In other words, Title X funding is not enough to cover the full cost of providing family-planning services in Shelby County. If the state requires the health department to take on the funding and maintain the current caseload (formerly a responsibility shared with Planned Parenthood, which leverages private funds to supplement Title X funding), the county would be unable to handle the influx of patients.

So why take on the funding in light of these hurdles?

"The state is not requiring the same level of caseload for those dollars," Madlock said. "And it does look like the state is going to make an incremental increase to the fee structure so we'll be able to bill more per service. Having the combination of both the caseload [requirement] removed and the opportunity for there to be more dollars in Shelby County, we can continue to provide services here through the Health Department."

But reducing the caseload requirement could be bad news for women in Shelby County.

"The dilemma that this creates is that fewer women are ultimately offered services," Madlock said. "It's not a total win."

Madlock said she probably won't be able to hire more help to handle extra work created by taking on Title X funding.

Planned Parenthood and other family-planning providers will likely still be subcontracted — by the county, instead of the state — to take on some of the caseload commensurate with the funding.

"The state has simply made the process more cumbersome and more costly," said Barry Chase, president of Planned Parenthood Greater Memphis. "The state could have issued a request for proposals the way they have done in the past, and then the county would not have to be assigning people to do something the state has done in the past. It's passing the responsibility down."

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