Maternal and Child Health Block Grant

Authorizing Legislation - Title V of the Social Security Act.

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

* * 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