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.
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2 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

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
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3 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

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.
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Table 2: Federal Funds Supporting the Domestic Activity of Three Nonprofit

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

Authorizing congressional

committeea

Administering Expenditure

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 affiliatesf

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.
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5 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

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.
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6 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

standard federal-state payment formulas.4HCFA’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.
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7 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

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

Recipient Expenditure

1997 1998 1999

Population Council $24,204,184 $30,053,254 $34,157,190a

International Planned Parenthood Federation and its regional offices

International Planned Parenthood

Federation grantsb

7,146,000 5,739,000 5,800,000

Western Hemisphere region

Cooperative agreementb

5,299,000c 0 0

Contraceptive shipments 1,142,243d2,572,425d1,578,364d

International Planned Parenthood family planning associations

Bilateral assistanceb8,125,000 8,926,000 8,449,000

Subprojects with cooperating

agenciesb

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

Family Planning International

Assistancee

1,627,283 6,859 0

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

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.
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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.

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9 GAO/HEHS-00-147R Federal Funds to Nonprofit Organizations

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)