The 104th Congress considered massive structural changes in federal aid to the states. Not only would federal categorical grants be consolidated into block grants, but entitlement programs would be converted to block grants too. Using family planning as a case study, this article examines whether program impacts change if different grant mechanisms are employed. Findings from a pooled time series analysis of state family planning expenditures show that categorical funding (here, title X of the Public Health Service Act) is the most cost effective in producing desired outcomes, such as lowering infant mortality. Policies using entitlement grants are generally more cost effective than those that rely upon block grants. We discuss the implications of these findings for health policy more broadly and for fiscal federalism in general.