Health Care Funding: Federal Funding for Certain Organizations Providing Health-Related Services, 2019 through 2022

What GAO Found

Since 1995, GAO has reported periodically on federal funding to various domestic and international organizations that provide preventive health care services, including sexual and reproductive health services, family planning, and activities related to the treatment and prevention of HIV/AIDS. For this most current review, GAO found that these organizations received federal funds through several sources from 2019 through 2021. These sources included grants and cooperative agreements, public health coverage programs, and Paycheck Protection Program loans—federally guaranteed loans to support small businesses and nonprofit entities affected by the COVID-19 pandemic that are fully forgivable if certain conditions are met. Specifically:

• Health Centers received about $21.69 billion in Department of Health and Human Services (HHS) grants. Health Centers, which may be eligible for grants administered by HHS' Health Resources and Services Administration, also received about $53.12 billion in payments from public health coverage programs, including Medicare (for persons aged 65 and over, individuals with disabilities, and individuals with end-stage renal disease), Medicaid (for certain low-income and medically needy individuals), and the Children's Health Insurance Program (CHIP—for certain uninsured, low-income children). Further, as of May 2023, 1,150 Health Centers had received an estimated $2.47 billion in Paycheck Protection Program loans, of which $2.45 billion—including accrued interest on these loans—had been forgiven.
• Planned Parenthood Federation of America affiliates received about $148 million in HHS grants or cooperative agreements and $1.54 billion in Medicare, Medicaid, and CHIP payments. Planned Parenthood affiliates also received 44 Paycheck Protection Program loans totaling approximately $89 million—the entire amount, including accrued interest, was forgiven.
• Domestic regional organizations—four privately owned providers of health-related services in various regions of the United States—received about $108 million in Medicare, Medicaid, and CHIP payments.
• International Planned Parenthood Federation received about $2.03 million from the U.S. Agency for International Development (USAID).
• MSI Reproductive Choices received about $1.35 million from USAID.

Why GAO Did This Study

To achieve their programmatic goals, some federal agencies provide funding, such as through grants and cooperative agreements, to various organizations that, in turn, use the funds received to implement programs and activities aligned with those goals. In addition, public health coverage programs, such as Medicare, Medicaid, and CHIP, may pay for certain services that organizations provide to beneficiaries of those programs. Organizations may also receive federally guaranteed loans.

GAO was asked to update our most recent reports—issued in 2020 and 2021—on federal funding for certain organizations that provide health-related services—Health Centers, Planned Parenthood Federation of America, four domestic regional organizations, International Planned Parenthood Federation, and MSI Reproductive Choices. This report describes federal funding obligations (federal funding committed through grants and cooperative agreements for payment), funds received, and expenditures for these organizations from 2019 (the first year of data since we last reported) through the most recent year available (2022 for obligations, and 2021 for funds received and expenditures). GAO obtained and reviewed information on federal funding from HHS, USAID, and the Small Business Administration. GAO also obtained information from each of the organizations, where possible.

For more information, contact Mary Denigan-Macauley at (202) 512-7114 or DeniganMacauleyM@gao.gov.