Summary

In response to a congressional request, GAO reviewed 13 States' implementation of the maternal and child health services block grant which was created by the Omnibus Budget Reconciliation Act of 1981.

GAO found that, after the act consolidated the Federal categorical program into a block grant and shifted primary administrative responsibility to the States, the States strived to maintain program continuity under the maternal and child health block grant, and most of them increased expenditures of State and other funds to help offset declining Federal support. However, as States reassessed their needs and confronted limitations on available funds, they tended to maintain or increase broader programs while providing less support for certain more narrowly targeted activities which were previously mandated or directly federally funded. States generally assigned maternal and child health block grant responsibilities to their State health agencies, resulting in limited organizational changes. Block grant management activities were often integrated with ongoing State efforts. Various methods were used to obtain public input, and the involvement of State elected officials and interest groups increased. Most State officials rated the block grant more flexible and desirable, whereas about half of the interest groups expressed a preference for the prior categorical approach.