Reproductive Health: Federal Funds Provided to Four Nonprofit
Organizations (Correspondence, 07/18/2000, GAO/HEHS-00-147R).

Pursuant to a congressional request, GAO provided information on the
Planned Parenthood Federation of America, the International Planned
Parenthood Federation, the Alan Guttmacher Institute and the Population
Council, focusing on: (1) the amount of federal funding that supports
these organizations; (2) federal agencies that receive and disburse the
funds; and (3) congressional committees with jurisdiction to authorize
or appropriate these funds.

GAO noted that: (1) GAO found that the Alan Guttmacher Institute, the
Planned Parenthood Federation of America and its affiliates, the
International Planned Parenthood Federation and its associations, and
the Population Council received approximately $170 million of federal
funds in fiscal year (FY) 1997 and $178 million in FY 1998; (2) complete
data for FY 1999 are not available; (3) the Department of Health and
Human Services and the Agency for International Development were the
major sources of these funds; (4) four committees in the Senate and
three committees in the House of Representatives have jurisdiction over
the authorization of the programs under which the funding was provided;
and (5) the Committee on Appropriations in the Senate and in the House
each have three subcommittees that have jurisdiction over the
appropriations of these funds.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-147R
     TITLE:  Reproductive Health: Federal Funds Provided to Four
	     Nonprofit Organizations
      DATE:  07/18/2000
   SUBJECT:  Birth control services
	     Federal funds
	     Congressional committees
	     Jurisdictional authority
	     Nonprofit organizations
	     Cooperative agreements
	     Block grants
IDENTIFIER:  Medicaid Program
	     Maternal and Child Health Block Grant
	     Social Services Block Grant

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GAO/HEHS-00-147R 

Federal Funds to Nonprofit Organizations

United States General Accounting Office Washington, DC 20548

Health, Education, and Human Services Division

B- 285589 July 18, 2000 The Honorable Phil Gramm United States Senate

The Honorable Christopher H. Smith House of Representatives

Subject: Reproductive Health: Federal Funds Provided to Four Nonprofit
Organizations This letter responds to your request that we identify (1) the
amount of federal funding that supported four nonprofit organizations- the
Alan Guttmacher Institute, the International Planned Parenthood Federation,
the Planned Parenthood Federation of America, and the Population Council- or
their activities in fiscal years 1997, 1998, and 1999; (2) the federal
agencies that received and disbursed the funds; and (3) the congressional
committees with jurisdiction to authorize or appropriate the funds. This
information updates our 1998 correspondence, entitled Family Planning:
Federal Funds Provided to Planned Parenthood Organizations, which provided
funding information for fiscal years 1994 through 1996. 1

In summary, we found that the Alan Guttmacher Institute, the Planned
Parenthood Federation of America and its affiliates, the International
Planned Parenthood Federation and its associations, and the Population
Council received approximately $170 million of federal funds in fiscal year
1997 and $178 million in fiscal year 1998. Complete data for fiscal year
1999 are not available. (See table 1.) The Department of Health and Human
Services (HHS) and the Agency for International Development (AID) were the
major sources of these funds. Four committees in the Senate and three
committees in the House of Representatives have jurisdiction over the
authorization of the programs under which the funding was provided. The
Committee on Appropriations in the Senate and in the House each have three
subcommittees that have jurisdiction over the appropriations of these funds.
2

1 GAO/ HEHS- 98- 171R, May 22, 1998. 2 The authorizing committees in the
Senate are Commerce, Science, and Transportation; Finance; Foreign

Relations; and Health, Education, Labor, and Pensions. In the House, they
are Commerce, International Relations, and Ways and Means. Funds are
appropriated by the Committee on Appropriations in the Senate and in the
House through their subcommittees on Labor, Health and Human Services, and
Education; Commerce, Justice, State, and the Judiciary; and Foreign
Operations, Export Financing, and related programs.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 2
Table 1: Federal Funds Received by Four Nonprofit Organizations That

Support Reproductive Health Activities, Fiscal Years 1997 and 1998

Recipient 1997 1998

Planned Parenthood Federation of America and affiliates

$115,795,461 $120,645,606 Population Council 28,242,725 35,463,767
International Planned Parenthood Federation and associations

25,010,243 20,984,425 Alan Guttmacher Institute 1,016,849 1,346,587

Total $170,065,278 $178,440,385

To obtain the information to address your request, we collected data from
and held discussions with officials from HHS, the Department of Commerce,
AID, the Alan Guttmacher Institute, the Planned Parenthood Federation of
America, the International Planned Parenthood Federation, and the Population
Council. The nonprofit organizations provided independently audited
financial statements and reports on expenditures of federal funds. Except
where noted, we used the expenditure data that the nonprofit organizations
reported. We conducted our work from May to July 2000 in accordance with
generally accepted government auditing standards.

BACKGROUND The Planned Parenthood Federation of America- a nonprofit
organization- and its 132 affiliates, with 850 local health centers, provide
reproductive medical care and birth control education. The affiliates are
independent, separately incorporated organizations with their own boards of
directors and financial autonomy. In 1998, the affiliates provided
reproductive health care to 2.4 million women and men and educational
services to 1.5 million individuals. The affiliates and their clinics
provide family planning counseling and birth control services, pregnancy
testing, abortions, cancer screening, human immunodeficiency virus (HIV)
testing, screening and treatment for sexually transmitted diseases, prenatal
and well- baby care, and other reproductive health care services.

The Alan Guttmacher Institute was originally a division of the Planned
Parenthood Federation of America and became an independent not- for- profit
corporation in 1977. It remains a special affiliate of the Planned
Parenthood Federation of America. The Alan Guttmacher Institute conducts
reproductive health and family planning research, policy analysis, and
public education nationally and internationally, and it publishes journals
about family planning and reproductive health.

The International Planned Parenthood Federation is a nonprofit,
nongovernmental family health care organization headquartered in London and
registered as a charity in the United Kingdom. It has six regional offices
and 127 affiliated family planning associations, and it operates in 160
countries. It provides family planning and reproductive health services,
including maternal care and screening and treatment for

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 3
sexually transmitted diseases. The International Planned Parenthood
Federation is

supported by financial contributions from more than 25 governments and by
donations from private foundations and individuals.

The Population Council is an international, nonprofit, nongovernmental
organization that conducts fundamental biomedical research in reproduction,
develops contraceptives and other products related to reproductive health,
works to improve the quality and outreach of family planning and
reproductive health services, and conducts research on reproductive health
and behavior. In addition, it works to strengthen professional resources in
developing countries through collaborative research, awards, fellowships,
and training. It is headquartered in New York City and has an office in
Washington, D. C., 5 regional offices, and 15 offices in developing
countries. In 1999, roughly half of the Population Council's staff of about
490 employees were based in developing countries.

FEDERAL FUNDS FOR THE DOMESTIC ACTIVITIES OF THE ALAN GUTTMACHER INSTITUTE,
THE PLANNED PARENTHOOD FEDERATION OF AMERICA, AND THE POPULATION COUNCIL

Federal programs accounted for approximately $119 million in fiscal year
1997 and $127 million in fiscal year 1998 in funding for domestic activities
of the Alan Guttmacher Institute, the Planned Parenthood Federation of
America and its affiliates, and the Population Council. (See table 2.) HHS
provided most of this funding, primarily through grants to states and
territories that disbursed the funds to these organizations.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 4
Table 2: Federal Funds Supporting the Domestic Activity of Three Nonprofit

Organizations That Support Reproductive Health Activities, Fiscal Years 1997
and 1998

Authorizing congressional committee a

Expenditure Administering agency

House Senate 1997 1998 Family planning grants (Public Health Service Act,
title X) b HHS, Office of Population Affairs

Commerce Health, Education, Labor, and Pensions

$46,685,122 $52,692,060

Medicaid (Social Security Act, title XIX) c HHS, Health Care Financing
Administration

Commerce Finance 34,121,631 36,195,038

Social Services Block Grants (Social Security Act, title XX) HHS,
Administration for Children and Families

Ways and Means

Finance 22,464,248 18,367,344

Maternal and Child Health Services Block Grants (Social Security Act, title
V) d HHS, Health Resources and Services Administration

Commerce Finance 5,046,413 3,377,485

Research project grants (Public Health Service Act, title IV) e HHS,
National Institutes of Health

Commerce Health, Education, Labor, and Pensions

4,252,312 5,663,433

Telecommunications Information and Infrastructure Assistance Grants
(Communications Act of 1934, sec. 392) Department of Commerce, National
Telecommunications and Information Administration

Commerce Commerce, Science, and Transportation

74,137 0

Additional federal payments to Planned Parenthood affiliates f

Multiple sources 6,165,751 10,550,174

Total $118,809,616 $126,845,534

Note: Complete fiscal year 1999 expenditure data are not available for
Planned Parenthood Federation of America. It reported title X expenditures
of $378,244, but no expenditure data for any of the programs are available
for its affiliates. The Alan Guttmacher Institute reported estimated fiscal
year 1999 expenditures of $862,632 for title X and $88,107 for NIH research
project grants. The Population Council reported receiving $5,518,283 in NIH
research project grants for fiscal year 1999 and $55,914 from the National
Science Foundation.

a The Committee on Appropriations in the Senate and in the House through
their subcommittees on Labor, Health and Human Services, and Education and
Commerce, Justice, State, and the Judiciary have jurisdiction over
legislation appropriating funds for these programs and activities.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 5 b
Includes $46,295,996 that the Planned Parenthood Federation of America spent
in fiscal year 1997 and

$52,148,706 in fiscal year 1998. The Alan Guttmacher Institute spent
$389,126 in fiscal year 1997 and $543,354 in fiscal year 1998. The
Population Council received no title X funds for either year.

c Includes state matching funds of approximately $3.4 million in fiscal year
1997 and $3.6 million in fiscal year 1998. d Includes a state match of $3
for every $4 of federal funds.

e Includes $4,038,541 that the Population Council spent in fiscal year 1997
and $5,410,513 that it spent in fiscal year 1998. Other expenditures were by
the Alan Guttmacher Institute. Funds from the National Institutes of Health
are provided directly to recipient organizations.

f Additional federal payments to Planned Parenthood affiliates include
federal funds for other health care, acquired immunodeficiency syndrome
(AIDS), and nutrition services. Additional federal funding data that Planned
Parenthood Federation of America affiliates provided did not always identify
specific sources of funds and related funding amounts. In some cases,
funding amounts for multiple programs were combined.

Source: GAO analysis of reports and independently audited annual financial
reports prepared in compliance with Office of Management and Budget (OMB)
Circular A- 133.

Title X of the Public Health Service Act authorizes grants for voluntary
family planning services, primarily for low- income women. Title X also
provides funding for training nurse practitioners and for health research
about family planning services. 3 Title X grantees include state and
territorial health departments, local health departments, hospitals, and
other organizations. Of the three nonprofit organizations we reviewed that
received federal funds for domestic activities, two- the Alan Guttmacher
Institute and the Planned Parenthood Federation of America and its
affiliates- received title X funds from fiscal year 1997 through fiscal year
1999. In fiscal year 1998, title X funds spent by these two organizations
were about $53 million. Grantees can dispense title X funds to other
agencies to provide services or to support clinics. Although there are no
matching requirements for grants, regulations specify that no clinic may be
fully supported by title X funds. The Public Health Service Act also
prohibits the use of title X funds in programs in which abortion is a method
of family planning.

Title XIX of the Social Security Act authorizes Medicaid grants to the
states and requires state Medicaid programs to cover family planning
services. The Health Care Financing Administration (HCFA) pays 90 percent
and states pay 10 percent of Medicaid's payments for family planning
services and supplies furnished to beneficiaries. This sharing formula
applies only to family planning services and supplies, defined as services
intended to affect family size. Other covered Medicaid services provided by
Planned Parenthood centers, including abortion when permitted under law, are
reimbursed under

3 The Planned Parenthood Federation of America received such training grants
of $688,070 in fiscal year 1997, $857,434 in fiscal year 1998, and $957,900
in fiscal year 1999. In addition, the Alan Guttmacher Institute received
$527,361 of title X funds in fiscal year 1997, $828,999 in fiscal year 1998,
and $350,238 in fiscal year 1999 for assessing family planning and
reproductive health needs and services in the United States.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 6
standard federal- state payment formulas. 4 HCFA's most recently published
state data

show that in fiscal year 1998, Medicaid paid about $449 million (0.3 percent
of Medicaid payments for claims) for family planning services. States do not
report to HCFA services that Planned Parenthood affiliates provide
separately from other providers.

The Social Security Act authorizes the Maternal and Child Health Services
Block Grant (MCHBG), title V, and the Social Services Block Grant (SSBG),
title XX. MCHBG and SSBG funds are distributed by formula to state and
territorial health and social service agencies. Federal MCHBG funds are
matched by states which are required to provide a $3 match for each $4 of
federal funds.) Each state determines the use of the combined funds for
MCHBG and its federal SSBG funds. Under either block grant, state agencies
may fund family planning activities directly or purchase them from Planned
Parenthood affiliates or others. The most recent SSBG data show that in
fiscal year 1998, states and territories used about $42.4 million, or 1.5
percent, of their SSBG funds for family planning services.

Title IV and section 301 of the Public Health Service Act authorize the
National Institutes of Health (NIH) to award research project grants. NIH
awarded research grants to the Population Council totaling about $4 million
in fiscal year 1997 and about $5 million in fiscal year 1998. The NIH
institutes and centers funding these grants were the National Institute of
Allergy and Infectious Diseases, the National Institute of Child Health and
Human Development, the National Institute of Diabetes and Digestive and
Kidney Diseases, and the Fogarty International Center. Also, in 1997, the
Alan Guttmacher Institute spent $213,771 under two research project grants
previously awarded by NIH's National Institute of Child Health and Human
Development's Center for Population Research, Demographic, and Behavioral
Sciences Branch to study contraceptive effectiveness and health behaviors of
pregnant women.

Under section 392 of the Communications Act of 1934, which authorizes the
Telecommunications and Information Infrastructure Assistance Grants in the
Department of Commerce, the National Telecommunications and Information
Administration, through its Office of Telecommunications and Information
Applications, awarded in 1994 a matching grant to the Planned Parenthood
Federation of America for developing a computerized information system for
collecting and exchanging data on reproductive health care. Some of these
funds, $74,137, were spent in fiscal year 1997- the last year funds were
spent under this grant.

4 Except for family planning services and services provided through Indian
Health Service facilities, the federal portion of payments for Medicaid
services is set annually for each state by a formula and may range from 50
to 83 percent, based on state per capita income.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 7
FEDERAL FUNDS FOR THE INTERNATIONAL ACTIVITIES

OF THE ALAN GUTTMACHER INSTITUTE, PLANNED PARENTHOOD ORGANIZATIONS, AND THE
POPULATION COUNCIL

For fiscal years 1997 through 1999, the Alan Guttmacher Institute, Family
Planning International Assistance, the International Planned Parenthood
Federation and its regional offices and affiliated family planning
associations, and the Population Council received annual financial support
for international activities from AID. The total amount of federal funding
was about $51 million for fiscal year 1997 and $52 million each for fiscal
years 1998 and 1999. (See table 3.)

Table 3: AID Funds Supporting the International Activity of Four Nonprofit
Organizations That Support Reproductive Health Activities, Fiscal Years
1997- 99

Expenditure Recipient 1997 1998 1999 Population Council $24,204,184
$30,053,254 $34,157,190 a

International Planned Parenthood Federation and its regional offices

International Planned Parenthood Federation grants b

7,146,000 5,739,000 5,800,000 Western Hemisphere region Cooperative
agreement b

5,299,000 c 0 0 Contraceptive shipments 1,142,243 d 2,572,425 d 1,578,364 d

International Planned Parenthood family planning associations

Bilateral assistance b 8,125,000 8,926,000 8,449,000 Subprojects with
cooperating agencies b

3,298,000 3,747,000 1,867,000

Family Planning International Assistance e

1,627,283 6,859 0

Alan Guttmacher Institute 413,952 550,313 572,765 a

Total $51,255,662 $51,594,851 $52,424,319

Note: The Senate Foreign Relations Committee and the House Committee on
International Relations have jurisdiction over the authorization of AID
activities. The Committee on Appropriations in the Senate and in the House
through their subcommittees on Foreign Operations have jurisdiction over
legislation appropriating funds for these activities.

a Estimates of fiscal 1999 expenditures. b These are obligation data that
AID provided. c Fiscal year 1997 obligations for the Western Hemisphere
region were from fiscal year 1996 funds obligated early in fiscal year 1997.
d Value ascribed by AID.

e Family Planning International Assistance is the international services
division of the Planned Parenthood Federation of America. Expenditures
include the value of contraceptive shipments and pass- through funds from
Family Health International.

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 8
Sources: AID's Office of Population, GAO analysis of independently audited
annual

financial reports prepared in compliance with OMB Circular A- 133, and
unaudited fiscal year 1999 data provided by the nonprofit organizations.

AID provides funding assistance through direct grants and cooperative
agreements, among other things. A cooperative agreement is a grant under
which substantial involvement is anticipated between AID and the recipient-
called a cooperating agency- during the performance of a funded activity.
AID missions fund some International Planned Parenthood family planning
associations directly. AID's cooperating agencies may also support some
International Planned Parenthood family planning associations through
subgrants.

AID grants to the International Planned Parenthood Federation are used to
introduce, expand, and improve family planning and reproductive health
information and services through its affiliated network of indigenous family
planning associations. AID's cooperative agreement with the International
Planned Parenthood Federation's Western Hemisphere region was used to
improve and expand family planning services in Latin America and the
Caribbean and to incorporate AIDS and other sexually transmitted disease
prevention services into family planning programs. In addition, one AID
mission had awarded a grant directly to Family Planning International
Assistance, the international service division of Planned Parenthood
Federation of America, to initiate a family planning and birth spacing
program in Cambodia.

The Alan Guttmacher Institute receives, through a subagreement, funding from
AID for publishing an international journal in English, French, and Spanish
about family planning and reproductive health issues. AID grants to the
Population Council are used to promote the use of operations research to
improve the quality, accessibility, and costeffectiveness of reproductive
health programs; conduct research on adolescent livelihoods and the
transition to marriage and adulthood; and conduct field- based operations
research in developing countries to identify best practices for the
prevention on HIV and AIDS and other sexually transmitted diseases.

Officials from AID, HHS, the Alan Guttmacher Institute, the Planned
Parenthood Federation of America, and the Population Council reviewed this
correspondence and provided additional information and technical comments,
which we incorporated where appropriate. HHS officials commented that the
dollar amounts they provided to us for domestic program funding were
different from the amounts we used in this correspondence. Some of the
information HHS provided was obligation data, while we used federal funds
expended by the nonprofit organizations in fiscal years 1997 and 1998 as
reported in audited financial reports and other documents. For consistency,
we used the same sources of expenditure data that we used for our 1998
correspondence, which this correspondence updates.

-----

B- 285589 GAO/ HEHS- 00- 147R Federal Funds to Nonprofit Organizations 9 As
we agreed with your offices, we are sending copies of this letter to the
relevent

congressional committees, the Secretary of HHS, the Acting Inspector General
of AID, the Planned Parenthood Federation of America, the Alan Guttmacher
Institute, and the Population Council. We will also make copies available to
others on request.

Major contributors to this letter were James O. McClyde and Paul T. Wagner,
Jr. Please contact me at (202) 512- 7119 if you have any questions.

Janet Heinrich Associate Director, Health Financing and

Public Health Issues (201069)
*** End of document. ***