St. Clair County residents urge retention of Title X services as medical director questions reapplying

Dozens of residents packed the St. Clair County Advisory Board of Health meeting to urge the board not to discontinue Title X family planning services, while the county’s medical director laid out a case for moving away from the federal grant.

"Title 10 exists to ensure that health care remains accessible to those who need it most," said Elizabeth Sigafus, a nurse practitioner with the St. Clair County Health Department, who described daily contraceptive counseling, STI testing and cancer screening provided to low-income residents and students. "Continuing participation in Title 10 directly supports that mission by ensuring access to essential preventative health care for some of our county's most vulnerable residents."

The public comments included personal accounts of care that speakers said would be lost if the county declines Title X funds: mammogram referrals, STI treatment and office-based insertion and removal of long-acting reversible contraception (LARC). "The nearest Title 10 clinic is 25 miles away," one speaker said, noting limited transportation and high gas prices for many residents.

Dr. Remy Nevin, the county’s medical director, told the advisory board that his memo raised six interrelated concerns — staffing, cost-effectiveness, legal conflicts, changing federal requirements, program volatility and training needs. He said the department currently runs the program at roughly $500,000 in combined grant and billing activity and estimated the direct program margin is small. He warned that pending FY27 Title X changes and long-standing confidentiality rules (citing federal rule 42 CFR 59.10b) could conflict with Michigan law and local expectations. "We must extricate those activities from this increasingly volatile, unreliable, likely-to-be-litigated program," he said, recommending the board consider not reapplying.

Board members and staff debated practical implications. Staff reported roughly 871 unduplicated Title X patients served in the most recent period and said about 30% of encounters involve LARCs. Finance staff explained the program's funding mix, noting Medicaid billing and supplemental reimbursements complicate the net fiscal picture. Jeff (finance) said the program's annual grant and billed revenue are near $500,000, with supply costs and staffing as major line items.

Several board members urged caution about an immediate withdrawal from Title X, stressing continuity-of-care and the difficulty of securing community alternatives for Medicaid or uninsured patients. Commissioners and board members repeatedly emphasized the need for more precise financial and operational data and for planning time to transfer care and schedule LARC removals if the county stops providing those procedures. One board member noted an estimated staffing impact if Title X were ended: "At least five staff would likely be put on layoff in the nursing division," staff responded in the meeting.

Rather than a vote to decline Title X today, the board pressed the county administration to prioritize filling an approved deputy medical director position and asked staff to provide additional data and contingency plans before a final decision. The advisory board emphasized it wanted to avoid abrupt interruptions of care and to ensure patients due for implant removal or reinsertion would have access during any transition period.

The meeting record shows no formal vote to terminate Title X funding; instead, the board committed to further analysis, recruitment for a deputy medical director role and closer financial and staffing review before any final action.

The advisory board will revisit the issue as staff supply additional numbers on service volumes, costs, and an implementation plan for any transition, with county budget deadlines (September) noted as a constraint on timing.