Page 1 GAO-24-106215 Health Care Funding
441 G St. N.W.
Washington, DC 20548
November 17, 2023
Congressional Requesters
Health Care Funding: Federal Funding for Certain Organizations Providing Health-
Related Services, 2019 through 2022
To achieve programmatic goals, some federal agencies provide funding to domestic and
international organizations that, in turn, use the funds to implement programs and activities
aligned with those goals. For example, federal agencies may award funding through grants or
cooperative agreements to organizations that use the funds to engage in health-related
activities. In addition, public health coverage programs, such as Medicare, Medicaid, and the
Children’s Health Insurance Program (CHIP), may pay for certain services that organizations
provide to beneficiaries of those programs.
1
Since 1995, we have reported periodically on federal funding to various domestic and
international organizations that offer health care and additional health-related services, such as
family planning or activities related to the treatment and prevention of HIV/AIDS.
2
The
organizations have included domestic organizations—such as certain health centers and
Planned Parenthood Federation of America—as well as international organizations, including
International Planned Parenthood Federation and MSI Reproductive Choices (formerly known
as Marie Stopes International).
3
1
Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with
disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care
program for certain low-income and medically needy individuals. CHIP is a joint federal-state financed program to
provide health care to certain uninsured, low-income children.
2
Our most recent reports on this topic were issued in June 2021 and December 2020. See GAO, Health Care
Funding: Planned Parenthood Federation of America Affiliates’ Expenditures of Federal Funds, 2016 through 2018,
GAO-21-608R (Washington, D.C.: June 22, 2021); and Health Care Funding: Federal Obligations to and Funds
Received by Certain Organizations Involved in Health-Related Services, 2016 through 2018, GAO-21-188R
(Washington, D.C.: December 21, 2020).
3
Certain eligible community-based health services organizations receive funding under the Health Center Program,
which is administered by the Bureau of Primary Health Care within the Department of Health and Human Services’
Health Resources and Services Administration. The Health Center Program provides grants to these organizations
under section 330 of the Public Health Service Act (“Section 330”). See 42 U.S.C. § 254b. For purposes of this report,
we refer to Section 330 recipients as “Health Center Program Award Recipients” or “Awardees.” Other health
services organizations meet all Health Center Program requirements but do not receive federal grant funding through
Section 330, which the Health Resources and Services Administration designates as Health Center Program Look-
alikes. Look-alikes may receive other benefits, including support through other federal programs. For the purpose of
this report, we use the term “Health Centers” to refer to both Awardees and Look-alikes. Health Centers and certain
other health services organizations are eligible to apply for the Centers for Medicare & Medicaid Services certification
as Federally Qualified Health Centers, which generally receive higher payment rates under Medicare and Medicaid,
but are not the focus of this report.
Page 2 GAO-24-106215 Health Care Funding
You asked us to provide updated information on federal funding for certain organizations that
provide health-related services.
This report describes federal funding
obligated to Health Centers, Planned
Parenthood affiliates, four domestic regional
organizations, International Planned
Parenthood Federation, and MSI
Reproductive Choices from 2019 through
2022. This report also describes federal
funding received and expended by these
organizations from 2019 through 2021. To
address our two reporting objectives, we
analyzed the most recent data available for
each objective, and interviewed agency
officials and representatives from the
organizations in our review. (See text box for
descriptions of key federal funding terms
used in this report.)
To determine what federal funds were
obligated to these organizations providing
health-related services from 2019 (the first
year of data since we last reported) through
2022, we analyzed data from the Department
of Health and Human Services’ (HHS)
Payment Management System and from the
U.S. Agency for International Development’s
(USAID) Phoenix System (for international organizations only).
To determine what federal funds were received by certain organizations providing health-related
services from 2019 through 2021, we analyzed data from multiple federal agency sources,
including: (1) HHS’s Health Resources and Services Administration’s Uniform Data System, (2)
HHS’s Payment Management System, and (3) USAID’s Phoenix System. In addition, we
analyzed data from Planned Parenthood affiliates on federal grant and cooperative agreement
funds received. To determine the amount Health Centers, Planned Parenthood affiliates, and
domestic regional organizations received in payments from Medicare, Medicaid, and CHIP, we
analyzed Uniform Data System data, Planned Parenthood affiliates’ annual financial reports,
and Medicaid and CHIP payment data from state Medicaid agencies, respectively. We also
analyzed data from the Small Business Administration’s (SBA) Paycheck Protection Program to
estimate the number and amounts of federally guaranteed loans and loans forgiven for Health
Centers and Planned Parenthood affiliates.
4
To determine what federal funds were expended by certain organizations providing health-
related services from 2019 through 2021, we analyzed data from 58 single audit reports for 35
4
Administered by SBA through a network of authorized, participating lenders, and guaranteed at 100 percent by SBA,
the Paycheck Protection Program provided forgivable loans, if certain conditions were met, for payroll and certain
other eligible costs to support eligible entities, such as small businesses and nonprofits affected by the COVID-19
pandemic.
Federal funding: key terms
In this report, we use the term “federal funding” to
mean funding awarded by federal agencies through
grants, cooperative agreements, payments made by
public health coverage programs such as Medicare,
Medicaid and the Children’s Health Insurance
Program, or through federally guaranteed loans.
Obligations are commitments made by a federal
agency that create a legal liability to make
payments, either immediately or in the future, such
as when an agency awards a grant to a selected
organization.
Funds received are the dollar amounts an
organization received. In this report, these funds
include: (1) grant funds disbursed by an awarding
agency, (2) payments from public health coverage
programs, and (3) loans from the Paycheck
Protection Program.
Expenditures are the amount of money spent by
organizations that receive federal funds.
Source: GAO. | GAO-24-106215
Page 3 GAO-24-106215 Health Care Funding
Planned Parenthood affiliates and data from International Planned Parenthood Federation and
MSI Reproductive Choices.
5
Based on our discussions with knowledgeable officials, analysis of the data provided, and
review of source documentation, we determined these data were sufficiently reliable for the
purposes of our reporting objectives.
For more detailed information on our scope and
methodology, including for funds expended, see enclosure I.
We conducted this performance audit from August 2022 to November 2023 in accordance with
generally accepted government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that the evidence obtained
provides a reasonable basis for our findings and conclusions based on our audit objectives.
Background
The organizations included in our review—Health Centers, Planned Parenthood Federation of
America, four domestic regional organizations, International Planned Parenthood Federation,
and MSI Reproductive Choices—engage in health-related activities, including supporting or
providing reproductive health services.
6
(See table 1.)
Table 1: Descriptions of the Organizations in GAO’s Review
Organization
Description
Health Centers
A network of approximately 1,500 community-based health services organizations that
receive grants and other benefits from
the Health Resources and Services Administration,
within the Department of Health and Human Services
. Health Centers provide
comprehensive health care services to individuals, regard
less of their ability to pay, through
more than 15,000
service delivery sites. Health Center services include primary care, such as
diagnostic testing and disease treatment, and preventive care, such as family planning and
prenatal and postpartum
care.
a
Planned Parenthood Federation of
America
A national, nonprofit organization that provides support services to about 50 affiliates—
independent organizations that operate with financial and governing autonomy.
b
Affiliates
operate
approximately 600 centers across the country, providing sexual and reproductive
health
-related services, and abortions.
Planned Parenthood affiliates also implement
programs related to sexual education, information, and advocacy.
Domestic Regional Organizations
Four privately owned providers of health-related services within various regions of the United
States.
Services include sexual and reproductive health-related services and abortions.
International Planned Parenthood
Federation
An international, nonprofit organization made up of seven offices throughout the world.
International Planned Parenthood
Federation works through approximately 140 autonomous
member associations and partner organizations to provide access to sexual and rep
roductive
health
-related services, including contraception, abortions, and the treatment and prevention
of HIV and
AIDS, from approximately 41,000 locations worldwide.
5
Nonfederal entities with expenditures of federal funding of $750,000 or more within the entity’s fiscal year are
required to undergo an audit in accordance with the Single Audit Act, as amended, and Office of Management and
Budget (OMB) implementing guidance, and to provide the results of this audit to OMB. See 31 U.S.C. § 7502; 2
C.F.R. § 200.501 (2023). The Federal Audit Clearinghouse is the repository for single audits, as designated by OMB.
6
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019). Similarly, foreign assistance funds cannot be used to pay for the performance of abortion
as a method of family planning or to motivate or coerce any person to practice abortions. See, e.g., Pub. L. No. 116-
94, div. G, tit. III, “Bilateral Economic Assistance—Global Health Programs,” 133 Stat. at 2827.
Page 4 GAO-24-106215 Health Care Funding
MSI Reproductive Choices
An international, nonprofit organization that delivers services through nearly 9,000 team
members
in 37 countries. MSI Reproductive Choices services are related to contraception
and abortion care. The organization also provides other sexual and reproductive health
-
related services.
Source: GAO summary of information from organizations’ websites and annual reports. | GAO-24-106215
Notes: Planned Parenthood Federation of America is a founding member of International Planned Parenthood Federation, but they
are separate organizations.
a
The Health Resources and Services Administration funds nearly 1,400 Health Center Program Award Recipients and
approximately 100 Health Center Program Look-alikes, collectively operating more than 15,000 service delivery sites in communities
across the country.
b
During the period of our review, there were more than 50 Planned Parenthood Federation of America affiliates operating depending
on the year. In 2022, Planned Parenthood reported 49 affiliates.
Federal Funding Sources
Organizations in our review may receive federal funds through several different sources. Types
of federal funding sources include:
• Grant awards or cooperative agreements. HHS and USAID may award
funding through grants or cooperative agreements to domestic or
international organizations.
7
HHS, with a
mission to enhance the health and well-being
of all Americans, generally awards this
funding to domestic organizations that
provide health-related services. USAID,
which leads the U.S. government’s
international development efforts, may award
funding to organizations that provide health-
related services in various countries.
For
each grant or cooperative agreement, the
federal agency must first obligate the
funds—that is, create a legal commitment to
pay a promised amount to an organization.
Agencies may obligate funds in one federal
fiscal year, while entities awarded these
funds may receive and expend them over
time, which may span multiple years.
8
As a result, the amount of federal
funding obligated, versus received or expended, may differ within the
same time period. See figure 1 for an example time sequence for
obligating, receiving, and expending a 5-year direct grant or cooperative
agreement.
7
Grants are used when substantial involvement by the federal agency is not expected in carrying out the activity, and
cooperative agreements are used when substantial involvement by the federal agency is expected.
8
Federal agencies must obligate funds appropriated within the time frame specified in the appropriation, such as a
single fiscal year; however, agencies may disburse the obligated funds for an additional 5 fiscal years beyond the
availability of the appropriation. As a result, a federal agency may obligate the full amount of a grant or cooperative
agreement within a single fiscal year, but disburse the award to the grant recipient over a multi-year period.
Federal funding: Direct vs. pass-through
Organizations in our review can receive grant and
cooperative agreement funds in two ways.
Direct funds are federal funds that a federal agency
directly awards, such as when the Department of
Health and Human Services awards funding through
the Health Center Program to a domestic
organization.
Pass-through funds are federal funds received
from a nonfederal entity. For example, a federal
agency can award funding to a state, which in turn
passes that funding through to an organization.
Source: GAO. | GAO-24-106215
Page 5 GAO-24-106215 Health Care Funding
Figure 1. Example Time Sequence for Obligating, Receiving, and Expending a Direct Federal Grant or
Cooperative Agreement
• Public health coverage programs. Organizations can receive federal funds through
payments for services provided to beneficiaries of public health coverage programs,
specifically Medicare, Medicaid, and CHIP. Medicare is federally funded, while Medicaid
and CHIP are both jointly funded by federal and state governments. With certain
exceptions, under Medicaid and CHIP, the federal government matches a portion of
each state’s expenditures, and the matching rates can vary depending on a variety of
factors, such as the services being provided or the populations served.
9
States have the
flexibility to cover certain services that are not paid for using federal dollars.
10
Figure 2
below illustrates how federal and state dollars are used in three different examples to
pay for Medicare, Medicaid, and CHIP-covered services.
9
The federal government matches most state expenditures for Medicaid services based on a calculated percentage
depending on each state’s per capita income relative to the national average. Federal matching rates for CHIP are
typically higher than Medicaid matching rates, and federal funding for CHIP is capped. Federal matching funds
generally are not available for abortions except in circumstances expressly permitted by law.
10
Medicaid by design, allows significant flexibility for states to design and implement their programs. States have
some discretion in, among other things, setting Medicaid eligibility standards and provider payment rates, as well as
determining the amount, scope, and duration of covered benefits. States can, at their own expense, choose to
provide benefits beyond those outlined in federal law. For example, states may opt to cover optional populations and
services, including abortions for which federal funding is not available.
Page 6 GAO-24-106215 Health Care Funding
Figure 2. Examples of Federal and State Funding Sources for Medicare, Medicaid, and Children’s Health
Insurance Program (CHIP)-Covered Services
Note: Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with disabilities,
and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care program for certain low-income
and medically needy individuals. CHIP is a joint federal-state financed program to provide health care to certain uninsured, low-
income children. States have the flexibility to cover certain services that are not paid for using federal dollars to individuals enrolled
in their Medicaid or CHIP programs. The examples shown for Medicare and Medicaid depict a fee-for-service arrangement in which
federal or state dollars are paid directly to a health services organization for services provided. Medicare and Medicaid services can
also be provided under a managed care arrangement, in which a managed care organization receives the federal or state dollars
and pays the health services organizations.
• COVID-19-related funding. In 2020 and 2021, Congress passed, and the President
signed into law, the CARES Act, the American Rescue Plan Act of 2021, and four other
COVID-19 relief bills, establishing a number of programs to support health-related
service providers.
11
For example:
11
Collectively, these laws provided about $4.7 trillion to address the public health and economic threats posed by
COVID-19. See the American Rescue Plan Act of 2021, Pub. L. No. 117-2, 135 Stat. 4; Consolidated Appropriations
Act, 2021, Pub. L. No. 116-260, 134 Stat. 1182 (2020); Paycheck Protection Program and Health Care Enhancement
Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); Families
First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); and the Coronavirus Preparedness and
Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146.
Page 7 GAO-24-106215 Health Care Funding
o The Provider Relief Fund: Congress appropriated a total of $178 billion to
reimburse eligible health care providers for health care-related expenses or lost
revenues that are attributable to COVID-19.
12
o The Paycheck Protection Program, administered by SBA, provided about $814
billion in loans to eligible entities, such as small businesses and nonprofit entities
affected by COVID-19 by June 30, 2021, when loan approvals ended.
13
The
program offered qualifying applicants low-interest (1 percent) loans, made by
lenders but guaranteed 100 percent by SBA, that are fully forgivable for payroll
and certain other eligible costs if certain conditions are met. Borrowers can apply
through their lender to have the loan forgiven any time on or before the maturity
date of the loan—the date when final loan repayment is due—if the borrower has
used all the loan proceeds for which the borrower is requesting forgiveness.
14
See figure 3 for the steps involved in applying for Paycheck Protection Program
loans and loan forgiveness.
12
Pub. L. No. 116-260, div. M, tit. III, 134 Stat. 1182, 1920 (2020); Pub. L. No. 116-139, div. B, tit. I, 134 Stat. 620,
622 (2020); Pub. L. No. 116-136, div. B, tit. VIII, 134 Stat. 281, 563 (2020). In June 2023, the Fiscal Responsibility
Act of 2023 rescinded unobligated Provider Relief Funds for provider relief payments. Pub. L. No. 118-5, div. B, tit. I,
§ 2, 137 Stat. 10, 23.
13
On June 30, 2021, SBA’s program authority expired and loan applications could no longer be processed.
14
In a loan transaction, the maturity date refers to the date on which the term of the loan expires and the outstanding
principal balance of the loan must be repaid to the lender. All other amounts payable by the borrower under the loan
agreement, such as interest, fees, and expenses, must also be paid at maturity.
Page 8 GAO-24-106215 Health Care Funding
Figure 3. Paycheck Protection Program Loan and Forgiveness Application Process
Note: Paycheck Protection Program loans may be approved for forgiveness for up to the full amount of the loans including any
interest accrued by the borrower
depending on how the borrower spends the loan proceeds. For example, if a borrower uses less
than 60 percent of the loan proceeds on payroll costs, then the borrower may be eligible for partial forgiveness based on the
percentage of proceeds spent on payroll costs.
Policies Affecting Certain Federal Funding, 2019 through 2022
Additions or changes to federal policies can affect the funding provided to certain organizations
in our review. For example:
• Title X Family Planning Program (Title X). Administered by the Office of Population
Affairs within HHS, Title X of the Public Health Service Act provides grants to public and
nonprofit agencies for family planning services, research, and training.
15
By statute, Title
X funds may not be used in programs where abortion is a method of family planning.
16
In
May 2019, HHS issued a final rule also prohibiting organizations receiving Title X
funding from promoting, referring for, or supporting abortion as a method of family
planning.
17
Effective November 2021, HHS revoked the requirements of the 2019
regulation.
18
• Protecting Life in Global Health Assistance. The Protecting Life in Global Health
Assistance policy was issued through a Presidential Memorandum in January 2017 and
implemented in May 2017. The policy applied to all global health assistance
15
See 42 U.S.C. § 300a.
16
See Family Planning Services and Population Research Act of 1970, Pub. L. No. 91-572, § 6(c), 84 Stat. 1504,
1506 (codified as amended at 42 U.S.C. § 300a-6).
17
See 84 Fed. Reg. 7,714 (Mar. 4, 2019).
18
See 86 Fed. Reg. 56,144 (Oct. 7, 2021).
Page 9 GAO-24-106215 Health Care Funding
implemented by all U.S. government departments or agencies, and required foreign
nongovernmental organizations to agree, as a condition of receiving this funding, that
they would not perform or actively promote abortion as a method of family planning or
provide financial support to any foreign nongovernmental organizations that conduct
such activities. The Protecting Life in Global Health Assistance policy was rescinded in
January 2021.
• Medicaid continuous enrollment. The Families First Coronavirus Response Act
temporarily increased the federal share of Medicaid funding beginning January 1, 2020,
and ending December 31, 2023.
19
To receive this increase, states must meet certain
conditions, which included agreeing to keep most Medicaid beneficiaries who were
enrolled on or after March 18, 2020, continuously enrolled through March 31, 2023.
20
Increased Medicaid enrollment also increased the number and percentage of federal
dollars provided through the Medicaid program.
Federal Obligations to Selected Organizations from 2019 through 2022
Our analysis of HHS data found that from 2019 through 2022, HHS obligated an estimated
$33.71 billion to certain organizations in our review. Specifically, HHS obligated an estimated
$33.67 billion to Health Centers and about $49 million to Planned Parenthood affiliates. (See
table 2 and enclosures II and III for more information on these HHS obligations.) HHS officials
reported that the department obligated no funds to the four domestic regional organizations in
our review.
21
Table 2: Department of Health and Human Services (HHS) Estimated Obligations to Certain Domestic Organizations
through G
rants or Cooperative Agreements, 2019-2022
Dollars in millions
Organization
2019
2020
2021
2022
Total
Health Centers
a
5,844.97
7,958.98
13,380.78
b
6,480.47
33,665.20
Planned Parenthood Federation of America
affiliates
12.05
c
4.08
5.71
27.06
d
48.91
Domestic regional organizations
0.00
0.00
0.00
0.00
0.00
Total
5,857.02
7,963.06
13,386.49
6,507.53
33,714.11
Source: GAO analysis of HHS data. | GAO-24-106215
Notes: Data are for the federal fiscal year, October 1 through September 30. Amounts in this table may not sum to totals due to
rounding.
a
Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized under
section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do not
receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b. The data systems used to
collect obligations data do not always distinguish between obligations directly to a Health Center from obligations to a larger
organization that includes the Health Center. Therefore, the estimated amount of federal obligations to Health Centers likely
19
See Pub. L. No. 116-127, div. F, § 6008, 134 Stat. 178, 208 (2020).
20
Increased matching funds are available to state Medicaid agencies for Medicaid expenditures through December
31, 2023. Increased matching funds are not direct payments to providers.
21
HHS officials searched the Payment Management System based on the names of the organizations and found no
results for the years under our review. The two organizations that responded to our request for information confirmed
that HHS obligated no funds to them.
Page 10 GAO-24-106215 Health Care Funding
overstates the amounts obligated to Health Centers because they may include obligations to a Health Center’s parent organization
(such as a university or health department) that operates the Health Center.
b
Health Resources and Services Administration officials attributed the large increase in obligations to Health Centers from fiscal year
2020 to fiscal year 2021 to one-time, emergency COVID-19 supplemental funding provided under the American Rescue Plan Act of
2021 for eligible Health Centers. See Pub. L. No. 117-2, 135 Stat. 4. Specifically, in fiscal year 2021, the Health Resources and
Services Administration obligated over $7.1 billion of American Rescue Plan Act of 2021 funding for Health Centers and Health
Center construction and capital improvements.
c
Planned Parenthood Federation of America officials attributed the decrease in funding for Planned Parenthood affiliates from fiscal
year 2019 to fiscal year 2020 to the Department of Health and Human Services’ issuance of new requirements in May 2019
restricting the promotion of, referral for, or support of abortions, which led almost all affiliates to discontinue using family planning
grants under Title X of the Public Health Service Act. See 42 U.S.C. § 300a. Planned Parenthood affiliates continued to receive
grants from other federal programs.
d
The HHS data show a large increase in obligations to Planned Parenthood affiliates from fiscal year 2021 to fiscal year 2022 from
Title X Family Planning Services and Family Planning Service Delivery Improvement Research grants. Planned Parenthood
Federation of America officials also attribute the increased funding to American Rescue Plan Act of 2021 funding provided to
affiliates. See Pub. L. No. 117-2, 135 Stat. 4.
Our analysis of USAID data found that from 2019 through 2022, the agency obligated about
$460,000 in awards to International Planned Parenthood Federation and de-obligated about
$1.46 million from awards to MSI Reproductive Choices.
22
De-obligations refer to USAID’s
cancellation or downward adjustment of previously incurred obligations. (See table 3 and
enclosures V and VI for more information on these USAID obligations.) HHS officials reported
that the department obligated no federal funds to these organizations for the years in our
review.
23
Table 3: U.S. Agency for International Development (USAID) Obligations to Certain International
Organizations through Grants or Cooperative Agreements, 2019
-2022
Dollars in millions
Organization
2019
2020
2021
2022
Total
International Planned Parenthood Federation
0.51
a
-0.05
b
0.00
0.00
0.46
MSI Reproductive Choices
-0.70
c
-0.66
c
-0.10
c
0.00
-1.46
Total
-0.19 -0.71 -0.10 0.00 -1.00
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds obligated directly to International Planned Parenthood Federation and MSI Reproductive Choices
or their affiliates. It does not include funds obligated to other organizations and passed through to these organizations. Data are
based on the federal fiscal year, October 1 through September 30.
a
Funds in fiscal year 2019 represent a combination of obligated and de-obligated funds. In fiscal year 2019, the agency obligated
about $630,000 in an award to an International Planned Parenthood Federation affiliate related to humanitarian assistance. The
agency also de-obligated about $130,000 from an award to International Planned Parenthood Federation to close an award related
to family planning and reproductive health.
b
USAID de-obligated funds to International Planned Parenthood Federation to close an award related to family planning and
reproductive health.
22
We reported in 2020 that these organizations declined the terms and conditions of the Protecting Life in Global
Health Assistance policy, which was implemented in May 2017 and rescinded in January
2021. For additional
information on the implementation of the Protecting Life in Global Health policy and data on declined awards, see
GAO, Global Health Assistance: Awardees’ Declinations of U.S. Planned Funding Due to Abortion-Related
Restrictions, GAO-20-347 (Washington, D.C. Mar. 18, 2020).
23
HHS officials searched the Payment Management System based on the names of the organizations and their
affiliates and unique identifiers when available and found no results for the years under our review.
Page 11 GAO-24-106215 Health Care Funding
c
USAID’s reasons for de-obligating funds to MSI Reproductive Choices include closing certain awards and reducing excess
obligations for other awards.
Federal Funds Received by Selected Organizations from 2019 through 2021
Grant and cooperative agreement funding received. Our analysis of Health Resources and
Services Administration and Planned Parenthood affiliate data found that, from 2019 through
2021, Health Centers and Planned Parenthood affiliates in our review received approximately
$21.7 billion and $148 million respectively, of federal funding in the form of previously obligated
grants and cooperative agreements.
24
HHS officials reported that federal agencies did not grant
funding to the domestic regional organizations during these years.
25
(See table 4 and
enclosures II and III for more information on these federal funds.)
Table 4: Federal Funds Received by Certain Domestic Organizations through Grants or Cooperative
Agreements, 2019-2021
Dollars in millions
Organization
2019
2020
2021
Total
Health Centers
a
5,494.35
7,547.65
8,652.89
21,694.89
Planned Parenthood Federation of America affiliates
b
84.90
c
27.45
35.80
148.15
Domestic regional organizations
0.00
0.00
0.00
0.00
Total
5,579.25
7,575.10
8,688.69
21,843.04
Source: GAO analysis of Health Resources and Services Administration and Planned Parenthood Federation of America data. | GAO-24-106215
Notes: This table includes information self-reported annually by Health Centers to the Health Resources and Services
Administration’s Uniform Data System and by Planned Parenthood affiliates to the Planned Parenthood Federation of America
through annual financial reports. Data from Planned Parenthood affiliates include amounts of federal funds received directly from the
federal government through grants or cooperative agreements and amounts passed through from other non-federal organizations,
such as a state agency. Data on amounts of federal funds received by Health Centers are based on the calendar year, January 1
through December 31. Data on amounts of federal funds received by Planned Parenthood affiliates are based on affiliate fiscal
years, which according to Planned Parenthood Federation of America officials, begin and end on several different dates. Amounts in
this table may not sum to totals due to rounding.
a
Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized under
section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do not
receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
b
The Planned Parenthood affiliate data may include some state funding.
c
Planned Parenthood Federation of America officials attributed the decrease in funds received by Planned Parenthood affiliates from
fiscal year 2019 to fiscal year 2020 to the Department of Health and Human Services’ issuance of new requirements in May 2019
restricting the promotion of, referral for, or support of abortions, which led almost all affiliates to discontinue using family planning
grants
under Title X of the Public Health Service Act. See 42 U.S.C. § 300a. Planned Parenthood affiliates continued to receive
grants from other federal programs.
Our analysis of USAID data found that from 2019 through 2021, International Planned
Parenthood Federation received about $2 million and MSI Reproductive Choices received about
$1.4 million in previously obligated funds from USAID. HHS officials reported that these
24
Federal funds obligated to an organization in any 1 year may be received and expended by the organization in a
different year or across multiple years.
25
HHS officials searched the Payment Management System based on the names of the organizations and found no
results for the years under our review.
Page 12 GAO-24-106215 Health Care Funding
organizations received no funds from the department for the years in our review.
26
(See table 5
and enclosures V and VI for more information on these funds received.)
Table 5: U.S. Agency for International Development (USAID) Funds Received by Certain International
Organizations through Grants or Cooperative Agreements, 2019-2021
Dollars in millions
Organization
2019
2020
2021
Total
International Planned Parenthood Federation
1.39
0.25
0.39
2.03
MSI Reproductive Choices
1.51
-0.07
a
-0.08
a
1.35
Total
2.90
0.18
0.31
3.38
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds received directly by International Planned Parenthood Federation and MSI Reproductive Choices or
their affiliates. It does not include funds that may have been received by other organizations and passed through to these
organizations or their affiliates. Data are for the federal fiscal year, October 1 through September 30. Amounts in this table may not
sum to totals due to rounding.
a
These reductions represent the agency collecting certain funds that MSI Reproductive Choices had previously received, such as
grant payment credits.
Public health coverage program payments received. Our analysis found that Health
Centers, Planned Parenthood affiliates, and domestic regional organizations received about
$54.8 billion in payments from Medicare, Medicaid, and CHIP for 2019 through 2021. With
respect to Medicaid and CHIP, these payments include state and federal spending. (See table 6
and enclosures II, III, and IV for more information on these public health coverage payments.)
Table 6: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) Payments Received by
Certain Domestic Organizations, 2019-2021
Dollars in millions
Organization
2019
2020
2021
Total
Health Centers
a
Medicare
b
2,743.08
2,901.89
3,427.11
9,072.08
Medicaid and CHIP
b
13,890.04
14,013.90
16,139.82
44,043.77
Planned Parenthood Federation of America
affiliates
Medicare
c
1.40
0.88
1.00
3.28
Medicaid and CHIP
c
475.43
530.83
529.06
1,535.32
Domestic Regional Organizations
Medicaid and CHIP
d
42.15
31.95
33.64.
107.74
Total
17,152.10
17,479.45
20,130.63
54,762.18
Source: GAO analysis of Health Resources and Services Administration, Planned Parenthood Federation of America, and State Medicaid Agency data. | GAO-24-106215
Notes: Medicare payments include only federal funds. Medicaid and CHIP payments include funding from both state and federal
sources; thus, the Medicaid and CHIP payment data overstate the amount of funding received from the federal government. The
actual amounts of Medicaid and CHIP payments from the federal government to states for qualifying expenditures to each of the
organizations are lower than amounts presented in the table, and would be limited to a matching percentage that differs across
26
HHS officials searched the Payment Management System based on the names of the organizations and their
affiliates and unique identifiers when available and found no results for the years under our review.
Page 13 GAO-24-106215 Health Care Funding
states and types of services provided. Additionally, these payments include state expenditures for services for which states do not
receive federal financial participation.
This table includes information self-reported annually by Health Centers to the Health Resources and Services Administration’s
Uniform Data System and by Planned Parenthood affiliates to the Planned Parenthood Federation of America through annual
financial reports. Data on amounts of public health coverage payments Health Centers received are based on the calendar year,
January 1 through December 31. Data on amounts of public health coverage payments Planned Parenthood affiliates received are
based on affiliate fiscal years, which according to Planned Parenthood Federation of America officials, begin and end on several
different dates. Data on amounts of public health coverage payments domestic regional organizations received were obtained from
the state Medicaid agencies in which the organizations operated during the time of our review and are based on a fiscal year from
July 1 through June 30. Amounts in this table may not sum to totals due to rounding.
a
Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized under
section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do not
receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
b
Medicare and Medicaid payments to Health Centers include payments from managed care organizations which private insurers
administer.
c
Medicare and Medicaid payments to Planned Parenthood affiliates include payments from managed care organizations which
private insurers administer.
d
One domestic regional organization reported Medicare payments of $2,311.87 for 2020 and $2,258.05 for 2021.
Federally guaranteed loans received. Our analysis of SBA loan data found that as of May 1,
2023, 1,150 of the 1,521 Health Centers and 38 of the 55 Planned Parenthood affiliates in our
review received an estimated $2.6 billion in SBA-guaranteed loans through the Paycheck
Protection Program, which are fully forgivable if certain conditions are met.
This estimated
amount represents approximately 0.32 percent of the total amount lent through the program.
27
Of the total amount lent to the organizations, $2.5 billion of the value of the loans plus incurred
interest had been approved for forgiveness. (See table 7 and enclosures II and III for more
information on these federally guaranteed loans.)
Table 7: Estimated Paycheck Protection Program Loan Amounts Received by and Forgiven for Health
Centers and Planned Parenthood Federation of America Affiliates, as of May 1, 2023
Dollars in millions
Organization
Loan amounts
received
Loan amounts forgiven
a
Health Centers
b
2,473.64
2,449.25
Planned Parenthood affiliates
89.30
90.41
Total
2,562.94
2,539.66
Source: GAO analysis of Small Business Administration data. | GAO-24-106215
Notes: Total amount of loans forgiven may not equal the total amount of loans received for several reasons. For example,
forgiveness totals include forgiven interest, while the loans received represent only the principal amount of the loans. Further,
organizations may not have received full forgiveness, may not have applied for forgiveness, or their forgiveness applications were
still in process.
a
Loans forgiven include both forgiven principal and interest and therefore may exceed the amount of loans received upon origination
–the amount originally approved. As of May 1, 2023, lenders had not submitted loan forgiveness decisions for four Paycheck
Protection Program loans made to Health Centers. In addition, 12 Health Centers had not submitted loan forgiveness applications to
their lenders for outstanding loans, as they generally have between 2 and 5 years to apply for forgiveness, depending on when the
loan was made.
27
We reported in April 2022 that, as of March 2022, lenders had made about 11.4 million Paycheck Protection
Program loans totaling $789 billion. Paycheck Protection Program loan applications were accepted through May 31,
2021, and SBA had until June 30, 2021, to process submitted applications. See GAO, COVID-19: Current and Future
Federal Preparedness Requires Fixes to Improve Health Data and Address Improper Payments, GAO-22-105397
(Washington, D.C.: April 27, 2022).
Page 14 GAO-24-106215 Health Care Funding
b
Health Center data include data for Health Center Program Award Recipients, who receive federal awards authorized under section
330 of the Public Health Service Act, and for organizations that meet all Health Center Program requirements but do not receive
such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b. We refer to these organizations
collectively as “Health Centers.” The amount of loans received and forgiven for Health Centers represent estimates and likely
overstate the amounts lent to these organizations, because they may include loans to a Health Center’s parent organization (such
as a university or health department) that operates the Health Center.
The first enclosure to this report provides detailed information about our methodology.
Subsequent enclosures provide further information on federal funding for Health Centers
(enclosure II), Planned Parenthood Federation of America (enclosure III), the four domestic
regional organizations in our review (enclosure IV), International Planned Parenthood
Federation (enclosure V), and MSI Reproductive Choices (enclosure VI).
Agency and Third-Party Comments
We provided a draft of this report to the Secretary of Health and Human Services, the SBA
Administrator, and the USAID Administrator for comment. HHS and SBA provided us with
technical comments, which we addressed as appropriate. USAID provided comments that are
reprinted in Enclosure VII. We also provided International Planned Parenthood Federation, MSI
Reproductive Choices, and Planned Parenthood Federation of America with excerpts of the
draft report. Each organization was asked to review our presentation of the information they
provided and review its accuracy. We incorporated their technical clarifications as appropriate.
- - - - -
As agreed with your offices, unless you publicly announce the contents of this report earlier, we
plan no further distribution until 30 days from the report date. At that time, we will send copies to
appropriate congressional members, the Secretary of Health and Human Services, the
Administrator of the U.S. Agency for International Development, and the Administrator of the
Small Business Administration. In addition, the report will be available at no charge on the GAO
website at https://www.gao.gov.
If you or your staff have any questions about this report, please contact me at (202) 512-7114 or
[email protected]. Contact points for our Offices of Congressional Relations and
Public Affairs may be found on the last page of this report. In addition to the contact named
above, Malissa G. Winograd (Assistant Director), Manuel Buentello (Analyst-in-Charge), Lily
Besel, and Elise Pressma made key contributions to this report. Also contributing were Samuel
Amrhein, Steven Flint, Jennifer Rudisill, and Ethiene Salgado-Rodriguez.
Mary Denigan-Macauley
Director, Health Care
Enclosures—7
Page 15 GAO-24-106215 Health Care Funding
List of Requesters
The Honorable Mitch McConnell
Minority Leader
United States Senate
The Honorable Mike Johnson
Speaker
House of Representatives
The Honorable John Barrasso
United States Senate
The Honorable Marsha Blackburn
United States Senate
The Honorable John Boozman
United States Senate
The Honorable Mike Braun
United States Senate
The Honorable Shelley Moore Capito
United States Senate
The Honorable Bill Cassidy, M.D.
United States Senate
The Honorable Michael D. Crapo
United States Senate
The Honorable Steve Daines
United States Senate
The Honorable Joni K. Ernst
United States Senate
The Honorable Deb Fischer
United States Senate
The Honorable Josh Hawley
United States Senate
The Honorable John Hoeven
United States Senate
The Honorable Cindy Hyde-Smith
United States Senate
The Honorable James Lankford
United States Senate
Page 16 GAO-24-106215 Health Care Funding
The Honorable Roger Marshall, M.D.
United States Senate
The Honorable Jerry Moran
United States Senate
The Honorable Markwayne Mullin
United States Senate
The Honorable James E. Risch
United States Senate
The Honorable Marco Rubio
United States Senate
The Honorable Rick Scott
United States Senate
The Honorable Tim Scott
United States Senate
The Honorable John Thune
United States Senate
The Honorable Thom Tillis
United States Senate
The Honorable Roger F. Wicker
United States Senate
The Honorable Todd Young
United States Senate
The Honorable Robert B. Aderholt
House of Representatives
The Honorable Rick W. Allen
House of Representatives
The Honorable Jodey C. Arrington
House of Representatives
The Honorable Brian Babin, D.D.S.
House of Representatives
The Honorable Don Bacon
House of Representatives
The Honorable James R. Baird
House of Representatives
Page 17 GAO-24-106215 Health Care Funding
The Honorable Troy Balderson
House of Representatives
The Honorable Jim Banks
House of Representatives
The Honorable Cliff Bentz
House of Representatives
The Honorable Andy Biggs
House of Representatives
The Honorable Gus M. Bilirakis
House of Representatives
The Honorable Dan Bishop
House of Representatives
The Honorable Lauren Boebert
House of Representatives
The Honorable Mike Bost
House of Representatives
The Honorable Larry Bucshon, M.D.
House of Representatives
The Honorable Ted Budd
House of Representatives
The Honorable Michael C. Burgess, M.D.
House of Representatives
The Honorable Kat Cammack
House of Representatives
The Honorable Earl L. ‘Buddy’ Carter
House of Representatives
The Honorable Ben Cline
House of Representatives
The Honorable Michael Cloud
House of Representatives
The Honorable Andrew S. Clyde
House of Representatives
The Honorable Eric A. “Rick” Crawford
House of Representatives
Page 18 GAO-24-106215 Health Care Funding
The Honorable Dan Crenshaw
House of Representatives
The Honorable Jeff Duncan
House of Representatives
The Honorable Jake Ellzey
House of Representatives
The Honorable Tom Emmer
House of Representatives
The Honorable Ron Estes
House of Representatives
The Honorable Randy Feenstra
House of Representatives
The Honorable Michelle Fischbach
House of Representatives
The Honorable Scott Fitzgerald
House of Representatives
The Honorable Charles J. “Chuck” Fleischmann
House of Representatives
The Honorable Virginia Foxx
House of Representatives
The Honorable C. Scott Franklin
House of Representatives
The Honorable Russ Fulcher
House of Representatives
The Honorable Bob Good
House of Representatives
The Honorable Garret Graves
House of Representatives
The Honorable H. Morgan Griffith
House of Representatives
The Honorable Glenn Grothman
House of Representatives
The Honorable Michael Guest
House of Representatives
Page 19 GAO-24-106215 Health Care Funding
The Honorable Brett Guthrie
House of Representatives
The Honorable Andy Harris, M.D.
House of Representatives
The Honorable Diana Harshbarger
House of Representatives
The Honorable Richard Hudson
House of Representatives
The Honorable Bill Huizenga
House of Representatives
The Honorable Darrel Issa
House of Representatives
The Honorable Ronny L. Jackson
House of Representatives
The Honorable Bill Johnson
House of Representatives
The Honorable Dusty Johnson
House of Representatives
The Honorable Jim Jordan
House of Representatives
The Honorable John Joyce
House of Representatives
The Honorable Mike Kelly
House of Representatives
The Honorable Trent Kelly
House of Representatives
The Honorable Young Kim
House of Representatives
The Honorable David Kustoff
House of Representatives
The Honorable Darin LaHood
House of Representatives
The Honorable Doug LaMalfa
House of Representatives
Page 20 GAO-24-106215 Health Care Funding
The Honorable Doug Lamborn
House of Representatives
The Honorable Robert E. Latta
House of Representatives
The Honorable Jake LaTurner
House of Representatives
The Honorable Debbie Lesko
House of Representatives
The Honorable Julia Letlow
House of Representatives
The Honorable Blaine Luetkemeyer
House of Representatives
The Honorable Nancy Mace
House of Representatives
The Honorable Thomas Massie
House of Representatives
The Honorable Brian J. Mast
House of Representatives
The Honorable Kevin McCarthy
House of Representatives
The Honorable Lisa C. McClain
House of Representatives
The Honorable Patrick T. McHenry
House of Representatives
The Honorable Carol D. Miller
House of Representatives
The Honorable Mary E. Miller
House of Representatives
The Honorable Mariannette Miller-Meeks, M.D.
House of Representatives
The Honorable John R. Moolenaar
House of Representatives
The Honorable Alexander X. Mooney
House of Representatives
Page 21 GAO-24-106215 Health Care Funding
The Honorable Barry Moore
House of Representatives
The Honorable Blake D. Moore
House of Representatives
The Honorable Ralph Norman
House of Representatives
The Honorable Gary J. Palmer
House of Representatives
The Honorable Scott Perry
House of Representatives
The Honorable Guy Reschenthaler
House of Representatives
The Honorable Mike Rogers
House of Representatives
The Honorable John Rose
House of Representatives
The Honorable Matthew M. Rosendale, Sr.
House of Representatives
The Honorable Chip Roy
House of Representatives
The Honorable John H. Rutherford
House of Representatives
The Honorable Steve Scalise
House of Representatives
The Honorable Austin Scott
House of Representatives
The Honorable Adrian Smith
House of Representatives
The Honorable Christopher H. Smith
House of Representatives
The Honorable Jason Smith
House of Representatives
The Honorable Lloyd Smucker
House of Representatives
Page 22 GAO-24-106215 Health Care Funding
The Honorable Elise M. Stefanik
House of Representatives
The Honorable Glenn “GT” Thompson
House of Representatives
The Honorable William R. Timmons IV
House of Representatives
The Honorable Beth Van Duyne
House of Representatives
The Honorable Tim Walberg
House of Representatives
The Honorable Michael Waltz
House of Representatives
The Honorable Randy K. Weber, Sr.
House of Representatives
The Honorable Daniel Webster
House of Representatives
The Honorable Brad R. Wenstrup, D.P.M.
House of Representatives
Page 23 GAO-24-106215 Health Care Funding
Enclosure I: Objectives, Scope, and Methodology
This report describes (1) federal funding obligated to certain health centers, Planned
Parenthood Federation of America, four domestic regional organizations, International Planned
Parenthood Federation, and MSI Reproductive Choices (formerly known as Marie Stopes
International) from 2019 through 2022; and (2) federal funding received and expended by these
organizations from 2019 through 2021.
1
This report updates information we have reported
periodically regarding federal funding provided to these types of organizations since 1995.
2
To determine what federal funds were obligated to certain organizations providing health-related
services from 2019 (the first year of data since we last reported) through 2022 (the most recent
data available), we analyzed data on grants and cooperative agreements from the Department
of Health and Human Services’ (HHS) Payment Management System. We also analyzed data
on grants and cooperative agreements from the U.S. Agency for International Development’s
(USAID) Phoenix System obligated to the international organizations—International Planned
Parenthood Federation and MSI Reproductive Choices—in our review.
3
We found that Payment Management System data likely overstate the amounts obligated to
Health Centers because they may include obligations to a parent organization (such as a
university or health department) that operates the Health Center.
4
Further, we did not find these
data sufficiently reliable to report obligations made to Health Centers by non-HHS agencies or
obligations to individual Health Centers, for the same reason. As such, we estimated obligations
made to Health Centers in the report by taking the following steps:
1
In this report, we use the term “federal funding” to mean funding awarded by federal agencies through grants,
cooperative agreements, payments made by federal health coverage programs such as Medicare, Medicaid and the
Children’s Health Insurance Program (CHIP), or federally guaranteed loans. The term “obligation” refers to a definite
commitment by a federal agency that creates a legal liability to make payments immediately or in the future, such as
when an agency awards a grant to a selected organization. The term “funds received” refers to the dollar amounts an
organization received. In this report, these funds include: (1) grant funds disbursed by an awarding agency, (2)
payments from public health coverage programs; and (3) loans from the Paycheck Protection Program.
“Expenditures” refer to the actual spending of money by organizations that receive federal funds.
2
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019). Similarly, foreign assistance funds cannot be used to pay for the performance of abortion
as a method of family planning or to motivate or coerce any person to practice abortions. See, e.g., Pub. L. No. 116-
94, div. G, tit. III, “Bilateral Economic Assistance—Global Health Programs,” 133 Stat. at 2827.
3
Amounts for grants and cooperative agreements obligated and received do not include funds obligated or received
by the organizations through pass-through funding or sub-awards, unless otherwise noted. Information on grants and
cooperative agreement sub-awards were not sufficiently reliable for the purposes of this report.
4
For purposes of this report, we use the term Health Centers to refer to centers that receive funds under the Health
Resources and Services Administration’s Health Center Program authorized under section 330 of the Public Health
Service Act as well as centers, known as “look-alikes”, which meet the requirements but do not receive such funds.
See 42 U.S.C. § 254b. Health Centers may be part of a larger organization, such as a state health department or a
university. The data systems used to collect obligations data do not always distinguish between obligations directly to
a Health Center from obligations to a larger organization that includes the Health Center. Therefore the estimated
amount of federal obligations to Health Centers likely overstates the amount provided to these organizations. The
Health Resources and Services Administration is the primary HHS source of grants or cooperative agreements
funding for Health Centers.
Page 24 GAO-24-106215 Health Care Funding
• We limited our analysis to only HHS awarding agencies, because HHS is the department
that oversees agencies that most align with the purpose and activities of Health Centers.
• We further limited our estimates to only those HHS awarding agencies most likely to
have obligated funds to Health Centers as confirmed by the Health Resources and
Services Administration. The Health Resources and Services Administration is the
primary HHS source of grants or cooperative agreements funding for Health Centers.
According to the Health Resources and Services Administration officials, the most
common obligating HHS agencies for Health Centers other than itself include the
Substance Abuse and Mental Health Services Administration, the Indian Health Service,
and the Office of the Secretary (Office of Minority Health).
After taking these steps, we found these data and the remaining HHS and USAID obligations
data reliable for the purpose of our report.
To determine what federal funds organizations received from 2019 through 2021 (the most
recent data available), we analyzed data on: 1) grants and cooperative agreements; 2)
payments from Medicare, Medicaid, and CHIP;
5
and 3) loans from the Small Business
Administration’s (SBA) Paycheck Protection Program. Specifically:
• To determine funds that organizations received from grants and cooperative
agreements, we analyzed data from: (1) HHS’s Health Resources and Services
Administration’s Uniform Data System; (2) HHS’s Payment Management System; and
(3) USAID’s Phoenix System. We also analyzed data from annual financial reports to
determine federal grant and cooperative agreement funds that Planned Parenthood
affiliates received. We found these data reliable for the purpose of our report.
• To determine the amounts that Health Centers, Planned Parenthood affiliates, and
domestic regional organizations received in payments from Medicare, Medicaid, and
CHIP, we used several sources, each of which we found reliable for the purpose of our
report:
o To determine the amount that Health Centers received in such payments, we
used data from the Health Resources and Services Administration’s Uniform
Data System. We also analyzed data from the Uniform Data System to report on
individuals served by Health Centers and selected diagnostic tests, screenings,
and preventive services Health Center patients received from 2019 through
2021.
o To determine the amount Planned Parenthood affiliates received in such
payments, we used data from the Planned Parenthood affiliates’ annual audit
reports.
6
5
Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with
disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care
program for low-income and medically needy individuals. CHIP is a joint federal-state financed program to provide
health care to certain uninsured, low-income children.
6
According to Planned Parenthood Federation of America officials, during the period of our review several Planned
Parenthood affiliates went through mergers or restructuring, causing the number and names of the affiliates in our
review to change over time. For example, due to mergers or restructuring that occurred between 2019 and 2021,
Page 25 GAO-24-106215 Health Care Funding
o To determine the amount that domestic regional organizations received in
Medicaid and CHIP payments, we obtained data from Medicaid agencies for
states in which the domestic regional organizations operated during the years
under review.
7
• We analyzed data from the Small Business Administration’s (SBA) Paycheck Protection
Program to estimate the number and amounts of federally guaranteed loans and loans
forgiven to Health Centers and Planned Parenthood affiliates. As with Health Center
obligations data, we found Paycheck Protection Program data likely overstate loans
received by and forgiven for Health Centers, because they may include loans to a Health
Center’s parent organization (such as a university or health department) that operates
the Health Center. Most Health Center loans were provided to organizations that self-
identified as belonging to the Health Care and Social Assistance sector. After reviewing
the data, we consider the amount of loans made to Health Centers and the amount of
these loans forgiven, in the report, to be estimates.
To determine what federal funding certain organizations expended from 2019 through 2021, we
examined data from Planned Parenthood affiliates, International Planned Parenthood
Federation, and MSI Reproductive Choices.
8
Expenditure information for Health Centers is not
centrally maintained, and we determined it was impracticable to collect those data from about
1,500 individual Health Centers. For Planned Parenthood affiliates, we examined reported
expenditures of federal funds through grants and cooperative agreements from audited financial
reports that affiliates submitted to the Federal Audit Clearinghouse.
9
Specifically, we reviewed
58 audit reports for 35 Planned Parenthood affiliates. We analyzed the audit reports to
determine the top 15 HHS programs by greatest reported expenditures across Planned
Parenthood affiliates. We also determined the top 10 programs from federal agencies other than
HHS. The 58 audit reports represent all single audits that Planned Parenthood affiliates
submitted from fiscal years 2019 through 2021, as required by the Single Audit Act. That is, the
35 Planned Parenthood affiliates submitted a single audit report within at least one of the years
covered by our review because they met the required annual audit threshold. The 35 Planned
Parenthood affiliates are a subset of the 55 Planned Parenthood affiliates in our review.
10
As
such, the data do not represent federal expenditures for all Planned Parenthood affiliates during
Planned Parenthood of Mid-Hudson Valley, Inc., Planned Parenthood of Nassau County, Inc., Planned Parenthood of
the Heartland, Planned Parenthood of the Southern Finger Lakes, and Planned Parenthood Mohawk Hudson no
longer operated independently and therefore did not submit independent data in 2020 and 2021. The affiliates
included in our data reflect all affiliates that operated and submitted data in any of the years under our review.
7
Collecting information on Medicare payments to the domestic regional organizations was beyond the scope of this
engagement.
8
For International Planned Parenthood Federation, funds expended are limited to International Planned Parenthood
Federation offices and does not include funding expended by International Planned Parenthood Federation affiliates.
9
Non-federal entities with expenditures of federal funding of $750,000 or more within the entity’s fiscal year are
required to undergo an audit in accordance with the Single Audit Act, as amended, and Office of Management and
Budget (OMB) implementing guidance, and to provide the results of this audit to OMB. See 31 U.S.C. § 7502; 2
C.F.R. § 200.501 (2023). The Federal Audit Clearinghouse is the repository for single audits, as designated by OMB.
10
Because of mergers and restructuring that occurred during the period of our review, some self-reported Planned
Parenthood affiliate names differ between the single audit reports and annual financial reports we analyzed. We
explain those differences when possible.
Page 26 GAO-24-106215 Health Care Funding
the period of our review and are not generalizable. We determined that the data were
sufficiently reliable for our reporting purposes.
To address both objectives, we interviewed agency officials from HHS (including the Health
Resources and Services Administration), SBA, and USAID. We also interviewed representatives
from Planned Parenthood Federation of America, International Planned Parenthood Federation,
and MSI Reproductive Choices, and from two of the four domestic regional organizations.
11
We conducted this performance audit from August 2022 to November 2023 in accordance with
generally accepted government auditing standards. Those standards require that we plan and
perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that the evidence obtained
provides a reasonable basis for our findings and conclusions based on our audit objectives.
11
Two of the four organizations did not respond to our request for interviews.
Page 27 GAO-24-106215 Health Care Funding
Enclosure II: Health Center Program Award Recipients and Health Center Program Look-
alikes (Health Centers)
Certain health centers receive Health Center Program awards through grants or Health Center
Program Look-alike designation from the Health Resources and Services Administration
(HRSA) within the Department of Health and Human Services (HHS).
12
These Health Centers
form a network of about 1,500 community-based organizations that provide comprehensive
health care services to individuals regardless of their ability to pay. Health Center services
include primary care, such as diagnostic testing and disease treatment, and preventive care,
such as family planning and prenatal and postpartum care.
Funding obligated. Our analysis of data from HHS found that it obligated an estimated $33.7
billion to Health Centers through grants or cooperative agreements from 2019 through 2022.
13
Almost all of the funding obligated, about $31.8 billion, came from HRSA. (See table 8.)
Table 8: Department of Health and Human Services (HHS) Estimated Obligations to Health Centers through Grants
or Cooperative Agreements
by HHS Awarding Office or Agency, 2019-2022
Dollars in millions
HHS office or agency
2019
2020
2021
2022
Total
Health Resources and Services
Administration
5,525.64
7,553.50
12,699.61
a
6,054.11
31,832.86
Substance Abuse and Mental Health
Services Administration
252.06
326
569.43
346.19
1,493.68
Office of the Secretary
36.50
49.97
82.89
43.29
212.65
Indian Health Service
30.77
29.52
28.84
36.88
126.01
Total
5,844.97
7,958.98
13,380.78
6,480.47
33,665.20
Source: GAO analysis of HHS data. | GAO-24-106215
12
Certain eligible community-based health services organizations receive funding under the Health Center Program,
which is administered by the Bureau of Primary Health Care within the Department of Health and Human Services’
Health Resources and Services Administration. The Health Center Program provides grants to these organizations
under section 330 of the Public Health Service Act (“Section 330”). See 42 U.S.C § 254b. For purposes of this report,
we refer to Section 330 recipients as “Health Center Program Award Recipients” or “Awardees.” Other health
services organizations meet all Health Center Program requirements but do not receive federal grant funding through
Section 330, which the Health Resources and Services Administration designates as Health Center Program Look-
alikes. Look-alikes may receive other benefits, including support through other federal programs. For the purpose of
this report, we use the term “Health Centers” to refer to both Awardees and Look-alikes. Health Centers and certain
other health services organizations are eligible to apply for the Centers for Medicare & Medicaid Services certification
as Federally Qualified Health Centers, which receive higher payment rates under Medicare and Medicaid, but are not
the focus of this report.
13
Health Centers may be part of a larger organization, such as a state health department or a university. The data
systems used to collect obligations data do not always distinguish between obligations directly to a Health Center
from obligations to a larger organization that includes the Health Center. Therefore, the estimated amount of federal
obligations to Health Centers likely overstates the amounts provided to these organizations.
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019).
Page 28 GAO-24-106215 Health Care Funding
Notes: Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
HHS data likely overstate the amounts obligated to Health Centers because they may include obligations to a Health Center’s
parent organization (such as a university or health department) that operates the Health Center. The Health Resources and
Services Administration is the primary HHS source of grants or cooperative agreements funding for Health Centers. According to
Health Resources and Services Administration officials, the most common obligating HHS agencies for Health Centers other than
itself include the Indian Health Service, the Office of Minority Health within the Office of the Secretary, and the Substance Abuse
and Mental Health Services Administration. We therefore limited our analysis of HHS obligations to Health Centers to these HHS
agencies.
Data on amounts of federal funds obligated to Health Centers are based on the federal fiscal year, October 1 through September
30. Amounts in this table may not sum to totals due to rounding.
a
Health Resources and Services Administration officials attribute the large increase in obligations to Health Centers from fiscal year
2020 to fiscal year 2021 to one-time, emergency COVID-19 supplemental funding provided under the American Rescue Plan Act of
2021 for eligible Health Centers. See Pub. L. No. 117-2, 135 Stat. 4. Specifically, in fiscal year 2021, the Health Resources and
Services Administration obligated over $7.1 billion of American Rescue Plan Act of 2021 funding for Health Centers and Health
Center construction and capital improvements.
Grant funding received.
14
Health Centers reported receiving approximately $21.7 billion in
federal funds through grants from both HHS and other federal agencies in 2019 through 2021.
15
(See table 9.) This amount includes the addition of $1.3 billion in 2020 and $2.2 billion in 2021
from COVID-19 supplemental grants, which includes funding from the CARES Act and the
American Rescue Plan Act of 2021, among other COVID-19 related funds.
16
Table 9: Federal Funds Received by Health Centers through Grants, 2019-2021
Dollars in millions
Grant type
2019
2020
2021
Total
Health Resources and Services Administration (HRSA)
grants
HRSA primary care and capital development grants
a
5,002.79
4,778.16
5,226.98
15,007.92
COVID-19 supplemental grants
b
NA
1,318.72
2,239.78
3,558.50
Other federal grants
c
491.56
1,450.78
1,186.13
3,128.47
Total
5,494.35
7,547.65
8,652.89
21,694.89
Source: GAO analysis of Health Resources and Services Administration data. | GAO-24-106215
14
Health Center data include federal grants but do not include funding from cooperative agreements. According to
HRSA officials, Health Centers do not enter into cooperative agreements with HRSA and do not report funding
received through cooperative agreements from other federal sources in the Uniform Data System data used in this
analysis.
15
The amounts received were previously obligated. Federal funding obligated to an organization in any 1 year may be
received by the organization in a different year or across multiple years. As a result, the amount of federal funding
obligated, versus received or expended, may differ within the same time period. Additionally, obligations and amounts
received should not be added together.
16
In 2020 and 2021, Congress passed and the President signed into law six COVID-19 relief bills providing about
$4.7 trillion to address the public health and economic threats posed by COVID-19. See the American Rescue Plan
Act of 2021, Pub. L. No. 117-2, 135 Stat. 4; Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, 134 Stat.
1182 (2020); Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620
(2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); Families First Coronavirus Response Act, Pub. L.
No. 116-127, 134 Stat. 178 (2020); and the Coronavirus Preparedness and Response Supplemental Appropriations
Act, 2020, Pub. L. No. 116-123, 134 Stat. 146.
Page 29 GAO-24-106215 Health Care Funding
Notes: Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
While the majority of funds received by Health Centers came from the Department of Health and Human Services, data may include
some funding from other federal agencies, such as the Department of Housing and Urban Development.
This table includes information self-reported annually by Health Centers to Health Resources and Services Administration’s Uniform
Data System. Data on amounts of federal funds received by Health Centers are based on the calendar year, January 1 through
December 31. Amounts in this table may not sum to totals due to rounding.
a
HRSA’s primary care grants are grants provided under the federal Health Center Program and authorized under section 330 of the
Public Health Service Act. See 42 U.S.C § 254b. Capital development grants include funds from the Health Center Program facility
program, HRSA administered school-based health center capital grant program, Capital Assistance for Hurricane Response and
Recovery Efforts, as well as other funds awarded by HRSA to assist in the reconstruction and repair of facilities destroyed or
damaged by natural disasters.
b
Reported COVID-19 supplemental grants include funding from the CARES Act, American Rescue Plan of 2021, funds for
Expanding Capacity for Coronavirus Testing, as well as other supplemental funding from HRSA.
c
This category includes funding from a variety of sources, such as the Ryan White HIV/AIDS Program and Medicare and Medicaid
Electronic Health Record Incentive Program grants. According to HRSA, the most common “other federal grants” reported are from
the Indian Health Service, the Office of Minority Health, and the Substance Abuse and Mental Health Services Administration and
the Department of Housing and Urban Development.
Public health coverage program payments received. In addition to funds associated with
grants, Health Centers reported receiving approximately $53 billion in payments from Medicare,
Medicaid, and the Children’s Health Insurance Program (CHIP), from 2019 through 2021.
17
(See
table 10.)
Table 10: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) Payments Received by
Health Centers, 2019-2021
Dollars in millions
Program
2019
2020
2021
Total
Medicare
2,743.08
2,901.89
3,427.11
9,072.08
Medicaid and CHIP
13,890.04
14,013.90
16,139.82
44,043.77
Total
16,633.13
16,915.79
19,566.93
53,115.85
Source: GAO analysis of Health Resources and Services Administration data. | GAO-24-106215
Notes:
Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
Medicare and Medicaid payments to Health Centers include payments from managed care organizations, which private insurers
administer. Medicare payments include only federal funds. Medicaid and CHIP payments include funding from both state and
federal sources; thus, the Medicaid and CHIP payment data overstate the amount of funding received from the federal government.
The actual amounts of Medicaid and CHIP payments from the federal government to Health Centers are lower than amounts
presented in the table and would be limited to a matching percentage that differs across states and types of services provided.
This table includes information self-reported annually by Health Centers to Health Resources and Services Administration’s Uniform
Data System. Data on amounts of federal funds received by Health Centers are based on the calendar year, January 1 through
December 31. Amounts in this table may not sum to totals due to rounding.
17
Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with
disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care
program for certain low-income and medically needy individuals. CHIP is a joint federal-state financed program to
provide health care to certain uninsured, low-income children.
Page 30 GAO-24-106215 Health Care Funding
Federally guaranteed loans received. Our analysis of data from the Small Business
Administration (SBA) found that between April 3, 2020, and June 30, 2021, an estimated 1,419
Paycheck Protection Program loans were made to Health Centers, ranging in amounts from
$625 to $10 million.
18
Lenders provided an estimated $2.47 billion in loans to Health Centers
and approved $2.45 billion, including interest, for loan forgiveness as of May 1, 2023.
Of the identified 1,419 loans, 1,359 of the loan applications were approved for full forgiveness,
44 for partial forgiveness, and four were being processed as of May 1, 2023. Health Centers
had yet to apply for forgiveness for 12 of the loans, as of May 1, 2023.
19
(See figure 4 for loan
forgiveness status for each of the 1,419 loans.)
Figure 4. Forgiveness Status for Each of 1,419 Paycheck Protection Program Loans Made to Health Centers
by Number and Percent of Total Loans, as of May 1, 2023
Notes:
Health Center data include data for Health Center Program Award Recipients, who receive federal awards authorized under
section 330 of the Public Health Service Act, and for organizations that meet all Health Center Program requirements but do not
receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
The Small Business Administration may approve forgiveness for the full amount of Paycheck Protection Program loans including
any interest accrued by the borrower if the borrower has used at least 60 percent of the loan proceeds on eligible payroll costs and
the balance has been spent on other eligible expenses. If a borrower uses less than 60 percent of the loan proceeds on payroll
costs, then the borrower may be eligible for partial forgiveness based on the percentage of proceeds spent on payroll costs.
Paycheck Protection Program data likely overstate loans received and forgiven for Health Centers, because they may include loans
to a Health Center’s parent organization (such as a university or health department) that operates the Health Center.
18
Administered by SBA through a network of authorized participating lenders, and guaranteed at 100 percent by
SBA, the Paycheck Protection Program provided forgivable loans for payroll and certain other eligible costs to
support small businesses and non-profits affected by the COVID-19 pandemic.
Paycheck Protection Program data likely overstate loans received and forgiven for Health Centers, because they may
include loans to a Health Center’s parent organization (such as a university or health department) that operates the
Health Center.
19
Paycheck Protection Program loans may be approved for forgiveness for up to the full amount of the loans
including any interest accrued by the borrower depending on how the borrower spends the loan proceeds. For
example, if a borrower uses less than 60 percent of the loan proceeds on payroll costs, then the borrower may be
eligible for partial forgiveness based on the percentage of proceeds spent on payroll costs.
Page 31 GAO-24-106215 Health Care Funding
Health Center patients and services. Our analysis of data reported by Health Centers to the
Health Resources and Services Administration found that Health Centers served an average of
about 30 million individuals each year (over 90 million individuals from 2019 through 2021),
largely with funds received through federal grants and public health insurance program
payments, such as through Medicaid. These individuals accessed any of a variety of diagnostic
tests, screenings and preventive services including vaccinations (28.9 million patients), Pap
tests (5.1 million patients), and mammograms (2.9 million patients). (See tables 11, 12, and 13.)
Table 11: Number of Individuals by Age and Sex Assigned at Birth Served at Health Centers, 2019-2021
2019
2020
2021
Total
Age groups
Males
Females
Males
Females
Males
Females
<1 through 17
4,696,482
4,678,814
4,017,944
4,039,827
4,468,195
4,449,502
26,350,764
18 through 64
7,030,730
11,096,855
7,160,545
11,044,336
7,408,145
11,426,001
55,166,612
65 and older
1,207,763
1,720,999
1,253,618
1,753,637
1,418,580
1,977,920
9,332,517
Total
12,934,975
17,496,668
12,432,107
16,837,800
13,294,920
17,853,423
90,849,893
Source: GAO analysis of Health Resources and Services Administration data. | GAO-24-106215
Notes: Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
This table includes information self-reported annually by Health Centers to Health Resources and Services Administration’s Uniform
Data System. Data on amounts of federal funds received by Health Centers are based on the calendar year, January 1 through
December 31.
Table 12: Number of Patients Who Received Selected Diagnostic Tests, Screenings, and Preventive Services
from Health Centers, 2019-2021
Number of patients
Selected service
2019
2020
2021
Total
Childhood lead test screening (9 to 72 months)
593,190
478,132
523,823
1,595,145
Comprehensive and intermediate eye exams
655,808
488,079
640,234
1,784,121
Contraceptive management
1,727,453
1,550,813
1,637,483
4,915,749
Coronavirus (SARS-CoV-2) vaccine
NA
NA
4,731,545
4,731,545
Health supervision of infant or child (ages 0
through 11)
3,818,134
3,257,545
3,667,095
10,742,774
Hepatitis B test
939,423
784,194
1,144,677
2,868,294
Hepatitis C test
1,191,570
1,248,801
2,005,395
4,445,766
Human immunodeficiency virus (HIV) test
2,258,938
2,079,852
2,817,276
7,156,066
Mammogram
845,166
835,080
1,210,284
2,890,530
Novel coronavirus (SARS-CoV-2) antibody test
NA
285,314
222,097
507,411
Novel coronavirus (SARS-CoV-2) diagnostic
test
NA
3,790,994
4,394,379
8,185,373
Pap test
1,838,805
1,436,955
1,832,650
5,108,410
Pre-Exposure Prophylaxis (PrEP) - associated
management of all PrEP patients
a
NA
398,587
88,092
486,679
Screening, Brief Intervention, and Referral to
Treatment (SBIRT)
b
1,385,326
1,257,905
1,494,914
4,138,145
Seasonal flu vaccine
4,884,754
4,656,636
4,150,317
13,691,707
Selected immunizations
c
4,068,692
3,112,938
3,336,124
10,517,754
Smoke and tobacco use cessation counseling
1,420,059
1,622,756
1,900,596
4,943,411
Total
25,627,318
27,284,581
35,796,981
88,708,880
Source: GAO analysis of Health Resources and Services Administration data. | GAO-24-106215
Notes: Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
Page 32 GAO-24-106215 Health Care Funding
These services do not reflect the full range of services rendered by a Health Center. The selected services represent those that are
prevalent among Health Center patients, have been regarded as sentinel indicators of access to primary care, or are of special
interest to the Health Resources and Services Administration.
This table includes information self-reported annually by Health Centers to Health Resources and Services Administration’s Uniform
Data System. Data on the number of patients receiving selected services by Health Centers are based on the calendar year,
January 1 through December 31.
a
Pre-exposure prophylaxis (PrEP) is a pill or injection taken to avoid contracting HIV.
b
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to
delivering early intervention and treatment services for persons with substance use disorders and those at risk of developing these
disorders.
c
Selected immunizations include vaccinations for hepatitis A; haemophilus influenzae B (HiB); pneumococcal, diphtheria, tetanus,
pertussis (DTaP) (DTP) (DT); measles, mumps, rubella (MMR); poliovirus; varicella; and hepatitis B.
Table 13: Number of Visits Provided by Health Centers for Selected Diagnostic Tests, Screenings, and
Preventive Services, 2019-2021
Number of visits
Selected service
2019
2020
2021
Total
Childhood lead test screening (9 to 72 months)
677,350
526,200
591,113
1,794,663
Comprehensive and intermediate eye exams
742,621
548,365
716,535
2,007,521
Contraceptive management
2,915,240
2,620,934
2,883,661
8,419,835
Coronavirus (SARS-CoV-2) vaccine
NA
NA
8,704,674
8,704,674
Health supervision of infant or child (ages 0 through 11)
5,856,761
5,129,902
5,767,962
16,754,625
Hepatitis B test
1,212,884
923,617
1,301,920
3,438,421
Hepatitis C test
1,447,286
1,401,332
2,217,187
5,065,805
Human immunodeficiency virus (HIV) test
2,746,280
2,529,547
3,362,458
8,638,285
Mammogram
957,814
938,230
1,408,074
3,304,118
Novel coronavirus (SARS-CoV-2) antibody test
NA
326,252
275,268
601,520
Novel coronavirus (SARS-CoV-2) diagnostic test
NA
4,939,680
6,454,090
11,393,770
Pap test
1,972,758
1,537,603
2,019,513
5,529,874
Pre-Exposure Prophylaxis (PrEP) - associated
management of all PrEP patients
a
NA
599,076
197,358
796,434
Screening, Brief Intervention, and Referral to Treatment
(SBIRT)
b
2,340,449
2,416,758
2,843,759
7,600,966
Seasonal flu vaccine
5,353,052
5,204,688
4, 468,045
15,025,785
Selected immunizations
c
5,546,244
4,196,332
4,489,634
14,232,210
Smoke and tobacco use cessation counseling
2,632,551
3,084,516
3,619,364
9,336,431
Total
34,401,290
36,923,032
51,320,615
122,644,937
Source: GAO analysis of Health Resources and Services Administration data. | GAO-24-106215
Notes: Health Center data include data from Health Center Program Award Recipients, who receive federal awards authorized
under section 330 of the Public Health Service Act, and from organizations that meet all Health Center Program requirements but do
not receive such funds, which may be known as Health Center Program Look-alikes. See 42 U.S.C. § 254b.
These services do not reflect the full range of services rendered by a Health Center. The selected services represent those that are
prevalent among Health Center patients, have been regarded as sentinel indicators of access to primary care, or are of special
interest to the Health Resources and Services Administration. During a single visit more than one test, screening, or preventive
service may be provided.
This table includes information self-reported annually by Health Centers to Health Resources and Services Administration’s Uniform
Data System. Data on the number of visits provided by Health Centers for selected services are based on the calendar year,
January 1 through December 31.
a
Pre-exposure prophylaxis (PrEP) is a pill or injection taken to avoid contracting HIV.
b
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to
delivering early intervention and treatment services for persons with substance use disorders and those at risk of developing these
disorders.
Page 33 GAO-24-106215 Health Care Funding
c
Selected immunizations include vaccinations for hepatitis A; haemophilus influenzae B (HiB); pneumococcal, diphtheria, tetanus,
pertussis (DTaP) (DTP) (DT); measles, mumps, rubella (MMR); poliovirus; varicella; and hepatitis B.
Page 34 GAO-24-106215 Health Care Funding
Enclosure III: Planned Parenthood Federation of America
Planned Parenthood Federation of America is a national, nonprofit organization that provides
support services to about 50 affiliates.
20
Planned Parenthood affiliates are independent
organizations that operate with financial and governing autonomy. Affiliates operate
approximately 600 centers across the country, providing sexual and reproductive health-related
services, and abortions.
Funding obligated. Our analysis of data from the Department of Health and Human Services
(HHS) found that it obligated approximately $49 million directly to Planned Parenthood affiliates
through grants or cooperative agreements from 2019 through 2022.
21
(See table 14.)
Table 14: Department of Health and Human Services (HHS) Estimated Obligations to Planned Parenthood
Federation of America Affiliates
through Grants or Cooperative Agreements by HHS Awarding Office or
Agency, 2019
-2022
Dollars in millions
HHS office or agency
2019
2020
2021
2022
Total
Office of the Secretary
10.94
2.78
3.79
25.00
a
42.51
Administration for Children and Families
1.12
1.10
1.28
1.28
4.77
Substance Abuse and Mental Health
Services Administration
0.00
0.20
0.20
0.60
1.00
Centers for Medicare & Medicaid
Services
0.00
0.00
0.22
0.18
0.39
Health Resources and Services
Administration
0.00
0.00
0.23
b
0.00
0.23
Total
12.05
4.08
5.71
27.06
48.91
Source: GAO analysis of HHS data. | GAO-24-106215
Notes: This table includes funds obligated directly through grants or cooperative agreements. It does not include funds obligated to
other organizations and passed through to Planned Parenthood affiliates. Data are based on the federal fiscal year, October 1
through September 30. Amounts may not sum to totals due to rounding.
a
The large increase in obligations made by the Office of the Secretary between 2021 and 2022 is due to increased Title X Family
Planning Services and Family Planning Service Delivery Improvement Research Grant funding obligated to Planned Parenthood
affiliates in 2022.
b
According to Health Resources and Services Administration officials, this one-time Health Resources and Services Administration
funding was provided through a competitive grant award issued under the Community Based COVID 19 Workforce Vaccine
Outreach program that was funded under the American Rescue Plan Act of 2021. See Pub. L. No. 117-2, 135 Stat. 4.
Grant and cooperative agreement funding received. Our analysis found that Planned
Parenthood affiliates received approximately $148 million in federal funds through grants or
20
During the period of our review there were more than 50 Planned Parenthood affiliates operating depending on the
year. In 2022, Planned Parenthood Federation of America reported 49 affiliates.
21
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019).
Page 35 GAO-24-106215 Health Care Funding
cooperative agreements from 2019 through 2021, mostly through HHS programs.
22
(See table
15.)
Table 15: Federal Funds Received by Planned Parenthood Federation of America Affiliates through Grants
or
Cooperative Agreements, 2019-2021
Dollars in millions
Organization
2019
2020
2021
Total
Planned Parenthood of Orange & San Bernardino Counties,
Inc.
3.92
3.62
3.55
11.09
Planned Parenthood of Greater New York
a
2.68
1.37
5.77
9.82
Planned Parenthood North Central States
5.54
1.56
2.31
9.40
Planned Parenthood of Michigan
b
5.63
1.87
1.44
8.94
Planned Parenthood of Northern, Central and Southern New
Jersey
, Inc.
5.03
1.92
1.91
8.86
Planned Parenthood of Southern New England, Inc.
c
4.28
2.67
1.61
8.56
Planned Parenthood Great Northwest, Hawai’i’, Alaska,
Indiana, Kentucky
6.09
2.14
---
d
8.23
Planned Parenthood of Maryland, Inc.
2.02
2.78
2.74
7.53
Planned Parenthood of Greater Ohio
4.81
0.46
0.14
5.41
Planned Parenthood of Illinois
4.49
0.19
0.00
4.68
Planned Parenthood of Wisconsin, Inc.
1.78
0.00
2.65
4.43
Planned Parenthood of Northern New England
e
1.98
0.57
1.84
4.39
Planned Parenthood Great Plains
1.52
0.96
1.24
3.73
Planned Parenthood Northern California
1.86
0.80
0.76
3.42
Planned Parenthood Mohawk Hudson
3.11
---
f
---
f
3.11
Planned Parenthood of Greater Washington and North Idaho
2.41
0.51
0.00
2.92
Planned Parenthood South Atlantic
2.32
0.15
0.23
2.70
Planned Parenthood Mar Monte
2.59
0.00
0.00
2.59
Planned Parenthood Southeastern Pennsylvania
1.73
0.54
0.27
2.54
Planned Parenthood Association of Utah
2.31
0.10
0.06
2.47
Virginia League for Planned Parenthood
0.00
0.97
1.45
2.42
Planned Parenthood Keystone
1.42
0.54
0.23
2.19
Planned Parenthood Arizona, Inc.
2.00
0.10
0.05
2.15
Planned Parenthood of South, East and North Florida
g
0.78
0.60
0.77
2.15
Planned Parenthood of Central and Western New York, Inc.
0.00
0.00
2.05
2.05
Planned Parenthood League of Massachusetts
0.88
0.05
1.08
2.02
Planned Parenthood Hudson Peconic, Inc.
0.77
0.65
0.44
1.86
Planned Parenthood of the Pacific Southwest
0.74
0.50
0.54
1.78
22
The data include amounts of federal funds received directly from the federal government through grants or
cooperative agreements and amounts passed through from other non-federal organizations such as a state agency.
The data may also include some state funding. All funds were previously obligated, including those received directly
from federal agencies as well as those that were passed through from non-federal agencies. Federal funding
obligated to an organization in any 1 year may be received by the organization in a different year or across multiple
years. As a result, the amount of federal funding obligated, versus received or expended, may differ within the same
time period. Additionally, obligations and funds received should not be added together.
Page 36 GAO-24-106215 Health Care Funding
Planned Parenthood of the Rocky Mountains, Inc.
0.74
0.66
0.17
1.58
Planned Parenthood of the Southern Finger Lakes
1.58
---
f
---
f
1.58
Planned Parenthood of Metropolitan New Jersey
1.11
0.14
0.20
1.45
Planned Parenthood Columbia Willamette
0.88
0.34
0.21
1.44
Planned Parenthood Pasadena and San Gabriel Valley, Inc.
0.48
0.00
0.85
1.33
Planned Parenthood Los Angeles
1.12
0.09
0.08
1.30
Planned Parenthood Southwest Ohio Region
0.88
0.04
0.21
1.13
Planned Parenthood of Montana, Inc.
0.92
0.00
0.00
0.92
Planned Parenthood California Central Coast
0.63
0.00
0.29
0.92
Planned Parenthood of the Heartland
0.81
---
f
---
f
0.81
Planned Parenthood of the Mid-Hudson Valley, Inc.
0.76
---
f
---
f
0.76
Planned Parenthood of Western Pennsylvania
0.29
0.32
0.14
0.75
Planned Parenthood of the St. Louis Region and Southwest
Missouri
0.48
0.13
0.00
0.61
Mt. Baker Planned Parenthood
0.54
0.01
0.00
0.54
Planned Parenthood of Metropolitan Washington, D.C., Inc.
0.13
0.00
0.29
0.42
Planned Parenthood of Nassau County, Inc.
0.34
---
f
---
f
0.34
Planned Parenthood of Delaware
0.30
0.00
0.00
0.30
Planned Parenthood of Greater Texas, Inc.
0.19
0.08
0.00
0.27
Planned Parenthood of the North Country New York, Inc.
0.00
0.00
0.16
0.16
Planned Parenthood Gulf Coast, Inc.
h
0.00
0.00
0.06
0.06
Planned Parenthood of Southwestern Oregon
0.03
0.00
0.00
0.03
Planned Parenthood of Southwest and Central Florida
0.00
0.00
0.00
0.00
Planned Parenthood Southeast, Inc.
0.00
0.00
0.00
0.00
Upper Hudson Planned Parenthood, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Tennessee and North Mississippi
0.00
0.00
0.00
0.00
Planned Parenthood South Texas
0.00
0.00
0.00
0.00
Total
84.90
27.45
35.80
148.15
Source: GAO analysis of Planned Parenthood Federation of America data. | GAO-24-106215
Notes: Amounts include funds from both the Department of Health and Human Services and other departments. The data include
amounts of federal funds received directly from the federal government through grants or cooperative agreements and amounts
passed through from other non-federal organizations such as a state agency. The data may also include some state funding.
Planned Parenthood Federation of America data are based on affiliates’ fiscal years ending in 2019, 2020, and 2021 which,
according to Planned Parenthood Federation of America officials, begin and end on several different dates. Amounts in this table
may not sum to totals due to rounding.
a
According to Planned Parenthood Federation of America officials, Planned Parenthood of New York City, Inc. became Planned
Parenthood of Greater New York in January 2020 after merging with several other affiliates, and as a result reported on 6 months of
data for the organization’s fiscal year 2020.
b
According to Planned Parenthood Federation of America officials, Planned Parenthood of Michigan changed their fiscal year end
date to June 30
th
, and as a result reported on 9 months of data for the organization’s fiscal year 2021.
c
According to Planned Parenthood Federation of America officials, Planned Parenthood of Southern New England, Inc. changed
their fiscal year end date to June 30
th
, and as a result reported on 15 months of data for the organization’s fiscal year 2020.
d
According to Planned Parenthood Federation of America officials, Planned Parenthood Great Northwest, Hawai‘i, Alaska, Indiana,
Kentucky did not submit their fiscal year 2021 revenue data as of May 31, 2023.
Page 37 GAO-24-106215 Health Care Funding
e
According to Planned Parenthood Federation of America officials, Planned Parenthood of Northern New England changed their
fiscal year end date to June 30
th
, and as a result reported on 6 months of data for the organization’s fiscal year 2020.
f
According to Planned Parenthood Federation of America officials, due to mergers or restructuring that took place between 2019 and
2021, Planned Parenthood Mohawk Hudson, Planned Parenthood of the Mid-Hudson Valley, Inc., Planned Parenthood of Nassau
County, Inc., Planned Parenthood of the Heartland, and Planned Parenthood of the Southern Finger Lakes no longer operated
independently and therefore did not submit independent data in 2020 and 2021.
g
According to Planned Parenthood Federation of America officials, Planned Parenthood of South, East and North Florida changed
their fiscal year end date to June 30
th
, and as a result reported on 9 months of data for the organization’s fiscal year 2020.
h
According to Planned Parenthood Federation of America officials, Planned Parenthood Gulf Coast, Inc. changed their fiscal year
end date to June 30
th
, and as a result reported on 10 months of data for the organization’s fiscal year 2020.
Public health coverage program payments received. Our analysis also found that Planned
Parenthood affiliates received approximately $1.5 billion in federal payments from Medicare,
Medicaid, and the Children’s Health Insurance Program (CHIP) from 2019 through 2021.
23
(See
table 16.)
Table 16: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) Payments Received by
Planned Parenthood Federation of America Affiliates
, 2019-2021
Dollars in millions
Program and organization
2019
2020
2021
Total
Medicare
Planned Parenthood Mar Monte
0.28
0.32
0.36
0.96
Planned Parenthood North Central States
0.11
0.14
0.15
0.40
Planned Parenthood of Central and Western New
York, Inc.
0.12
0.08
0.11
0.31
Planned Parenthood of Greater New York
a
0.16
0.05
0.04
0.25
Planned Parenthood of Southern New England,
Inc.
b
0.08
0.08
0.06
0.21
Planned Parenthood of Northern California
0.18
0.00
0.00
0.18
Planned Parenthood of Greater Ohio
0.05
0.06
0.05
0.16
Planned Parenthood of Northern New England
c
0.04
0.02
0.08
0.14
Upper Hudson Planned Parenthood, Inc.
0.04
0.04
0.02
0.10
Planned Parenthood of the North Country New
York, Inc.
0.04
0.02
0.04
0.09
Planned Parenthood Great Northwest, Hawai’i,
Alaska, Indiana, Kentucky
0.03
0.05
---
d
0.08
Planned Parenthood of the Southern Finger Lakes
0.07
---
e
---
e
0.07
Planned Parenthood of the St. Louis Region and
Southwest Missouri
0.02
0.01
0.03
0.06
Planned Parenthood Mohawk Hudson
0.05
0.00
0.00
0.05
Planned Parenthood of the Mid-Hudson Valley, Inc.
0.05
0.00
0.00
0.05
Planned Parenthood Great Plains
0.03
0.01
0.00
f
0.04
Planned Parenthood California Central Coast
0.00
0.00
f
0.04
0.03
23
Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with
disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care
program for certain low-income and medically needy individuals. CHIP is a joint federal-state financed program to
provide health care to certain uninsured, low-income children.
Page 38 GAO-24-106215 Health Care Funding
Mt. Baker Planned Parenthood
0.01
0.01
0.01
0.03
Planned Parenthood of the Heartland
0.02
---
e
---
e
0.02
Planned Parenthood of Western Pennsylvania
0.01
0.00
0.00
0.01
Virginia League for Planned Parenthood
0.00
0.00
0.01
0.01
Planned Parenthood of Montana, Inc.
0.01
0.00
0.00
0.01
Planned Parenthood of Delaware
0.00
0.00
0.00
0.00
Planned Parenthood of Maryland, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Arizona, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Association of Utah
0.00
0.00
0.00
0.00
Planned Parenthood Columbia Willamette
0.00
0.00
0.00
0.00
Planned Parenthood Gulf Coast, Inc.
g
0.00
0.00
0.00
0.00
Planned Parenthood Hudson Peconic, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Keystone
0.00
0.00
0.00
0.00
Planned Parenthood League of Massachusetts
0.00
0.00
0.00
0.00
Planned Parenthood Los Angeles
0.00
0.00
0.00
0.00
Planned Parenthood of Greater Texas, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Greater Washington and
North Idaho
0.00
0.00
0.00
0.00
Planned Parenthood of Illinois
0.00
0.00
0.00
0.00
Planned Parenthood of Metropolitan New Jersey
0.00
0.00
0.00
0.00
Planned Parenthood of Metropolitan Washington,
D.C., Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Michigan
h
0.00
0.00
0.00
0.00
Planned Parenthood of Nassau County, Inc.
0.00
---
e
---
e
0.00
Planned Parenthood of Northern, Central and
Southern New Jersey, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Orange & San Bernardino
Counties, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of South, East and North
Florida
i
0.00
0.00
0.00
0.00
Planned Parenthood of Southwest and Central
Florida
0.00
0.00
0.00
0.00
Planned Parenthood of Southwestern Oregon
0.00
0.00
0.00
0.00
Planned Parenthood of Tennessee and North
Mississippi
0.00
0.00
0.00
0.00
Planned Parenthood of the Pacific Southwest
0.00
0.00
0.00
0.00
Planned Parenthood of the Rocky Mountains, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Wisconsin, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Pasadena and San Gabriel
Valley, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood South Atlantic
0.00
0.00
0.00
0.00
Planned Parenthood South Texas
0.00
0.00
0.00
0.00
Planned Parenthood Southeast, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Southeastern Pennsylvania
0.00
0.00
0.00
0.00
Planned Parenthood Southwest Ohio Region
0.00
0.00
0.00
0.00
Total Medicare
1.40
0.88
1.00
3.28
Page 39 GAO-24-106215 Health Care Funding
Medicaid
Planned Parenthood Mar Monte
71.19
90.57
82.35
244.11
Planned Parenthood of the Pacific Southwest
59.53
81.39
76.65
217.57
Planned Parenthood of Orange & San Bernardino
Counties, Inc.
56.84
73.32
74.53
204.69
Planned Parenthood Los Angeles
50.47
69.14
75.78
195.39
Planned Parenthood of Northern California
33.60
38.82
33.91
106.33
Planned Parenthood of Greater New York
19.13
10.14
20.81
50.08
Planned Parenthood Pasadena and San Gabriel
Valley, Inc.
14.66
16.53
15.89
47.08
Planned Parenthood of Wisconsin, Inc.
12.24
13.54
19.36
45.14
Planned Parenthood North Central States
13.09
12.24
13.65
38.99
Planned Parenthood of Southern New England,
Inc.
b
11.69
14.33
12.28
38.29
Planned Parenthood California Central Coast
11.46
14.61
12.20
38.27
Planned Parenthood of the Rocky Mountains, Inc.
9.62
8.71
9.40
27.73
Planned Parenthood Columbia Willamette
9.35
8.25
8.41
26.00
Planned Parenthood Hudson Peconic, Inc.
8.75
8.78
6.06
23.60
Planned Parenthood Great Northwest, Hawai’i,
Alaska, Indiana, Kentucky
11.49
10.14
---
d
21.63
Planned Parenthood of Illinois
5.22
6.24
9.94
21.40
Planned Parenthood of Greater Washington and
North Idaho
5.72
5.89
7.11
18.73
Planned Parenthood of Northern, Central and
Southern New Jersey, Inc.
6.10
5.28
5.63
17.01
Planned Parenthood of Central and Western New
York, Inc.
5.35
3.84
5.86
15.05
Planned Parenthood of Greater Ohio
4.43
4.16
4.68
13.27
Planned Parenthood League of Massachusetts
4.46
4.18
4.46
13.09
Planned Parenthood of Southwestern Oregon
5.23
3.78
2.42
11.43
Planned Parenthood of Maryland, Inc.
3.64
3.30
3.51
10.45
Planned Parenthood of Northern New England
c
3.64
1.47
3.03
8.14
Planned Parenthood Southeastern Pennsylvania
3.41
2.25
1.65
7.31
Upper Hudson Planned Parenthood, Inc.
2.33
2.04
2.36
6.73
Planned Parenthood Gulf Coast, Inc.
g
3.07
1.71
1.54
6.32
Planned Parenthood Mohawk Hudson
5.24
---
e
---
e
5.24
Planned Parenthood of Metropolitan New Jersey
1.92
1.54
1.42
4.88
Planned Parenthood of Michigan
h
2.14
1.21
0.95
4.29
Planned Parenthood of the North Country New
York, Inc.
1.05
1.04
1.83
3.92
Planned Parenthood Southwest Ohio Region
1.54
1.14
1.21
3.89
Planned Parenthood Keystone
1.71
0.95
1.20
3.86
Planned Parenthood of the St. Louis Region and
Southwest Missouri
0.51
1.32
1.77
3.60
Planned Parenthood of Southwest and Central
Florida
0.93
0.99
1.34
3.26
Planned Parenthood South Atlantic
0.99
1.34
0.69
3.02
Page 40 GAO-24-106215 Health Care Funding
Planned Parenthood of Nassau County, Inc.
2.70
---
e
---
e
2.70
Mt. Baker Planned Parenthood
0.88
0.81
0.89
2.59
Planned Parenthood of Metropolitan Washington,
D.C., Inc.
0.64
0.70
0.96
2.30
Planned Parenthood Great Plains
0.91
0.54
0.61
2.06
Virginia League for Planned Parenthood
0.00
0.84
1.14
1.98
Planned Parenthood of Western Pennsylvania
0.74
0.57
0.64
1.95
Planned Parenthood of Montana, Inc.
1.78
0.00
0.00
1.78
Planned Parenthood of the Southern Finger Lakes
1.78
---
e
---
e
1.78
Planned Parenthood Arizona, Inc.
0.46
1.14
0.00
1.60
Planned Parenthood of Greater Texas, Inc.
0.74
0.72
0.03
1.49
Planned Parenthood of the Mid-Hudson Valley, Inc.
1.35
---
e
---
e
1.35
Planned Parenthood of Delaware
0.40
0.41
0.39
1.20
Planned Parenthood South Texas
0.50
0.63
0.05
1.19
Planned Parenthood of South, East and North
Florida
i
0.20
0.19
0.39
0.79
Planned Parenthood of the Heartland
0.46
---
e
---
e
0.46
Planned Parenthood Association of Utah
0.10
0.07
0.06
0.23
Planned Parenthood Southeast, Inc.
0.00
0.01
0.01
0.02
Planned Parenthood of Tennessee and North
Mississippi
0.00
0.00
0.00
0.00
Total Medicaid
475.40
530.82
529.05
1,535.27
CHIP
Planned Parenthood of the Southern Finger Lakes
0.03
---
e
---
e
0.03
Planned Parenthood of Western Pennsylvania
0.01
0.01
0.01
0.02
Mt. Baker Planned Parenthood
0.00
0.00
0.00
0.00
Planned Parenthood Arizona, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Association of Utah
0.00
0.00
0.00
0.00
Planned Parenthood California Central Coast
0.00
0.00
0.00
0.00
Planned Parenthood Columbia Willamette
0.00
0.00
0.00
0.00
Planned Parenthood Great Northwest, Hawai’i,
Alaska, Indiana, Kentucky
0.00
0.00
---
d
0.00
Planned Parenthood Great Plains
0.00
0.00
0.00
0.00
Planned Parenthood Gulf Coast, Inc.
g
0.00
0.00
0.00
0.00
Planned Parenthood Hudson Peconic, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Keystone
0.00
0.00
0.00
0.00
Planned Parenthood League of Massachusetts
0.00
0.00
0.00
0.00
Planned Parenthood Los Angeles
0.00
0.00
0.00
0.00
Planned Parenthood Mar Monte
0.00
0.00
0.00
0.00
Planned Parenthood Mohawk Hudson
0.00
---
e
---
e
0.00
Planned Parenthood North Central States
0.00
0.00
0.00
0.00
Planned Parenthood Northern California
0.00
0.00
0.00
0.00
Planned Parenthood of Central and Western New
York, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Delaware
0.00
0.00
0.00
0.00
Page 41 GAO-24-106215 Health Care Funding
Planned Parenthood of Greater New York
0.00
0.00
0.00
0.00
Planned Parenthood of Greater Ohio
0.00
0.00
0.00
0.00
Planned Parenthood of Greater Texas, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Greater Washington and
North Idaho
0.00
0.00
0.00
0.00
Planned Parenthood of Illinois
0.00
0.00
0.00
0.00
Planned Parenthood of Maryland, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Metropolitan New Jersey
0.00
0.00
0.00
0.00
Planned Parenthood of Metropolitan Washington,
D.C., Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Michigan
h
0.00
0.00
0.00
0.00
Planned Parenthood of Montana, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Nassau County, Inc.
0.00
---
e
---
e
0.00
Planned Parenthood of Northern New England
c
0.00
0.00
0.00
0.00
Planned Parenthood of Northern, Central and
Southern New Jersey, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of Orange & San Bernardino
Counties, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of South, East and North
Florida
i
0.00
0.00
0.00
0.00
Planned Parenthood of Southern New England,
Inc.
b
0.00
0.00
0.00
0.00
Planned Parenthood of Southwest and Central
Florida
0.00
0.00
0.00
0.00
Planned Parenthood of Southwestern Oregon
0.00
0.00
0.00
0.00
Planned Parenthood of Tennessee and North
Mississippi
0.00
0.00
0.00
0.00
Planned Parenthood of the Heartland
0.00
---
e
---
e
0.00
Planned Parenthood of the Mid-Hudson Valley, Inc.
0.00
---
e
---
e
0.00
Planned Parenthood of the North Country New
York, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of the Pacific Southwest
0.00
0.00
0.00
0.00
Planned Parenthood of the Rocky Mountains, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood of the St. Louis Region and
Southwest Missouri
0.00
0.00
0.00
0.00
Planned Parenthood of Wisconsin, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Pasadena and San Gabriel
Valley, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood South Atlantic
0.00
0.00
0.00
0.00
Planned Parenthood South Texas
0.00
0.00
0.00
0.00
Planned Parenthood Southeast, Inc.
0.00
0.00
0.00
0.00
Planned Parenthood Southeastern Pennsylvania
0.00
0.00
0.00
0.00
Planned Parenthood Southwest Ohio Region
0.00
0.00
0.00
0.00
Upper Hudson Planned Parenthood, Inc.
0.00
0.00
0.00
0.00
Virginia League for Planned Parenthood
0.00
0.00
0.00
0.00
Total CHIP
0.04
0.01
0.01
0.05
Total Medicare, Medicaid and CHIP
476.84
531.71
530.06
1,538.60
Page 42 GAO-24-106215 Health Care Funding
Source: GAO analysis of Planned Parenthood Federation of America data. | GAO-24-106215
Notes: Medicare payments include only federal funds. Medicaid and CHIP payments include funding from both state and federal
sources; thus, the Medicaid and CHIP payment data overstate the amount of funding received from the federal government. The
actual amounts of Medicaid and CHIP payments from the federal government to Planned Parenthood affiliates are lower than
amounts presented in the table, and would be limited to a matching percentage, which differs across states and types of services
provided. Both Medicare and Medicaid payments to Planned Parenthood affiliates include payments made through these programs
by managed care organizations.
Planned Parenthood Federation of America data are based on affiliates’ fiscal years ending in 2019, 2020, and 2021 which,
according to Planned Parenthood Federation of America officials, begin and end on several different dates. Amounts in this table
may not sum to totals due to rounding.
a
According to Planned Parenthood Federation of America officials, Planned Parenthood of New York City, Inc. became Planned
Parenthood of Greater New York in January 2020 after merging with several other affiliates, and as a result reported on 6 months of
data for the organization’s fiscal year 2020.
b
According to Planned Parenthood Federation of America officials, Planned Parenthood of Southern New England, Inc. changed
their fiscal year end date to June 30
th
, and as a result reported on 15 months of data for the organization’s fiscal year 2020.
c
According to Planned Parenthood Federation of America officials, Planned Parenthood of Northern New England changed their
fiscal year end date to June 30
th
, and as a result reported on 6 months of data for the organization’s fiscal year 2020.
d
According to Planned Parenthood Federation of America officials, Planned Parenthood Great Northwest, Hawai‘i, Alaska, Indiana,
Kentucky did not submit their fiscal year 2021 revenue data as of May 31, 2023.
e
According to Planned Parenthood Federation of America officials, due to mergers and restructuring that took place between 2019
and 2021, Planned Parenthood Mohawk Hudson, Planned Parenthood of the Mid-Hudson Valley, Inc., Planned Parenthood of
Nassau County, Inc., Planned Parenthood of the Heartland, and Planned Parenthood of the Southern Finger Lakes no longer
operated independently and therefore did not submit independent data in 2020 and 2021.
f
The affiliates each reported negative Medicare payment revenue of less than $5,000. Planned Parenthood Federation of America
officials did not have information about why the affiliates reported negative revenue amounts.
g
According to Planned Parenthood Federation of America officials, Planned Parenthood Gulf Coast, Inc. changed their fiscal year
end date to June 30
th
, and as a result reported on 10 months of data for the organization’s fiscal year 2020.
h
According to Planned Parenthood Federation of America officials, Planned Parenthood of Michigan changed their fiscal year end
date to June 30
th
, and as a result reported on 9 months of data for the organization’s fiscal year 2021.
i
According to Planned Parenthood Federation of America officials, Planned Parenthood of South, East and North Florida changed
their fiscal year end date to June 30
th
, and as a result reported on 9 months of data for the organization’s fiscal year 2020.
Medicaid and CHIP payments to Planned Parenthood affiliates are funded with both state and
federal funds, and the state share of this approximately $1.5 billion could be sizeable. With
certain exceptions, the federal government matches a portion of each state’s Medicaid and
CHIP expenditures, and the matching rates can vary depending on a variety of factors, such as
the services provided or the populations served.
24
Additionally, states may choose to use state-
only funds to cover certain services that may be available in that state to Medicaid-enrolled or
CHIP-enrolled individuals.
Federal matching funds are paid directly to the state Medicaid agencies, not to providers,
making it difficult for providers to know what portion of each payment comes from federal versus
state funding. According to Planned Parenthood Federation of America officials, the Medicaid
24
The federal government matches most state expenditures for Medicaid services based on a calculated percentage
depending on each state’s per capita income relative to the national average. For fiscal year 2023, states’ calculated
percentages—also referred to as matching rates—ranged from 50 percent to about 78 percent. Federal matching
rates for CHIP are typically higher than Medicaid matching rates and federal funding for CHIP is capped. Federal
matching funds generally are not available for abortions except in circumstances expressly permitted by law.
Page 43 GAO-24-106215 Health Care Funding
and CHIP payments to affiliates do not indicate what portion of each payment is matched by
federal dollars. Further, some Medicaid payments are made by managed care organizations
that contract with state Medicaid agencies to pay for a set plan of services in exchange for a per
capita fee. According to Planned Parenthood Federation of America officials, it would be
impossible to determine the federal share for services paid under managed care.
Federally guaranteed loans received. Our analysis of Small Business Administration data
found that between April 3, 2020, and May 31, 2021, 38 Planned Parenthood affiliates received
44 Paycheck Protection Program loans ranging in amounts from approximately $500,000 to $10
million.
25
In total, Planned Parenthood affiliates received approximately $89 million in loans, of
which the entire amount—including interest—had been forgiven as of May 1, 2023. (See table
17.)
Table 17: Paycheck Protection Program Loan Amounts Received by and Forgiven for Planned Parenthood
Federation of America Affiliates, as of May 1, 2023
Dollars in millions
Organization
Loans received
Loans forgiven
Planned Parenthood of Greater New York
10.00
10.07
Planned Parenthood Gulf Coast, Inc.
a
4.72
4.78
Planned Parenthood Columbia Willamette
a
4.64
4.69
Planned Parenthood of the Rocky Mountains, Inc.
4.42
4.49
Planned Parenthood of Illinois
3.85
3.91
Planned Parenthood of Southern New England, Inc.
3.55
3.60
Planned Parenthood of Maryland, Inc.
a
3.32
3.36
Planned Parenthood of Greater Ohio
2.90
2.94
Planned Parenthood of Northern, Central, and Southern
New Jersey, Inc.
2.85
2.89
Planned Parenthood of Northern New England
2.72
2.75
Planned Parenthood of Wisconsin, Inc.
2.65
2.69
Planned Parenthood of Metropolitan Washington, D.C.,
Inc.
a
2.64
2.66
Planned Parenthood of Central and Western New York,
Inc.
2.63
2.67
Planned Parenthood of Montana, Inc.
a
2.53
2.57
Planned Parenthood South Atlantic
2.44
2.47
Planned Parenthood of Michigan
2.36
2.40
Planned Parenthood League of Massachusetts
2.30
2.33
Planned Parenthood of Southwestern Oregon
a
2.13
2.15
Planned Parenthood of Southwest and Central Florida
2.08
2.11
Planned Parenthood of South, East and North Florida
1.94
1.98
25
Some affiliates received two separate loans through the Paycheck Protection Program, as federal law allowed
certain businesses that had already received a Paycheck Protection Program loan to receive a second loan, known
as a “second draw” loan. See 15 U.S.C. § 636(a)(37). In 2022, the SBA Office of Inspector General considered
whether three large nonprofits that received loans under the program, including Planned Parenthood of Illinois, were
eligible for loans in light of their size. To carry out this review, the OIG reviewed the nonprofits’ affiliation with their
national organizations according to SBA standards and determined that the Planned Parenthood organization met the
program eligibility criteria. See SBA Office of Inspector General, Paycheck Protection Program Eligibility for Nonprofit
Organizations, Report 22-21 (Washington, D.C.: Sept. 26, 2022).
Page 44 GAO-24-106215 Health Care Funding
Planned Parenthood Pasadena and San Gabriel Valley,
Inc.
1.93
1.95
Planned Parenthood Southeastern Pennsylvania
1.92
1.94
Planned Parenthood of Greater Texas, Inc.
1.90
1.92
Planned Parenthood California Central Coast
1.77
1.80
Planned Parenthood of Greater Washington and North
Idaho
1.70
1.73
Planned Parenthood Hudson Peconic, Inc.
1.67
1.69
Planned Parenthood of the St. Louis Region and
Southwest Missouri
1.61
1.64
Planned Parenthood Great Plains
1.44
1.46
Planned Parenthood Arizona, Inc.
1.33
1.35
Planned Parenthood Southwest Ohio Region
1.03
1.04
Virginia League for Planned Parenthood
0.97
0.98
Planned Parenthood of Metropolitan New Jersey
0.90
0.91
Planned Parenthood Keystone
0.85
0.86
Planned Parenthood South Texas
0.84
0.85
Upper Hudson Planned Parenthood, Inc.
0.83
0.84
Planned Parenthood of Western Pennsylvania
0.74
0.72
Planned Parenthood of the North Country New York,
Inc.
0.69
0.70
Planned Parenthood of Delaware
0.50
0.51
Total
89.30
90.41
Source: GAO analysis of Small Business Administration Paycheck Protection Program data. | GAO-24-106215
Notes: Total amount of loans forgiven does not equal the total amount of loans received. For example, forgiveness totals include
forgiven accrued interest, while the loans received represent only the principal amount of the loans. Some affiliates received two
separate loans through the Paycheck Protection Program, as federal law authorized SBA to guarantee an additional loan (a “second
draw loan”) to certain businesses that previously received a Paycheck Protection Program loan and would have used the full
amount of their initial loan for authorized purposes on or before disbursement of the second draw loan. See 15 U.S.C. § 636(a)(37).
Amounts in this table may not sum to totals due to rounding.
a
Affiliate received two loans.
Planned Parenthood affiliates’ expenditures of federal funding, 2019 through 2021. Our
analysis of 58 audited financial reports for 35 Planned Parenthood affiliates found that they
reported expending approximately $126 million in federal funding from 2019 through 2021. (See
table 18.) This amount included funds received directly from federal agencies and funds passed
through to the affiliates by non-federal entities.
Table 18 Federal Funds Expended by Planned Parenthood Federation of America Affiliates, 2019-2021
Dollars in millions
Organization
a
2019
2020
2021
Total
Planned Parenthood of Orange & San
Bernardino Counties, Inc.
3.73
3.61
3.42
10.76
Planned Parenthood of Michigan
5.63
1.87
1.44
8.94
Planned Parenthood of Northern, Central and
Southern New Jersey, Inc.
5.02
1.92
1.91
8.84
Planned Parenthood of Central and Western
New York, Inc.
1.72
2.82
3.71
8.25
Page 45 GAO-24-106215 Health Care Funding
Planned Parenthood of the Great Northwest and
Hawaiian Islands
a
5.88
2.22
--
8.11
Planned Parenthood North Central States
4.51
1.84
1.60
7.94
Planned Parenthood of Southern New England,
Inc.
3.98
2.26
1.58
7.82
Planned Parenthood of Greater New York
--
1.68
5.33
7.01
Planned Parenthood of Greater Ohio
4.99
--
0.89
5.88
Planned Parenthood of Illinois
4.39
--
--
4.39
Planned Parenthood Northern California
1.93
1.08
1.03
4.03
Virginia League for Planned Parenthood
0.98
1.00
1.45
3.43
Planned Parenthood Great Plains
1.53
0.96
0.92
3.41
Planned Parenthood of Northern New England
1.74
--
1.28
3.03
Planned Parenthood of New York City, Inc.
b
2.68
--
--
2.68
Planned Parenthood Mar Monte
2.41
--
--
2.41
Planned Parenthood of Greater Washington and
North Idaho
2.41
--
--
2.41
Planned Parenthood of Maryland, Inc.
--
--
2.36
2.36
Planned Parenthood South Atlantic
2.32
--
--
2.32
Planned Parenthood Association of Utah
2.24
--
--
2.24
Planned Parenthood of the Heartland
c
2.07
--
--
2.07
Planned Parenthood Arizona, Inc.
2.00
--
--
2.00
Planned Parenthood of Wisconsin, Inc.
1.78
--
--
1.78
Planned Parenthood Southeastern Pennsylvania
1.73
--
--
1.73
Planned Parenthood of South, East and North
Florida
0.82
--
0.77
1.59
Planned Parenthood Keystone
1.42
--
--
1.42
Planned Parenthood of Indiana and Kentucky,
Inc.
d
1.24
--
--
1.24
Planned Parenthood of Metropolitan New Jersey
1.21
--
--
1.21
Planned Parenthood Los Angeles
1.12
--
--
1.12
Planned Parenthood of Columbia Willamette
0.93
--
--
0.93
Planned Parenthood of Montana, Inc.
0.92
--
--
0.92
Planned Parenthood League of Massachusetts
0.88
--
--
0.88
Planned Parenthood Mohawk Hudson
0.87
--
--
0.87
Planned Parenthood Southwest Ohio Region
0.84
--
--
0.84
Planned Parenthood Hudson Peconic, Inc.
0.77
--
--
0.77
Total
76.71
21.25
27.70
125.67
Legend: -- = No single audit report was submitted to the Federal Audit Clearinghouse.
Source: GAO analysis of audited financial reports of 35 Planned Parenthood affiliates. | GAO-24-106215
Notes: This table reflects expenditures reported in single audit reports to the Federal Audit Clearinghouse for the 35 Planned
Parenthood affiliates that met the reporting threshold of $750,000 or more in expenditures of federal funding in at least one of the
fiscal years reviewed. It includes direct and pass-through funding.
Direct funding refers to federal funds made available through an
award received directly from a federal agency. Pass-through funding refers to federal funds made available through a sub-award
from a non-federal entity.
Unless the affiliate’s fiscal year end changed during a given year, such as due to a merger, the data are
based on a 12-month fiscal year, which varies by affiliate.
Amounts in this table may not sum to totals due to rounding.
Page 46 GAO-24-106215 Health Care Funding
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is the result of
rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed. See, e.g., Further
Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat. 2534, 2606, 2607 (2019).
Affiliate names in this table align with other tables in this report and were confirmed with Planned Parenthood Federation of America
officials. However, names may appear differently than they did at the time of the single audit report filing. Several Planned
Parenthood affiliate names have changed due to mergers that occurred after the single audits were submitted.
a
Planned Parenthood of the Great Northwest and Hawaiian Islands has since merged with Planned Parenthood of Indiana and
Kentucky, Inc.
b
Planned Parenthood of New York City, Inc. has since merged with several other affiliates to become Planned Parenthood of
Greater New York in January 2020 (Planned Parenthood of the Southern Finger Lakes, Planned Parenthood of Nassau County,
Inc., Planned Parenthood of the Mid-Hudson Valley, Inc., and Planned Parenthood Mohawk Hudson).
c
Planned Parenthood of the Heartland is now a (c)(3) ancillary organization under Planned Parenthood North Central States starting
January 1, 2019.
d
Planned Parenthood of Indiana and Kentucky, Inc. is now a (c)(3) ancillary organization under Planned Parenthood Great
Northwest, Hawai’i, Alaska, Indiana, Kentucky.
Planned Parenthood affiliates’ expenditures of federal funding by direct and pass-
through funding, 2019 through 2021. Our analysis of 58 audited financial reports for Planned
Parenthood affiliates found that about $95 million of the approximately $126 million
(approximately 75 percent) expended in federal funding for federal grant and cooperative
agreements was passed through to affiliates, while about $31 million (approximately 25 percent)
was funded directly to them from 2019 through 2021. (See table 19.)
Table 19: Direct and Pass-through Federal Funding Expended by Planned Parenthood Federation of
America Affiliates, 2019-2021
Dollars in millions
Type of funding
2019
2020
2021
Total
Percent of
total
funding
Direct
24.30
3.42
3.40
31.13
24.77
Pass-through
52.41
17.83
24.30
94.54
75.23
Total
76.71
21.25
27.71
125.67
100.00
Source: GAO analysis of audited financial reports of 35 Planned Parenthood affiliates. | GAO-24-106215
Notes: This table reflects expenditures reported in single audit reports to the Federal Audit Clearinghouse for the 35 Planned
Parenthood affiliates that met the reporting threshold of $750,000 or more in expenditures of federal funding in at least one of the
fiscal years reviewed. Direct funding refers to federal funds made available through an award received directly from a federal
agency. Pass-through funding refers to federal funds made available through a sub-award from a non-federal entity. Unless the
affiliate’s fiscal year end changed during a given year, such as due to a merger, the data are based on a 12-month fiscal year, which
varies by affiliate Amounts in this table may not sum to totals due to rounding.
Top 15 HHS program funds expended by Planned Parenthood affiliates: Our analysis of
Planned Parenthood affiliates’ audited financial reports found that of the approximately $126
million expended from 2019 through 2021, about $109 million (about 87 percent) were
expenditures of HHS funds. Nearly all of these funds—about $108 million—were associated
with 15 HHS programs.
26
(See table 20.) The largest reported amount was for Family Planning
26
These 15 programs fund a range of services, including family planning, reproductive health education, and
preventive health screenings.
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
Page 47 GAO-24-106215 Health Care Funding
Services, for which Planned Parenthood affiliates expended approximately $54 million from
2019 through 2021.
Table 20: Top 15 Department of Health and Human Services (HHS) Program Funds Expended by Planned
Parenthood Federation of America Affiliates, 2019-2021
Dollars in millions
Program name
a
2019
2020
2021
Total
Percent of
total HHS
funds
Percent of
total federal
funds
Family Planning Services
(Title X Services) (CFDA #:
93.217), Office of Assistant
Secretary for Health
49.16
1.60
3.10
53.86
49.28
42.86
Teenage Pregnancy
Prevention Program (CFDA #:
93.297), Office of Assistant
Secretary for Health
6.35
3.18
2.76
12.28
11.23
9.77
Maternal and Child Health
Services Block Grant to the
States (CFDA #: 93.994),
Health Resources and
Services Administration
3.51
3.63
3.78
10.92
9.99
8.69
Social Services Block Grant
(CFDA #: 93.667),
Administration for Children
and Families
3.18
2.10
2.93
8.21
7.51
6.53
Affordable Care Act (ACA)
Personal Responsibility
Education Program (CFDA #:
93.092), Administration for
Children and Families
3.30
1.81
2.42
7.54
6.89
6.00
Temporary Assistance for
Needy Families (CFDA #:
93.558), Administration for
Children and Families
1.59
1.22
1.69
4.50
4.12
3.58
Medical Assistance Program
(CFDA #: 93.778), Centers for
Medicare & Medicaid
Services
0.79
0.86
1.45
3.09
2.83
2.46
HIV Emergency Relief Project
Grants to Eligible
Metropolitan and Transitional
Areas (CFDA #: 93.914),
Health Resources and
Services Administration
1.13
0.44
0.86
2.43
2.22
1.93
Provider Relief Fund
(CFDA #: 93.498), Health
Resources and Services
Administration
0.00
0.00
1.65
1.65
1.51
1.31
HIV Prevention Activities
Health Department Based
(CFDA #: 93.940), Centers for
Disease Control and
Prevention
0.70
0.27
0.48
1.46
1.33
1.16
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019).
Page 48 GAO-24-106215 Health Care Funding
Child Health and Human
Development Extramural
Research (CFDA #: 93.865),
National Institutes of Health
0.64
0.13
0.04
0.81
0.75
0.65
Birth Defects and
Developmental Disabilities -
Prevention and Surveillance
(CFDA #: 93.073), Centers for
Disease Control and
Prevention
0.00
0.32
0.26
0.58
0.53
0.46
Sexually Transmitted
Diseases (STD) Prevention
and Control Grants (CFDA #:
93.977), Centers for Disease
Control and Prevention
0.09
0.05
0.12
0.27
0.24
0.21
Title V State Sexual Risk
Avoidance Education (Title V
State SRAE) Program (CFDA
#: 93.235), Administration for
Children and Families
0.08
0.08
0.09
0.25
0.23
0.20
Cooperative Agreement to
Support Navigators in
Federally-facilitated
Exchanges (CFDA #: 93.332),
Centers for Medicare &
Medicaid Services
0.25
0.00
0.00
0.25
0.22
0.20
Subtotal (Top 15 HHS
Programs)
70.76
15.71
21.62
108.08
98.89
86.01
All other HHS Programs
0.67
0.13
0.41
1.22
1.11
0.97
Total (All HHS Programs)
71.43
15.84
22.03
109.30
100.00
86.98
Source: GAO analysis of audited financial reports of 35 Planned Parenthood affiliates. | GAO-24-106215
Notes: This table reflects expenditures reported in single audit reports to the Federal Audit Clearinghouse for the 35 Planned
Parenthood affiliates that met the reporting threshold of $750,000 or more in expenditures of federal funding in at least one of the
fiscal years reviewed. Table 20 is a combination of direct and pass-through funding which varies considerably by program.
Specifically, Family Planning Services (Title X), Teenage Pregnancy Prevention Program, and Affordable Care Act (ACA) Personal
Responsibility Education Program include both direct and pass-through funding. The remaining 12 programs consisted solely of
either direct or pass-through funding. Direct funding refers to federal funds made available through an award received directly from a
federal agency. Pass-through funding refers to federal funds made available through a sub-award from a non-federal entity. Unless
the affiliate’s fiscal year end changed during a given year, such as due to a merger, the data are based on a 12-month fiscal year,
which varies by affiliate. Amounts in this table may not sum to totals due to rounding.
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is the result of
rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed. See, e.g., Further
Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat. 2534, 2606, 2607 (2019).
a
This column lists the federal programs as reported in the 2021 Annual Publication of Assistance Listings, their corresponding
Catalogue of Federal Domestic Assistance (CFDA)
number, and the federal office or agency administering the program. These 15
programs fund a range of services, including family planning, reproductive health education, and preventive health screenings.
Top non-HHS program funds expended by Planned Parenthood affiliates Our analysis of
Planned Parenthood affiliates’ audited financial reports found that about $16 million of the
approximately $126 million in expenditures were of funds from 10 non-HHS programs.
27
The
largest non-HHS expenditure reported was of funds from the Department of Agriculture’s
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, for
27
These 10 programs fund a range of services including nutrition programs, sexual assault services, and legal aid for
sexual assault victims.
Page 49 GAO-24-106215 Health Care Funding
which Planned Parenthood affiliates expended approximately $9.5 million from 2019 through
2021. (See table 21.)
Table 21: Top Non-Department of Health and Human Services (HHS) Agency Program Funds Expended by
Planned Parenthood Federation of America Affiliates, 2019-2021
Dollars in millions
Federal agency and program
name
a
2019
2020
2021
Total
Percent of
total non-
HHS
funds
Percent of
total federal
funds
Department of Agriculture
(USDA) Special Supplemental
Nutrition Program for Women,
Infants, and Children—WIC
(CFDA #: 10.557)
3.22
3.21
3.02
9.46
57.80
7.53
Department of Justice Crime
Victim Assistance (CFDA #:
16.575)
1.13
1.61
1.89
4.64
28.36
3.69
Department of Housing and
Urban Development Housing
Opportunities for Persons with
AIDS (CFDA #: 14.241)
0.36
0.37
0.43
1.17
7.15
0.93
Department of Justice Violence
Against Women Formula Grants
(CFDA #: 16.588)
0.12
0.09
0.11
0.31
1.91
0.25
Department of Housing and
Urban Development
Community Development Block
Grants/Entitlement Grants (CFDA
#: 14.218)
0.31
0.00
0.00
0.31
1.89
0.25
Department of Justice Sexual
Assault Services Formula
Program (CFDA #: 16.017)
0.05
0.05
0.05
0.14
0.86
0.11
USDA State Administrative
Matching Grants for the
Supplemental Nutrition Assistance
Program (CFDA #: 10.561)
0.05
0.04
0.05
0.14
0.85
0.11
Department of Justice Grants to
Encourage Arrest Policies and
Enforcement of Protection Orders
Program (CFDA #: 16.590)
0.03
0.02
0.04
0.09
0.52
0.07
Department of Treasury
Coronavirus Relief Fund (CFDA #
21.019)
0.00
0.00
0.05
0.05
0.30
0.04
Department of Homeland
Security Disaster Grants—Public
Assistance (Presidentially
Declared Disasters) (CFDA #
97.036)
0.00
0.00
0.02
0.02
0.15
0.02
Subtotal of Top 10 Non-HHS
Programs
5.27
5.40
5.66
16.33
99.82
13.00
All other non-HHS Programs
0.00
0.02
0.02
0.03
0.21
0.03
Total (All non-HHS Programs)
5.28
5.41
5.67
16.36
100.00
13.02
Source: GAO analysis of audited financial reports of 35 Planned Parenthood affiliates. | GAO-24-106215
Page 50 GAO-24-106215 Health Care Funding
Notes: This table depicts the top 10 non-HHS programs by Planned Parenthood affiliates’ expenditures. This table reflects
expenditures reported in single audit reports to the Federal Audit Clearinghouse for the 35 Planned Parenthood affiliates that met
the reporting threshold of $750,000 or more in expenditures of federal funding in at least one of the fiscal years reviewed. It includes
solely pass-through funding received from any federal agency. Pass-through funding refers to federal funds made available through
a sub-award from a non-federal entity. Unless the affiliate’s fiscal year end changed during a given year, such as due to a merger,
the data are based on a 12-month fiscal year, which varies by affiliate. Amounts in this table may not sum to totals due to rounding.
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is the result of
rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed. See, e.g., Further
Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat. 2534, 2606, 2607 (2019).
a
This column lists the federal programs as reported in the 2021 Annual Publication of Assistance Listings, their corresponding
Catalog of Federal Domestic Assistance (CFDA) number, and the federal office or agency administering the program. These 10
programs fund a range of services including nutrition programs, sexual assault services, and legal aid for sexual assault victims.
Page 51 GAO-24-106215 Health Care Funding
Enclosure IV: Four Domestic Regional Organizations
The organizations in our review included four privately-owned providers of health-related
services within various regions of the United States. The organizations operated in a total of
eight states during the time frame of this study. The services they provide include sexual and
reproductive health-related services. Officials from organizations A and B said they provide
preventative health care services. For example, Organization A said that the organization
provided annual physical exams, and Organization B said patients could get vaccinations.
All four domestic regional organizations received Medicaid and CHIP payments for fiscal years
2019-2021, and Organization A reported receiving some Medicare payments for fiscal years
2020 and 2021.
28
The total amount of Medicaid and CHIP payments received was
approximately $108 million. (See table 22.) Department of Health and Human Services (HHS)
officials reported that the department obligated no funds to the four organizations.
29
Organizations A and B also said that they received no federal awards during the years under
review.
30
Table 22: Medicaid and the Children’s Health Insurance Program (CHIP) Payments Received by Four
Domestic Regional Organizations, 2019-2021
Dollars in millions
Organization
2019
2020
2021
Total
Domestic Regional Organization A
a
1.32
0.85
0.57
2.74
Domestic Regional Organization B
38.92
29.93
31.86
100.71
Domestic Regional Organization C
0.46
0.28
0.31
1.05
Domestic Regional Organization D
1.45
0.90
0.89
3.24
Total
42.15
31.95
33.64
107.74
Source: GAO analysis of state Medicaid agency data. | GAO-24-106215
Note: Data for two of the four domestic regional organizations were obtained from the Medicaid agencies for states in
which the organizations operated during the years under review. Data for Domestic Regional Organization C were
obtained from one of the three states in which it operated. Organization A received Medicaid payments from several
states in which it operated. All data are based off the same fiscal year, July 1-June 30, for states that had Medicaid
claim data for the organizations. Amounts in this table may not sum to totals due to rounding.
a
Organization A reported Medicare payments of $2,311.87 for 2020 and $2,258.05 for 2021. Organization A also operated a
telehealth clinic for which no Medicaid payments were received during the timeframe of our study.
28
Medicare is the federally financed health coverage program for persons aged 65 and over, certain individuals with
disabilities, and individuals with end-stage renal disease. Medicaid is a joint federal-state financed health care
program for certain low-income and medically needy individuals. CHIP is a joint federal-state financed program to
provide health care to certain uninsured, low-income children.
Federal funds for domestic activities are generally not available to pay for abortions, except where the pregnancy is
the result of rape or incest or the life of the pregnant woman would be endangered unless an abortion is performed.
See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. A, tit. V, §§ 506, 507, 133 Stat.
2534, 2606, 2607 (2019).
29
HHS officials searched the Payment Management System based on the names of the organizations and found no
results for the years under our review.
30
Organizations C and D did not respond to our request for interviews.
Page 52 GAO-24-106215 Health Care Funding
Enclosure V: International Planned Parenthood Federation
International Planned Parenthood Federation is an international, nonprofit organization made up
of seven offices, working through approximately 140 autonomous member associations and
partner organizations to provide access to sexual and reproductive health-related services from
approximately 41,000 locations worldwide. Their services include contraception, abortion, and
the treatment and prevention of HIV.
Funding obligated. Our analysis of U.S. Agency for International Development (USAID) data
found that it obligated approximately $630,000 in federal funding through grants or cooperative
agreements to an award to an International Planned Parenthood Federation affiliate from 2019
through 2022. During 2019 and 2020, the agency also de-obligated about $170,000 from an
award to International Planned Parenthood Federation.
31
(See table 23.) All obligated funds
were in the “humanitarian assistance” program area; however, these funds were offset by de-
obligated funds in the “family planning and reproductive health” program area.
32
De-obligations
refer to USAID’s cancellation or downward adjustment of previously incurred obligations.
Officials from the Department of Health and Human Services (HHS) reported that it did not
obligate any funds to International Planned Parenthood Federation during these years.
33
Table 23: U.S. Agency for International Development (USAID) Obligations to International Planned
Parenthood Federation
through Grants or Cooperative Agreements, 2019–2022
Dollars in millions
USAID program area
2019
2020
2021
2022
Total
Family planning and reproductive health
-0.13
a
-0.05
a
0.00
0.00
-0.17
Humanitarian assistance
b
0.63
0.00
0.00
0.00
0.63
Total
0.51 -0.05 0.00
0.00
0.46
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds obligated directly to International Planned Parenthood Federation or affiliates. It does not include
funds that may have been obligated to other organizations and passed through to International Planned Parenthood Federation and
31
International Planned Parenthood Federation declined to accept the terms and conditions of awards from USAID
due to a policy in effect for certain years under our review. Specifically, the organization publicly stated that it would
not be able to meet the conditions of the Protecting Life in Global Health Assistance policy, which required foreign
nongovernmental organizations to agree that, during the term of the award, they would not perform or actively
promote abortion as a method of family planning or provide financial support to any foreign nongovernmental
organization that does. The policy was implemented in May 2017 and rescinded in January 2021. According to
Department of State and USAID officials, nongovernmental organizations that declined to accept the conditions of the
Protecting Life in Global Health Assistance policy were permitted to continue to expend any remaining obligated
funds.
Other limits exist on the use of foreign assistance to provide abortions. Specifically, foreign assistance funds cannot
be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to
practice abortions. See e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. G, tit. III,
“Bilateral Economic Assistance—Global Health Programs,” 133 Stat. 2534, 2827 (2019).
32
USAID de-obligated funds to International Planned Parenthood Federation in fiscal years 2019 and 2020 to close
an award. Humanitarian assistance includes protection and assistance for refugees, stateless persons, and other
victims of conflict and disasters. Funding for humanitarian assistance was not subject to the Protecting Life in Global
Health Assistance policy.
33
HHS officials searched the Payment Management System based on the names of the organization and its affiliates
and unique identifiers when available and found no results for the years under our review.
Page 53 GAO-24-106215 Health Care Funding
affiliates. Data are based on the federal fiscal year, October 1 through September 30. Amounts may not sum to totals due to
rounding.
International Planned Parenthood Federation declined to accept the terms and conditions of awards from USAID
due to a policy in
effect for certain years under our review. Specifically, International Planned Parenthood Federation publicly stated that it would not
be able to meet the conditions of the Protecting Life in Global Health Assistance policy, which required foreign nongovernmental
organizations to agree that, during the term of the award, they would not perform or actively promote abortion as a method of family
planning
or provide financial support to any foreign nongovernmental organization that does. The policy was implemented in May
2017 and rescinded in January 2021. According to Department of State and USAID officials, nongovernmental organizations that
declined to accept the conditions of the Protecting Life in Global Health Assistance policy were permitted to continue to expend any
remaining obligated funds.
a
USAID de-obligated funds to International Planned Parenthood Federation in fiscal years 2019 and 2020 to close an award.
b
Humanitarian assistance includes protection and assistance for refugees, stateless persons, and other victims of conflict and
disasters. Funding for humanitarian assistance was not subject to the Protecting Life in Global Health Assistance policy.
Funds received. Our analysis found that International Planned Parenthood Federation received
approximately $2 million in federal funding from USAID through grants or cooperative
agreements from 2019 through 2021.
34
About $1.3 million of these funds were in the “family
planning and reproductive health” program area. (See table 24.) HHS officials reported that
International Planned Parenthood Federation received no funds from the department from 2019
through 2021.
35
Table 24: U.S. Agency for International Development (USAID) Funds Received by International Planned
Parenthood Federation through G
rants or Cooperative Agreements, 2019–2021
Dollars in millions
USAID program area
2019
2020
2021
Total
Family planning and reproductive health
1.30
0.00
a
0.00
1.30
Humanitarian assistance
b
0.00
0.25
0.39
0.63
Program design and learning
0.00
0.00
c
0.00
0.00
Social services
-0.07
0.00
d
0.00
-0.06
Other public health threats
0.16
0.00
0.00
0.16
Total
1.39
0.25
0.39
2.03
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds received directly by International Planned Parenthood Federation or affiliates. It does not include
funds that may have been received by other organizations and passed through to International Planned Parenthood Federation or
affiliates. Data are based on the federal fiscal year, October 1 through September 30. Amounts may not sum to totals due to
rounding.
International Planned Parenthood Federation declined to accept the terms and conditions of awards from USAID due to a policy in
effect for certain years under our review. Specifically, International Planned Parenthood Federation publicly stated that it would not
be able to meet the conditions of the Protecting Life in Global Health Assistance policy, which required foreign nongovernmental
34
The amounts received were previously obligated. Federal funding obligated to an organization in any 1 year may be
received by the organization in a different year or across multiple years. As a result, the amount of federal funding
obligated, versus received or expended, may differ within the same time period. Additionally, obligations and amounts
received should not be added together.
According to Department of State and USAID officials, non-governmental organizations that declined to accept the
conditions of the Protecting Life in Global Health Assistance policy were permitted to continue to expend any
remaining obligated funds.
35
HHS officials searched the Payment Management System based on the names of the organization and its affiliates
and unique identifiers when available and found no results for the years under our review.
Page 54 GAO-24-106215 Health Care Funding
organizations to agree that, during the term of the award, they would not perform or actively promote abortion as a method of family
planning or provide financial support to any foreign nongovernmental organization that does. The policy was implemented in May
2017 and rescinded in January 2021. According to Department of State and USAID officials, nongovernmental organizations that
declined to accept the conditions of the Protecting Life in Global Health Assistance policy were permitted to continue to expend any
remaining obligated funds.
a
Total for this program area in 2020 was approximately $800.
b
Humanitarian assistance includes protection and assistance for refugees, stateless persons, and other victims of conflict and
disasters. Funding for humanitarian assistance was not subject to the Protecting Life in Global Health Assistance policy.
c
Total for this program area in 2020 was approximately $600.
d
Total for this program area in 2020 was approximately $4,400.
Funds expended. Our analysis of International Planned Parenthood Federation data from 2019
through 2021 found that the organization expended $118,055 in federal funding from USAID in
2019 and no funding in 2020 and 2021.
36
International Planned Parenthood Federation
expended these funds for close out and financial reporting actions on a cooperative agreement
named Support to International Family Planning and Health Organizations 2 Sustainable
Networks.
36
This amount includes federal funding expended by International Planned Parenthood Federation offices that was
received directly from USAID and does not include funding that may have been expended by International Planned
Parenthood Federation affiliates. These data are based on the calendar year, January 1 through December 31.
Page 55 GAO-24-106215 Health Care Funding
Enclosure VI: MSI Reproductive Choices
MSI Reproductive Choices (formerly known as Marie Stopes International) is an international,
nonprofit organization that delivers services through nearly 9,000 team members in 37
countries. MSI Reproductive Choices delivers sexual and reproductive health-related services to
women, including contraception, abortion services, and post-abortion care.
Funding obligated. Our analysis of U.S. Agency for International Development (USAID) data
found that it de-obligated approximately $1.5 million in federal funding through grants or
cooperative agreements to MSI Reproductive Choices from 2019 through 2022.
37
(See table
25.) De-obligations refer to USAID’s cancellation or downward adjustment of previously incurred
obligations. Almost all de-obligated funds were in the “family planning and reproductive health”
program area. Officials from the Department of Health and Human Services (HHS) reported that
it did not obligate any funds to MSI Reproductive Choices during these years.
38
Table 25: U.S Agency for International Development (USAID) Obligations to MSI Reproductive Choices
through Grants or Cooperative Agreements, 2019-2022
Dollars in millions
USAID program area
2019
2020
2021
2022
Total
Family planning and reproductive health
a
-0.70
-0.66
-0.10
0.00
-1.46
HIV and AIDS
a
0.00
-0.01
0.00
0.00
-0.01
Total
-0.70
-0.66
-0.10
0.00
-1.46
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds obligated directly to MSI Reproductive Choices or affiliates. It does not include funds that may have
obligated to other organizations and passed through to MSI Reproductive Choices or affiliates. Data are based on the federal fiscal
year, October 1 through September 30. Amounts may not sum to totals due to rounding.
MSI Reproductive Choices declined to accept the terms and conditions of awards from the Department of Health and Human
Services and USAID due to a policy in effect for certain years under our review. Specifically, the organization publicly stated that it
would not be able to meet the conditions of the Protecting Life in Global Health Assistance policy, which required foreign
nongovernmental organizations to agree that, during the term of the award, they would not perform or actively promote abortion as a
method of family planning
or provide financial support to any foreign nongovernmental organization that does. The policy was
implemented in May 2017 and rescinded in January 2021. According to Department of State and USAID officials, nongovernmental
organizations that declined to accept the conditions of the Protecting Life in Global Health Assistance policy were permitted to
continue to expend any remaining obligated funds.
37
MSI Reproductive Choices declined to accept the terms and conditions of awards from USAID due to a policy in
effect for certain years under our review. Specifically, the organization publicly stated that it would not be able to meet
the conditions of the Protecting Life in Global Health Assistance policy, which required foreign nongovernmental
organizations to agree that, during the term of the award, they would not perform or actively promote abortion as a
method of family planning or provide financial support to any foreign nongovernmental organization that does. The
policy was implemented in May 2017 and rescinded in January 2021. According to Department of State and USAID
officials, nongovernmental organizations that declined to accept the conditions of the Protecting Life in Global Health
Assistance policy were permitted to continue to expend any remaining obligated funds.
Other limits exist on the use of foreign assistance to provide abortions. Specifically, foreign assistance funds cannot
be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to
practice abortions. See, e.g., Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94, div. G, tit. III,
“Bilateral Economic Assistance—Global Health Programs,” 133 Stat. 2534, 2827 (2019).
38
HHS officials searched the Payment Management System based on the names of the organization and its affiliates
and unique identifiers when available and found no results for the years under our review.
Page 56 GAO-24-106215 Health Care Funding
a
According to USAID officials, reasons for de-obligating funds to MSI Reproductive Choices include closing certain awards and
reducing excess obligations for other awards.
Funds received. Our analysis found that MSI Reproductive Choices received approximately
$1.35 million in federal funding from USAID through grants or cooperative agreements from
2019 through 2021.
39
While MSI Reproductive Choices received over $1.5 million in federal
funds in 2019, this amount was reduced by approximately $150,000 during 2020 and 2021.
40
(See table 26.) HHS officials reported that MSI Reproductive Choices received no funds from
the department from 2019 through 2021.
41
Table 26: U.S Agency for International Development (USAID) Funds Received by MSI Reproductive
Choices through Grants or Cooperative Agreements, 2019-2021
Dollars in millions
U.S. AID program area
2019
2020
2021
Total
Family planning and reproductive health
1.22
-0.07
-0.08
1.07
HIV and AIDS
0.00
-0.01
0.00
-0.01
Maternal and child health
0.29
0.00
0.00
0.29
Total
1.51
-0.07
-0.08
1.35
Source: GAO analysis of USAID data. | GAO-24-106215
Notes: This table includes funds received directly by MSI Reproductive Choices or affiliates. It does not include funds that may have
been received by other organizations and passed through to MSI Reproductive Choices or affiliates. Data are based on the federal
fiscal year, October 1 through September 30. Amounts may not sum to totals due to rounding.
MSI Reproductive Choices declined to accept the terms and conditions of awards from USAID due to a policy in effect for certain
years under our review. Specifically, the organization publicly stated that it would not be able to meet the conditions of the Protecting
Life in Global Health Assistance policy, which required foreign nongovernmental organizations to agree that, during the term of the
award, they would not perform or actively promote abortion as a method of family planning
or provide financial support to any
foreign nongovernmental organization that does. The policy was implemented in May 2017 and rescinded in January 2021.
According to Department of State and USAID officials, nongovernmental organizations that declined to accept the conditions of the
Protecting Life in Global Health Assistance policy were permitted to continue to expend any remaining obligated funds.
Funds expended. Our analysis of MSI Reproductive Choices data from 2019 through 2021
found that the organization expended approximately $7 million in federal funding from USAID.
One MSI Reproductive Choices affiliate based in Malawi expended almost all these funds. (See
table 27.)
39
The amounts received were previously obligated. Federal funding obligated to an organization in any 1 year may be
received by the organization in a different year or across multiple years. As a result, the amount of federal funding
obligated, versus received or expended, may differ within the same time period. Additionally, obligations and
amounts received should not be added together.
According to Department of State and USAID officials, non-governmental organizations that declined to accept the
conditions of the Protecting Life in Global Health Assistance policy were permitted to continue to expend any
remaining obligated funds.
40
These reductions include collection of funds that USAID had previously obligated and grant payment credits.
41
HHS officials searched the Payment Management System based on the names of the organization and its affiliates
and unique identifiers when available and found no results for the years under our review.
Page 57 GAO-24-106215 Health Care Funding
Table 27: U.S. Agency for International Development (USAID) Grant or Cooperative Agreement Funds
Expended
by MSI Reproductive Choices and Affiliates, 2019–2021
Dollars in millions
USAID program
2019
2020
2021
Total
Support to International Family Planning and Health Organizations 2
Sustainable Networks
0.04
0.00
0.00
0.04
Organized Network of Services for Everyone
a
Banja La Mtsogolo (Malawi)
2.41
2.43
1.98
6.82
Sustaining Health Outcomes through the Private Sector Project Plus
Marie Stopes Society Pakistan
0.00
0.00
0.01
0.01
Total
2.46 2.43 1.99 6.87
Source: GAO analysis of MSI Reproductive Choices data. | GAO-24-106215
Note: This table includes federal funding expended by MSI Reproductive Choices and affiliates that was received directly from
USAID as well as expenditures of federal funding received by other organizations and passed through to MSI Reproductive
Choices. Data are based on the calendar year, January 1 through December 31. Amounts may not sum to totals due to rounding.
a
Organized Network of Services for Everyone expenditures were funded through a subcontract from Management Sciences for
Health.
Page 58 GAO-24-106215 Health Care Funding
Enclosure VII: Comments from the U.S. Agency for International Development
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