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Maternal and Child Health Block Grant
|
FY
2007
Actual |
FY
2008
Enacted |
FY
2009
Request |
FY
2009 +/-
FY 2008 |
BA |
$693,000,000 |
$666,155,000 |
$666,155,000 |
--- |
Authorizing
Legislation - Title V of the Social Security Act.
FY
2009 Authorization |
$850,000,000
|
Allocation Methods:
- Direct
federal/intramural
-
Contract
- Formula
grant/co-operative agreement
- Competitive
grant/co-operative agreement
Program
Description and Accomplishments
The mission of the Maternal and Child Health (MCH)
Block Grant Program, as authorized under Title V of
the Social Security Act, is to improve the health
of all mothers, children, and their families. Specifically
the program seeks to: (1) assure access to quality
care, especially for those with low-incomes or limited
availability of care; (2) reduce infant mortality;
(3) provide and ensure access to comprehensive prenatal
and postnatal care to women (especially low-income
and at risk pregnant women); (4) increase the number
of children receiving health assessments and follow-up
diagnostic and treatment services; (5) provide and
ensure access to preventive and child care services
as well as rehabilitative services for certain children;
(6) implement family-centered, community-based, systems
of coordinated care for children with special health
care needs (CSHCN); and (7) provide toll-free hotlines
and assistance in applying for services to pregnant
women with infants and children who are eligible for
Title XIX (Medicaid).
These legislated responsibilities reduce health disparities,
improve access to health care, and improve the quality
of health care. They are also consistent with the
President’s New Freedom Initiative which states
that “the Health and Human Services (HHS) Health
Resources and Services Administration, will take the
lead in partnership with States, tribes and other
organizations, in developing and implementing a plan
to achieve appropriate community-based service systems
for children and youth with special health care needs
and their families.” (Reference: Delivering
on the Promise: Preliminary Report of Federal Agencies’
Actions to Eliminate Barriers and Promote Community
Integration. Presented to the President of the
United States December 21, 2001.)
Section 502 of the Social Security Act states that
of the amounts appropriated, up to $600,000,000, 85%
is for allocation to the States, and 15 % is for Special
Projects of Regional and National Significance (SPRANS)
activities. Any amount appropriated in excess of $600,000,000
is distributed as follows: 12.75% is for Community
Integrated Service Systems (CISS) activities; of the
remaining amount, 85% is for allocation to the States,
and 15% is for SPRANS activities.
The MCH Block Grant is at its core a public health
program that reaches across economic lines to improve
the health of all mothers and children. Created as
a partnership with State MCH programs and with broad
State discretion, State Title V programs use appropriated
formula grant funds for: capacity and systems building,
public information and education, knowledge development,
outreach and program linkage, technical assistance,
provider training, evaluation, support for newborn
screening and genetic services, lead poisoning and
injury prevention, additional support services for
children with special health care needs, and promotion
of health and safety in child care settings.
Special efforts are made to build community capacity
to deliver such enabling services as care coordination,
transportation, home visiting, and nutrition counseling.
Where no services are available, States also use Title
V to provide categorical direct care such as prenatal
care or services for children with special health
care needs.
Additional activities that support the improved health
care of mothers and children are SPRANS and CISS.
SPRANS funds support projects (through grants, contracts,
and other mechanisms) in research, training, genetic
services and newborn screening and follow-up, sickle
cell disease, hemophilia, and maternal and child health
improvement. SPRANS projects must:
-
Support national needs and priorities or emerging
issues
-
Have regional or national significance
-
Demonstrate ways to improve State systems of care
for mothers and children.
CISS projects (through grants, contracts, and other
mechanisms) seek to increase the capacity for service
delivery at the local level and to foster formation
of comprehensive, integrated, community level service
systems for mothers and children using six specified
strategies:
-
Provide maternal and infant home health visiting,
health education, and related support services for
pregnant women and infants up to one year old.
-
Increase participation of obstetricians and pediatricians
under Titles V and XIX.
-
Integrate MCH service delivery systems.
-
Operate MCH centers under the direction of not-for-profit
hospitals.
Increase MCH projects in rural areas.
-
Provide outpatient and community-based services
for children with special health care needs.
The
Title V Block grant program provides support to all
59 States and jurisdictions. Consistent with other
HRSA programs, the MCH Block grant addresses three
overarching goals: 1) improving access to health care;
2) eliminating health disparities; and 3) improving
the quality of health care. Funds are allotted to
States based on a legislated formula which provides
the amount allotted to each state in 1983, and when
the amount available exceeds that level, the excess
is distributed based on the States proportion of children
in poverty.
In addressing the improvement of access to health
care, the program has been able to increase both the
number of children served by the States under Title
V (to 29 million in FY 2006) and the number of children
receiving Title V services who have Medicaid and State
Child Health Insurance Program (SCHIP) coverage. Increased
coverage under Medicaid and SCHIP for children receiving
Title V services better assures access, availability,
and continuity of care to a wide range of preventive
and acute care services. These increases are significant
as they occurred in a period of severe financial constraints
at the State and local levels. The 11 million children
who received Title V services and had Medicaid and
SCHIP coverage in 2006 is a significant increase over
the FY 2002 baseline of 5.9 million.
Title V programs work towards the elimination of health
disparities in health outcomes through the removal
of economic, social, and cultural barriers to receiving
comprehensive, timely, and appropriate health care.
Based on preliminary data, the ratio of the black
infant mortality rate to the white infant mortality
rate decreased from 2.48:1 to 2.38:1 from FY 2002
to FY 2005 (National Vital Statistics Reports).
The Title V program plays an important role in the
delivery of appropriate and effective care for high-risk
pregnant women and infants. Efforts to reduce the
overall infant mortality rate continue, with the rate
having decreased slightly from 7.0 per 1,000 live
births in 2002 to 6.8 per 1,000 live births in 2004.
Nationally, the number of low birth weight infants
(less than 2500 grams) has been steadily increasing.
From 2002 to 2005, the rate of low birth weight infants
increased from a baseline of 7.8 percent to 8.2 percent.
Delivering low birth weight infants at facilities
with specialized equipment and personnel significantly
contributes to reducing the risk of mortality. The
percent of low birth weight infants delivered at facilities
for high-risk deliveries and neonates declined from
76.1 percent in 2003 to 67.7 percent in 2005. In 2006,
the rate improved slightly to 68.1 percent. Prenatal
care is one of the most important interventions for
ensuring the health of pregnant women and their infants.
While progress in the timely initiation of prenatal
care for all population groups has been made over
the past decade, the rate of increase has been slow
in recent years. The rate was unchanged from 2004
to 2005. Given the increasing prevalence of diabetes,
obesity and pregnancy-induced hypertension during
pregnancy, there is a need for such risk factors to
be monitored and for timely and appropriate prenatal
care to be provided. The MCHB has worked with the
State MCH programs to build a data capacity that supports
the performance elements in the Title V MCH Block
Grant. Efforts have centered on the development of
client-based data systems that more accurately capture
the direct, enabling and population-based services
provided, as required. Previously reported data on
the number of children served by Title V and the number
of children served who have Medicaid and SCHIP coverage
were often based on the direct services provided.
In addition, increases in the number of children served
by Title V who have Medicaid and SCHIP coverage reflect
the ongoing efforts of the States to do outreach to
eligible populations and to increase participation
in these programs. MCHB regularly provides technical
support to the States around the priorities identified
in their comprehensive five-year needs assessments
and the areas of needed technical assistance outlined
in their annual applications. In the FY 2007 and 2008
MCHBG applications, two frequently identified areas
of needed technical assistance were disparities in
infant mortality, specifically between the Black and
White Infant Mortality Rates, and early entry into
prenatal care.
The Title V Block Grant received a PART review rating
in 2002 of Moderately Effective. The review cited
that the program was well designed and the program
regularly collects timely and credible performance
data and is achieving results, but that regular evaluations
were not conducted. Since that time, the program has
undertaken evaluations at several levels. These efforts
include: 1) conducting an evaluation of the results
of the States’ investment in health systems
infrastructure; 2) conducting a technical review and
evaluation of the States’ Title V MCH priority
needs, State performance measures and promising practices
to determine national priorities, analyze trends,
identify emerging issues, monitor changes in the MCH
landscape, and assess National and State progress
in addressing the needs of mothers, children and their
families; and 3) examining the processes used by States
to conduct their 2005 Needs Assessments.
In FY 2004, the Title V Block Grant program initiated
a customer satisfaction survey utilizing the American
Customer Satisfaction Index (a standardized methodology
used by both public and private sectors). Recipients
of the Title V Block grantees’ services were
surveyed. As a result, the program received a score
of 91 out of a possible 100, the second highest score
ever recorded for a government program.
The FY 2008 appropriation resulted in $20 million
being moved from the MCH Block Grant SPRANS program
to the new Autism and Other Developmental Disorders
program. These funds are used to support the Leadership
Education for Neurodevelopmental Disbilities and Behavioral
Pediatrics Training Program, which were previously
funded under the MCH Block Grant SPRANS program. Appropriations
language was included to provide additional funds
in SPRANS for Oral Health ($4.7 million); Sickle Cell
($3.8 million); Epilepsy ($2.8 million); Heritable
Disorders ($1.9 million); Fetal Alcohol ($0.97 million);
Doula ($1.5 million); and First time motherhood ($4.9
million).
Funding includes costs associated with grant reviews,
processing of grants through the Grants Administration
Tracking and Evaluation System (GATES) and HRSA’s
electronic handbook, and follow-up performance reviews.
Funding History
FY
1999 |
$694,779,000
|
FY
2000 |
$703,991,000 |
FY
2001 |
$709,151,000 |
FY
2002 |
$731,259,000 |
FY
2003 |
$730,710,000 |
FY
2004 |
$729,817,000
|
FY
2005 |
$723,928,000 |
FY
2006 |
$692,521,000 |
FY
2007 |
$693,000,000 |
FY
2008 |
$666,155,000 |
* *
Reflects moving $20 million to the Autism and Other
Developmental Disorders Program.
Budget Request
The FY 2009 Request of $666,155,000 is the same as
the FY 2008 Enacted level.
Based on the legislated formula, of the amount requested,
$559,062,202 is for State Block Grant awards, an increase
of $2,481,480 from the FY 2008 Enacted amount, and
$107,092,798 is available for the SPRANS and CISS
set-asides. No funding is included for the SPRANS
programmatic earmarks included in the FY 2008 Consolidated
Appropriations Act. Title V is the only Federal program
that focuses solely on improving the health of all
mothers, adolescents and children, whether insured
or not, through a broad array of public health and
community-based programs that are designed and carried
out through well-established Federal/State partnerships.
The requested funds will help State Title V programs
support capacity and infrastructure building, population-based
and enabling services, as well as direct health care
services where no services are available. In these
latter roles, Title V programs serve as a safety net
for uninsured and underinsured children, including
CSHCN. Title V continues to play a valuable, complementary
role to SCHIP and Medicaid programs.
The FY 2009 target for number of children served by
the Title V Block Grant is 29 million. Due to large
increases in the number of children served by Title
V, particularly in FY 2004, the target for FY 2009
was increased. The MCHB will continue to work with
States to further enhance their data capacity for
tracking and reporting the number of clients served
through direct, enabling and population-based services.
Further gains in the number of clients served by Title
V may be modest, given the improvements in State data
capacity that have been achieved and the reductions
in State MCH allocations for FY 2006, 2007 and 2008.
Similarly, the FY 2009 target of 11.5 million for
the number of children receiving Title V services
who are enrolled in and have Medicaid and SCHIP coverage
was increased based on lower than the FY 2006 performance
level of 11 million. In FY 2003, the number of children
receiving Title V services with Medicaid and SCHIP
coverage increased to 9.7 million from 5.9 million
in FY 2002. This increase was due to a change in reporting
methods by several large States which previously did
not report many recipients due to reliance on the
use of reimbursement data. The MCHB will continue
to monitor and support State efforts to provide outreach
to eligible populations for enrollment in Medicaid
and SCHIP.
The FY 2009 targets were also adjusted for the other
performance measures, with the exception of the measure
to reduce the infant mortality rate, to reflect improved
performance. The MCHB will continue to monitor emerging
issues and areas of needed technical assistance in
providing technical support to the States. In addition,
the MCHB will continue to explore promising models
and effective strategies that promote improved MCH
outcomes.
SPRANS and CISS funds will support innovative projects
in the areas of: applied MCH research; MCH Leadership
training in areas such as neurodevelopmental disabilities,
developmental behavioral pediatrics, pediatric pulmonary
centers, pediatric dentistry, nursing, nutrition,
schools of public health, adolescent health; expansion
of genetics services capacity, hemophilia treatment
centers; and a variety of MCH Improvement Projects
(MCHIP) including, adolescent health; SIDS; “Bright
Futures” guidelines for practitioners; medical
homes; early childhood comprehensive care systems;
and oral health disease prevention and early treatment
interventions. SPRANS and CISS both complement and
help ensure the success of State Title V, Medicaid,
and SCHIP programs, building community capacity to
create family-centered, integrated systems of care
for mothers and children, including children with
special health care needs.
See Table
FY 2009 DISCRETIONARY STATE/FORMULA GRANTS
CFDA NUMBER/PROGRAM NAME: 93.994/Maternal and Child
Health Block Grant
State/Territory |
FY
2007
Actual |
FY
2008
Estimate |
FY
2009
Estimate |
Difference
+/- 2008 |
Alabama |
11,875,207 |
11,683,733 |
11,731,751 |
48,018 |
Alaska |
1,130,366 |
1,112,624 |
1,117,074 |
4,450 |
Arizona |
7,257,234 |
7,049,799
|
7,101,819 |
52,020 |
Arkansas |
7,192,447
|
7,074,670 |
7,104,206 |
29,536
|
California
|
44,452,058
|
43,037,736
|
43,392,420
|
354,684
|
Colorado
|
7,327,232
|
7,229,343 |
7,253,892 |
24,549
|
Connecticut
|
4,803,715
|
4,734,566 |
4,751,907 |
17,341 |
Delaware |
1,981,651 |
1,962,811
|
1,967,536
|
4,725 |
District
of Columbia |
7,090,436 |
7,061,969
|
7,069,108
|
7,139
|
Florida
|
19,568,836
|
19,063,350
|
19,190,115
|
126,765
|
Georgia
|
16,518,390
|
16,224,268
|
16,298,028
|
73,760
|
Hawaii
|
2,300,367
|
2,267,734
|
2,275,918
|
8,184
|
Idaho |
3,269,997
|
3,228,247
|
3,238,717 |
10,470
|
Illinois |
21,989,640
|
21,621,872
|
21,714,101 |
92,229
|
Indiana |
11,892,361
|
11,741,197
|
11,779,106
|
37,909
|
Iowa
|
6,580,205
|
6,516,418 |
6,532,414
|
15,996
|
Kansas
|
4,772,923
|
4,705,344 |
4,722,292
|
16,948
|
Kentucky
|
11,486,098
|
11,322,259
|
11,363,347
|
41,088
|
Louisiana
|
13,567,652
|
13,310,343
|
13,374,871
|
64,528
|
Maine |
3,427,211 |
3,394,876 |
3,402,985 |
8,109
|
Maryland
|
12,045,757
|
11,931,558
|
11,960,197
|
28,639
|
Massachusetts
|
11,566,209
|
11,423,430
|
11,459,236
|
35,806
|
Michigan |
19,101,965
|
18,817,881
|
18,889,124
|
71,243
|
Minnesota |
9,151,370
|
9,053,419
|
9,077,983
|
24,564
|
Mississippi
|
9,869,139
|
9,702,964
|
9,744,637
|
41,673
|
Missouri
|
12,529,273
|
12,351,744
|
12,396,265
|
44,521
|
Montana
|
2,462,574
|
2,428,033
|
2,436,695 |
8,662
|
Nebraska
|
4,059,575
|
4,015,726
|
4,026,722 |
10,996
|
Nevada |
1,837,608 |
1,781,443 |
1,795,528 |
14,085
|
New Hampshire |
2,018,049 |
1,999,025 |
2,003,796 |
4,771
|
New
Jersey |
11,830,942
|
11,647,618 |
11,693,592 |
45,974
|
New
Mexico |
4,439,493
|
4,338,702 |
4,363,979 |
25,277
|
New
York |
41,629,217
|
40,892,146
|
41,076,989
|
184,843 |
North
Carolina |
16,815,791
|
16,565,419
|
16,628,207
|
62,788 |
North
Dakota |
1,832,366
|
1,814,527
|
1,819,001
|
4,474
|
Ohio
|
22,382,670
|
22,053,712 |
22,136,208
|
82,496
|
Oklahoma |
7,401,402
|
7,263,013 |
7,297,718
|
34,705
|
Oregon
|
6,304,107
|
6,206,342
|
6,230,859
|
24,517
|
Pennsylvania
|
24,663,638
|
24,324,168
|
24,409,300
|
85,132
|
Rhode
Island
|
1,796,789
|
1,763,657 |
1,771,965 |
8,308
|
South
Carolina |
11,527,593
|
11,376,852
|
11,414,655 |
37,803
|
South
Dakota |
2,279,887
|
2,252,548
|
2,259,404 |
6,856
|
Tennessee
|
11,857,608
|
11,658,473
|
11,708,412
|
49,939 |
Texas
|
35,207,084
|
4,249,284
|
34,489,481
|
240,197
|
Utah
|
6,059,780
|
6,002,015 |
6,016,502 |
14,487 |
Vermont |
1,705,272
|
1,691,915
|
1,695,264
|
3,349
|
Virginia |
12,525,377
|
12,356,721
|
12,399,017
|
42,296
|
Washington |
9,153,087
|
8,989,776
|
9,030,731 |
40,955
|
West
Virginia |
6,494,674 |
6,417,325
|
6,436,722 |
19,397
|
Wisconsin |
10,920,991 |
10,800,119
|
10,830,432
|
30,313
|
Wyoming
|
1,268,017 |
1,253,355 |
1,257,032
|
3,677
|
Subtotal |
541,221,330
|
531,766,069
|
534,137,260
|
2,371,191
|
Indian
Tribes |
Migrant
Program |
American
Samoa |
505,547
|
496,715
|
498,929
|
2,214 |
Guam |
780,789
|
767,149
|
770,570
|
3,421
|
Marshall
Islands |
235,920
|
231,799
|
232,832
|
1,033
|
Micronesia |
533,633
|
524,310
|
526,648
|
2,338
|
Northern
Mariana Islands |
477,461
|
469,120
|
471,212
|
2,092
|
Palau |
151,665
|
149,015
|
149,680 |
665 |
Puerto
Rico |
16,278,600
|
15,994,209
|
16,065,529
|
71,320
|
Virgin
Islands |
1,533,492
|
1,506,701
|
1,513,420 |
6,719 |
Subtotal
|
20,497,107
|
20,139,018
|
20,228,820
|
89,802
|
Total
States/Territories
TOTAL RESOURCES |
$561,718,437
|
$551,905,087 |
$554,366,080 |
$2,460,993
|
|