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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations onboarding new providers into their Title X network under the 2019 rule, they faced resistance or a lack of interest, and their provider networks did not increase under the 2019 rule, continuing to adversely impact the communities they serve.
These public comments suggest that the effects identified in this regulatory impact analysis for the time horizon covering calendar year 2022 through 2026 are unlikely to be limited to a reversal of what was observed immediately after issuance of the 2019
final rule. The Department acknowledges persistent challenges with clearly disaggregating the effects that represent transfers from effects that represent benefits and costs as a result of this final rule; however, it is important to reiterate that total Title X
funding remained unchanged upon issuance of the 2019 final rule and will be unchanged as a result of this final rule, so while some entities receive less funding and they and their clients experience regulation-induced ancillary harm, which can manifest itself in the quantity or quality of associated services, other entities receive more funding. The Department maintains the analytical approach of estimating the number of additional clients served and services provided under the Title X
program under this final rule, while acknowledging challenges in quantitatively assessing whether this final rule will result in additional clients served and family planning services provided, not limited to the Title X program, as compared to the baseline of no further regulatory action.
Despite such uncertainty, analysis based on evidence available at this time generally supports a conclusion that the projections accompanying the 2019 rule have not been borne out.

e. Further Discussion of Distributional Effects The Title X program is designed to provide services with priority given to persons from low-income families.
According to the 2019 figures, 64
percent of clients have income under 101% of the federal poverty level; 14
percent between 101 percent FPL and 150 percent FPL; seven percent between 151 percent FPL to 200 percent FPL;
three percent between 201 percent FPL
and 250 percent FPL; seven percent over 250 percent FPL; and five percent have an unknown or unreported income level. Among program clients, 33
percent self-identified as Hispanic or Latino of all races; three percent as Asian and Not Hispanic or Latino; 22
percent as Black or African American and Not Hispanic or Latino; 32 percent as White and Not Hispanic or Latino;
five percent as Other or Unknown and Not Hispanic or Latino; and four percent are Unknown or Not Reported.
Furthermore, Title X requires Title X
projects to provide services for adolescents without required parental consent, thereby making Title X a critical source of sexual and reproductive healthcare for young people. In 2019, two percent of program clients were younger than 15, and eight percent were younger than 18.
Additional information about the number and distribution of all family planning clients by age and year are available in Exhibit A3a of the 2019
Family Planning Annual Report. The benefits of revoking the 2019 rule would likely accrue proportionally with these income and race and ethnicity figures.
The costs of revoking the 2019 rule would likely accrue proportionally to the income and other demographics of the general public.
This final rule will also likely have important geographic effects. As described in greater detail in the
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Baseline section, six states currently have no Title X services, and six additional states have limited Title X
services. This final rule is expected to result in restoration of services to individuals in these states.
f. Uncertainty and Sensitivity Analysis All of the major drivers of the quantified effects of this analysis are dependent on the forecast of the baseline number of clients served. The Department acknowledges the uncertainty in this baseline and has performed a sensitivity analysis to quantify its importance. For the primary baseline, the analysis uses 2.5 million annual clients of Title X services, which corresponds to the number of clients in calendar year 2019 among remaining grantees. For its sensitivity analysis, the Department investigates the effect of the proposed rule compared to a baseline with 1.5 million clients, corresponding to the estimates for 2020. For comparison, the analysis reviewed the effects using an upper bound of 3.1
million clients served, which is the reported figure for 2019, but which includes 19 grantees, 231 subrecipients, and 945 service sites that withdrew from the Title X program following the 2019 rule.
Table F1 presents the number of clients served under different assumptions of the baseline. The analysis also recalculates the number of clients served for the final rule scenario for each of the baseline assumptions.
Since the number of clients served in the first year is the midpoint between the baseline and long-run equilibrium figure, the number of clients served in 2022 under the final rule is lower for the lower-bound scenario than the primary baseline. Similarly, the number of clients served under the final rule is higher in the upper-bound scenario.

TABLE F1TITLE X CLIENTS SERVED UNDER DIFFERENT BASELINE ASSUMPTIONS
Year
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2022
2023
2024
2025
2026

Baseline

2,512,066
2,512,066
2,512,066
2,512,066
2,512,066

Table F2 calculates the effect of the final rule under different baseline assumptions. These estimates are reported by year, as well as in present value and annualized for the five-year time horizon of the analysis, applying a
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Baseline, LB

Baseline, UB

1,536,743
1,536,743
1,536,743
1,536,743
1,536,743

3,095,666
3,095,666
3,095,666
3,095,666
3,095,666

three percent and a seven percent discount rate. Under the lower-bound baseline scenario, the final rule will have about a 66 percent greater impact on the number of clients served in annualized terms under the primary
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Proposed rule 3,247,958
3,983,849
3,983,849
3,983,849
3,983,849

Proposed rule, LB

Proposed rule, UB

2,760,296
3,983,849
3,983,849
3,983,849
3,983,849

3,539,758
3,983,849
3,983,849
3,983,849
3,983,849

baseline scenario. Under the upperbound baseline scenario, the final rule will have approximately a 64 percent lesser impact.

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